Ministers have failed to tackle “appalling” and “glaring” racial disparities in maternal health despite repeated promises, MPs have said, as they called for new targets to eliminate inequalities.
In a scathing report, the women and equalities committee said maternal death rates in deprived areas were on the rise, with women in the poorest areas about two and half times more likely to die in childbirth than those in the richest areas.
Black women are still almost four times more likely to die from childbirth than white women, the report says, and too many black women receive treatment that “falls short of acceptable standards”. The government and NHS leaders have “underestimated the extent to which racism plays a role”, it adds.
It comes after Kemi Badenoch, the equalities minister, admitted on Monday that less than half the measures set out in the government’s plan to tackle racial inequality and level up communities had been delivered.
In February last year, the Guardian exposed how radical action was needed to tackle “overwhelming” racial health inequalities, after a leaked report concluded that “vast” and “widespread” inequity in all aspects of healthcare was harming the health of millions of patients.
Racism, racial discrimination, barriers to accessing healthcare and woeful collection of ethnicity data had “negatively impacted” the health of black, Asian and minority ethnic people for years, according to the review, commissioned by the NHS Race and Health Observatory. But more than a year on, MPs say there has been “much talk and little action”.
A government taskforce set up to tackle disparities in maternity care – announced nine days after the Guardian’s report – has met just three times, the committee found. The last time it met was nine months ago, in July 2022. Other government measures have proved “insufficient”, the report says.
The inaction was “frankly shameful”, said the committee’s chair, Caroline Nokes. “NHS births are among the safest in the world and yet we continue to see appalling disparities in maternal deaths,” she said. “It is shocking that black women are almost four times more likely to die from childbirth than white women.”
Health leaders and campaigners said they were saddened but not surprised by the MPs’ findings. “We are tired of this issue being a talking point – we’re ready for tangible action,” said Dr Habib Naqvi, the chief executive of the NHS Race and Health Observatory, an independent expert group.
“The stark outcomes that black women face as a result of racial discrimination in maternity care has to be urgently prioritised and tackled. Evidence clearly shows that black and other minority ethnic women are often paying with their lives for the lack of action on racial bias in healthcare,” Naqvi said.
“It is not acceptable that, today in 2023, these women are subject to higher risk of dying during pregnancy or childbirth, nor should they be experiencing higher rates of stillbirth or neonatal deaths in comparison to their white counterparts.”
Janaki Mahadevan and Shanthi Gunesekera, the joint chief executives of the charity Birthrights, called the committee’s report “deeply concerning”.
They said: “How many more reports or statistics do we need to see about the racism that exists in the structures, cultures and practices that govern maternity care in the UK before serious and meaningful action is taken?”
The voices of black and ethnic minority mothers were still too often ignored or dismissed, they added. “Layer on to this racial microaggressions and stereotyping, failure to recognise serious medical conditions due to skin colour, and a lack of respect for culture and religion, and the inequalities in outcomes are unsurprising.”
The committee said a target was needed to eliminate the disparity between black and other minority ethnic women and white women, and the related gap between those living in the most and least deprived areas.
Among their recommendations, MPs called for Health Education England to lead a coordinated review involving the Royal College of Midwives and others “to ensure that both the training curricula and continuing professional development requirements for all maternity staff include evidence-based learning on maternal health disparities, its possible causes and how to deliver culturally competent, personalised and evidence-led care.”
The committee also called for “continuity of carer” for patients – something it said was currently difficult “due to the considerable staffing shortages across maternity services”.
MPs said a fully staffed, properly funded maternity workforce was “fundamental to delivering safe, personalised care to pregnant women and new mothers” and they called on ministers to commit to an annual uplift of up to £350m for maternity units.
Better data was also needed, they said, warning that black women were “regularly under-represented in research or data and therefore in policymaking” and that ethnicity data held by trusts was “incomplete or inaccurate”.
Nokes said: “We cannot let these women remain invisible to the systems supposed to serve them. We are also afraid the government and NHS have not fully grasped that racism has played a key part in the complex reasons underlying the disparities, and that eradicating it is part of the solution.”
Laura Seebohm, the chief executive of the Maternal Mental Health Alliance, said: “Enduring inequalities in maternity care continue to be deeply shocking. All women, babies and families have a right to high-quality, compassionate care during and after pregnancy. The human and economic consequences of failing to provide this are significant, making it vital that such disparities in maternal experiences and outcomes are addressed.”
The NHS said it was “committed to ensuring all women receive high-quality care” and had provided £6.8m to help local health systems reduce health inequalities.
A spokesperson acknowledged there was “more to be done” and said the service would review the committee’s recommendations.
A Department of Health and Social Care spokesperson said: “While the NHS is already one of the safest places to give birth in the world, we are absolutely clear that we must ensure maternity care is of the same high standard, regardless of race.
“We’ve invested £165m since 2021 to grow the maternity workforce and are promoting careers in midwifery with an extra 3,650 training places per year, while every local NHS maternity system has a plan in place to tackle disparities on a local level.
“The maternity disparities taskforce – a collective of mothers, clinicians and key organisations – is being chaired today by minister Maria Caulfield to focus on how we can eradicate disparities and improve maternity outcomes for all mothers.”
On Monday, Badenoch admitted that only 32 of the 74 measures in the Inclusive Britain strategy published just over a year ago had been completed.
The Black Equity Organisation, an independent group, said there needed to be an acceptance that structural racism exists, and until then ministers would “continue to tinker around the edges” of the problem.
