Read: Mothers and babies pay the price for deep-rooted health inequality

For too many years report after report has highlighted the inequalities that exist in health, and yet despite successive governments attempts to address these deep rooted issues, inequality persists. Levelling up in this country requires us to take concerted and purposeful actions that reverse those inequalities. These have been laid bare in a new study published this week in the Lancet . The study found that thousands of babies in England are born prematurely, smaller than expected or stillborn as a result of socioeconomic and racial inequalities - known risk factors for poor pregnancy outcomes.

Research carried out by the National Maternity and Perinatal Audit looked at more than a million births between 2015 and 2017. It found that a quarter of all stillbirths, a fifth of preterm births and a third of foetal growth restriction (FGR), a condition where babies are smaller than expected, were a result of socioeconomic inequalities. When the figures are adjusted for ethnicity, maternal smoking and body mass index (BMI) they decrease substantially, indicating that these characteristics are often major factors in that inequality.

The study also suggests that complications in pregnancy disproportionately affected women from Black and minority ethnic backgrounds, with one in ten stillbirths and almost one in five FGR cases a result of racial inequalities.

Significantly, the report noted that these poor outcomes would not have occurred if all women had the same risk of adverse pregnancy outcomes as women in the least deprived group. This is starkly illustrated by the fact that over half of stillbirths and nearing three quarters of FGR cases amongst south Asian women living in the most deprived fifth of neighbourhoods in England could be avoided if they had the same risks as white women in the most affluent fifth.

These figures speak for themselves. They are a grave reminder of the impact of health inequality in some of our most disadvantaged communities – the personal and often lifelong toll on women and their families because of their traumatic experiences is a tragedy. And there is an economic cost on our healthcare services as both babies and mothers require on-going care as a result of poor maternal outcomes. Surviving babies still face huge challenges as they grow up in relation to their education and employment prospects.

They also highlight that political solutions which consider healthy pregnancies and antenatal care in isolation are simply not good enough. Far more comprehensive action is needed to tackle the broader socioeconomic and ethnic inequalities which are the determinants of health - poverty, unemployment, poor housing, low education rates and social isolation. Every woman should be able to rely on access to good quality healthcare and to services that provide information and advice on healthier lifestyles and preventative care.

The NHS has set a welcome target to halve stillbirth and neonatal death rates and reduce levels of preterm birth by a quarter by 2025. But real progress can only be made to improve the disparity in birth outcomes if there is a concerted effort by government, working with public health professionals and healthcare providers, to better understand the barriers and risks that exist for women in disadvantaged groups and how services can be tailored to be more effective for them.

Many NHS providers and community groups are already delivering care that meets the needs of the local population. The best are targeting the groups that need the most help, based on their local knowledge and expertise, and successfully collaborating with local partners. The figures in this study are, however, further evidence that the system is letting too many women and babies down and urgent action is needed to ensure that outcomes improve, closing the appalling gaps in healthcare that are experienced by the most disadvantaged. The tragic consequences this report highlights should be a call to arms with much greater ambitions to reverse the trends. We have a duty to enable mothers and their babies to start life on a level playing field – an equal society where everyone wherever they are born has an equal chance in life.     

By Rt Hon Anne Milton