MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) have now published their seventh annual report for 20201, reviewing maternal deaths and their possible causes. The report shows that pregnancy remains very safe in the UK, where approximately 0.01% of pregnancies resulted in mortality either during or up to 6 weeks after pregnancy between 2016 and 2018. Of this 0.01%, however, mothers from Black, Asian and minority ethnic (‘BAME’) backgrounds are disproportionately overrepresented.
In December 2019, their annual report revealed that Black mothers are five times more likely than White mothers to die during pregnancy, whilst mixed ethnicity mothers are three times more likely, and Asian mothers twice as likely. Whilst the existence of such a disparity is not fully understood, studies show that social and ethnic inequalities are possible causes. Women living in deprived areas are far more likely to die during pregnancy, as are women with a mental health diagnosis, substance use and those suffering domestic abuse. The latest data also show a significant increase in deaths of those who had involvement of social services, which MBRRACE described as an indicator of the otherwise largely invisible levels of need and adversity experienced by the many women who die. Cardiac disease is the largest single cause of maternal deaths, followed by neurological causes (such as epilepsy or stroke).
The statistics remain largely unchanged in the 2020 report, however the latest data reveal that Black women are now four times more likely to die than White women during pregnancy. Such a disparity has only been heightened by the COVID-19 pandemic, which we have seen affecting BAME individuals at a higher proportion. The 2020 report highlights that women from Black and other ethnic minority groups are more likely to be hospitalised with infection than White (and in particular, UK-born) women. A proportion of the women who died from infection during pregnancy were Black or minority ethnic, who did not speak English as their first language. Communication difficulty appears to have magnified as the women became more unwell, due to their inability to express themselves or misinterpretation of different cultural expressions of illness by healthcare workers.
These stark but important statistics are even more relevant in the wake of movements such as Black Lives Matter, showing the crucial need to address racial inequalities that exist across the board, even within our healthcare system.
Whilst the data from the 2020 report do not come much closer to closing the maternal mortality gap between races, it is encouraging to see that the response to address this has changed dramatically since the 2019 report. Various research units, societies, third sector organisations, and government bodies have now teamed with the NHS to devise multiple actions, ranging from the first national Five x More Black Women’s Maternal Health Awareness Week to a new Race Equality Taskforce.
What is clear though is that we must actively engage in conversations to continue dismantling the systemic racial inequalities that exist. There are significant gaps between our health and social care systems which would benefit greatly from a multi-disciplinary approach in improving peripartum care for BAME women. The largely unchanged data from the 2020 report shows that there is still much work to be done to keep mothers from BAME backgrounds as safe as White mothers during and after pregnancy.