Read: The tragedy of health inequalities
Women from deprived communities and those from ethnic minority backgrounds at greater risk of maternal death
New figures have highlighted the continuing tragedy of health inequality, with a report on maternal outcomes showing that women from the most deprived parts of the country are twice as likely to die as those who live in the most affluent areas.
Women from Black ethnic backgrounds are four times as likely to die as women from White backgrounds and those from an Asian background are almost twice as likely. Levelling up this country means levelling up health outcomes so that no communities are forced to experience these losses.
The report from MBRRACE (Mother and Babies: Reducing the Risk through Audits and Confidential Enquiries across the UK) found that, out of the 2,173,810 who had a child from 2017-2019, 191 women died during or up to six weeks after the end of their pregnancy from causes associated with the pregnancy. A total of 495 women died during pregnancy or up to a year after giving birth.
The report, which also looks at mental health and cancer care for pregnant women, showed that the most common cause of maternal death was heart disease followed by epilepsy and stroke. Maternal suicide remains the leading direct, pregnancy-related cause of death in the first year after pregnancy.
While pregnancy remains safe for most women - and there have been slight decreases in the maternal death rate in recent years - there have not been any significant improvements to these rates since the 2010 to 2012 period. In examining all causes of deaths, assessors judged that in 37% of cases – so in over a third - improvements in care may have made a difference to the outcome.
It is a real cause for concern that, despite government action over the years to address the problem, there is still such a disparity in maternal outcomes and that the right improvements in care are not being made. Health inequality itself can’t be seen in isolation and is part of a much broader picture. A range of factors are responsible for driving it, including poverty, unemployment, poor housing, low education rates and social isolation. Many of the women who have died will have experienced many of these multiple disadvantages, including domestic abuse and addiction, and it is these fundamental issues which need to be resolved if we are to deliver improved health outcomes for everyone.
The authors of the MBRRACE report have highlighted a number of reasons why pregnant women do not all receive equal care. As with other health disparities, it is essential to address the wider cultural and structural biases that can exist in order to reduce maternal mortality. This should include an examination of the needs of the communities where it is worst, to assess what more can be done to treat the woman rather than just her pregnancy and to ensure that potential symptoms are not just attributed to pregnancy alone. Women should also be encouraged to feel confident in asking for help during their pregnancy or in childbirth and should be treated without bias. This could include patient advocacy and peer support and close liaison with healthcare agencies in the local area, including specialist voluntary sector agencies.
The MBRRACE report comes hot on the heels of other research carried out by the National Maternity and Perinatal Audit which found that thousands of babies in England are born prematurely, smaller than expected or are stillborn because of socioeconomic and racial inequalities. It is further evidence that embedded health inequalities for the those most disadvantaged, have a direct impact on the health of babies and their mothers.
The personal, societal and economic cost is huge, to the families involved and to the country. The pandemic has made worse many of the challenges that the most badly affected communities are facing. This will inevitably have an on-going and significant impact on other health issues. This research is further evidence that breaking down the barriers to good maternal health, with fewer maternal deaths, requires a better understanding of the problems women in some communities face. The provision of more tailored services to respond to the specific and particular needs of these women is essential. If we can facilitate access to the right services with effective touchpoints and enable them to voice their concerns more easily, they will be able to make more informed and better choices. We need to give every woman the information and empower them to lead healthy lives with more positive opportunities.
By Rt Hon Anne Milton