The births of babies to black mothers are almost twice as likely to be investigated for potential NHS safety failings, in a shocking disparity that has been labelled a “national disgrace”.
More than 2,300 investigations were completed by England’s maternity safety watchdog between 2020 and 2023 into cases including the tragic deaths of babies before, during and soon after birth, and the deaths of expectant or new mothers.
For every 1,000 deliveries by black women, there were 2.3 investigations, compared with 1.3 for white women, Guardian research found.
The head of the Royal College of Midwives (RCM) said the issue was “purely down to institutional racism”. The Labour government has pledged to prioritise improvements to maternity care, including tackling the stark racial disparities.
Maternity and Newborn Safety Investigations (MNSI), which is part of the Care Quality Commission (CQC), is a safety programme that examines serious instances of maternal or neonatal death, stillbirths and babies born with severe brain injuries across the NHS in England.
All NHS trusts are required to tell the MNSI about certain patient safety incidents in order for an independent investigation to be carried out. The monitoring body is part of a national strategy to improve maternity safety.
Between 2020 and 2023, the MNSI completed 2,334 investigations of maternity incidents that had been referred to it. It looks into cases in which a baby dies during labour and before birth, when a baby is alive but dies in the first week of life, and when a baby is born with a potential severe brain injury diagnosed in the first seven days of life. Cases when a mother dies while pregnant or within 42 days of the end of their pregnancy are also examined.
Freedom of information requests and research by the Guardian shows black women are almost twice as likely to be subject to a maternity investigation than their white counterparts.
Black mothers are also three times more likely to be subject to an investigation regarding an instance of maternal death and just over twice as likely in cases of intrapartum stillbirths, when the baby dies after labour begins.
The higher rate of investigations is a reflection of black women’s increased likelihood of experiencing maternal death, stillbirths and having babies born with severe brain injuries.
Black women across the UK are four times more likely to die in pregnancy and childbirth, and also more likely to experience some of the most serious birth complications.
Bell Ribeiro-Addy, the Labour chair of the all-party parliamentary group on black maternal healthcare, said the figures were shocking.
“Hearing such figures is always shocking, however these are figures that we’ve heard quite consistently over the past few years and the previous government has done absolutely nothing to tackle it,” she said.
“The idea that the colour of your skin when you give birth should have such a huge impact, and potentially a fatal impact, on your outcomes is a national disgrace. I’m pleased that the current Labour government, in one of their manifesto commitments, [will] set a target to reduce the disparities when it comes to black maternal health, and I’m hoping to see detail of that soon.”
Gill Walton, the chief executive of the RCM, said the issue was “purely down to institutional racism”.
“It should not be the case in the 21st century a baby’s or mothers’ chance of survival is determined by the colour of their skin or where they are born,” she said. “But, sadly, that is the experience of too many families. It is not enough to express our shock and sorrow: we must act. All of us involved in commissioning and delivering maternity services, from governments to midwives, must work together to address these disparities.
“We know that the new Westminster government shares our ambition to reach a point where the outcomes for pregnant women and their babies are no longer defined by their ethnicity or their backgrounds. We have already written to the new health secretary setting out our willingness to work with him on this issue as a matter of urgency. [The disparity] is purely down to institutional racism and much has to be done to tackle that.”
The RCM said it had made efforts to ensure the midwifery curriculum had a focus on the care of minority ethnic women, and it had launched a tool to enable midwives and other healthcare workers to assess the needs of pregnant women and to deliver the most appropriate package of care.
Sandy Lewis, the director of the MNSI’s maternity investigation programme, said the figures “confirm what we already know” about ethnic disparities in maternal care.
“These figures tell the same story, that black women and ethnic minority women experience lesser outcomes than white women, that’s what we know and our investigations absolutely say that and demonstrate that,” she said. “I think what’s really clear, for me, is that it’s about an equitable outcome, so we need to make sure the care is individualised and supports women and birthing people.
“I think the challenging question for us all is to understand the ‘why’, and that’s the area where we need to explore much further.”
Donna Ockenden, a maternity expert who led a landmark review of Shrewbury and Telford hospital NHS trust, said: “We are hearing, far too often, of racial inequalities and disparity present in the delivery of healthcare, especially within maternity services in England.
“It is alarming to hear that black mothers are almost three times more likely to have an investigation for a maternal death, and twice as likely to have an investigation in regards to a stillbirth. This highlights the problem of inequality in the standard of perinatal care provided to families across England and must be tackled immediately.”
NHS England said: “It is unacceptable for black mothers and their babies to experience disparities in care. While the NHS has made improvements to maternity services over the last decade, we know much more work is needed to tackle inequalities and ensure that all women and families, receive high-quality care before, during and after their pregnancy.”
A Department of Health and Social Care spokesperson said: “It is completely unacceptable that too many babies and their mothers are not receiving the care they deserve.
“This government will take action to tackle the stark inequalities that exist and ensure all women and their babies receive safe, personalised, and compassionate care from maternity and neonatal services.”
