Death in pregnancy and childbirth is rare in the UK. In fact, maternal mortality rates in the UK are among the lowest in the world.
But according to a recent report from MBRACE-UK, there is still a proportionally higher risk to BAME women than white.
Black women are still four times more likely than white women to die in pregnancy or 6 weeks after childbirth in the UK, even though they account for just 4% of those giving birth. Women from Asian ethnic minority backgrounds are twice as likely to die during childbirth and shortly after.
We'll put these stats into numbers; this means that between 2016 and 2018 in the UK, 34 Black women died among every 100,000 giving birth, 15 Asian women died among every 100,000 giving birth, and 8 white women died among every 100,000 giving birth.
The latest study shows a slight narrowing of data released in 2019, when reportedly black women were 5 times more likely to die during pregnancy and childbirth.
But the inequalities in maternal care are stark - these results are not a sign of significant progress being made and highlight the fact that change needs to happen fast to address these shocking inequalities.
"We must not lose sight of the actions that are required to address
systemic biases that impact on the care we provide for black and ethnic minority women." Professor Maggie Rae, President of the Faculty of Public Health
The COVID-19 pandemic has worsened the disparities
The risk of pregnancy and childbirth complications for BAME is even more prominent during the COVID-19 pandemic. Research from Oxford University shows that 55% of the pregnant women admitted to hospital with COVID-19 are from a BAME background, even though they only make up a quarter of the births in England and Wales.
“While the number of maternal deaths remains low, inequalities are widening. These figures [in the latest study] relate to a period pre-Covid-19 and we know those inequalities will become even more profound as women’s lives continue to be adversely impacted by the pandemic.” Kirsty Kitchen, Head of Policy at Birth Companions
Why is this happening?
Mars Lord, a doula who supports women through childbirth, said one of the biggest problems is that conversations about racial bias in maternity care are "often shut down by those who feel uncomfortable with the suggestion it exists".
Racism in healthcare, both conscious and subscious, is a topic which has been avoided being discussed by healthcare professionals and organisations in the UK. This refusal to acknowledge its existence is something which only serves to perpetuate racial bias in the medical field.
It's not until it is recognised and acknowledged by individuals and organisations that they can address the part they have to play in challenging racism, and changing their approach to reduce these numbers.
What is being done to reduce BAME maternal death rates?
Since the 2019 study hit the headlines, conversations have been sparked about BAME maternal care, and it is recognised that disparity in maternal mortality simply because of a woman’s ethnicity is completely unacceptable.
Whilst we are yet to see a significant change in the statistics, the response from individuals, organisations, research units, professional societies and NHS and government bodies has been notably positive.
The first national Black Women's Maternal Health Awareness Week took place in September organised by the Five X More campaign. Their petition for the government to improve maternal mortality rates and health outcomes for black women gained more than 150,000 signatures.
The petition has been scheduled for debate in UK parliament on 19th April 2021.
The NHS Long Term Plan has set out the aim that by 2024, 75% of women from Black and minority ethnic communities will receive continuity of care from their midwife throughout pregnancy, labour and the 6-week postnatal period, with the aim of reducing reducing the disparity on BAME maternal death rates.
The Royal College of Midwives have launched a Race Matters initiative, setting out a five point plan for promoting positive pregnancy outcomes for BAME women, whilst the Royal College of Obstetricians and Gynaecologists have launched the Race Equality Taskforce to tackle disproportionate risk to women from BAME backgrounds.
The president of the RCOG, Dr Edward Morris, has also urged the government to commit to a target of a 50% reduction in maternal mortality for black, Asian and minority ethnic women over the next five years.
In light of the pandemic, NHS maternity units in England have also been requested to take four specific actions to minimise COVID-19 risk for Black and minority ethnicity women and their babies, who are at greater risk of hospitalisation.
What needs to be done now?
More research needs to be done and more conversations need to be had. Whilst the actions above are a step in the right direction, it is still not enough.
Awareness of BAME mortality rates needs to be continuously raised, and pressure on the government needs to be made in order to ensure research is funded and the lives of BAME women are taken seriously by those who have the power to make change.