Maternal death rates in the United Kingdom during and in the 42 days following childbirth are the highest they have been in 20 years. The number of women dying has not been as high since 2003-2005. What is happening and why?
Let’s break down the statistics:
- In 2022-2023, 13.41 deaths occurred for every 100,000 maternity cases. This is significantly higher than the 8.79 deaths for 100,000 maternity cases in the period 2017-2019.
- 293 women died during childbirth or in the 42 days following the end of pregnancy.
Now that we’ve examined some basic statistics, remember that the women we are talking about are more than their numbers. They are mothers, wives, daughters and friends. Nationwide people are devastated by these deaths. Women should feel safe and free to give birth. So, what exactly is happening?
A data brief published this February by Mothers, Babies, Reducing Risk through Audits and Confidential Enquiries (MBRRACE-UK) outlines the most common direct and indirect causes of maternal deaths in the UK between 2022 and 2023.
The data collected by MBRRACE-UK shows Thrombosis as the most common direct cause, while the second most common causes are suicide and sepsis due to pregnancy-related symptoms. Thrombosis is a blood clot within blood vessels that limits blood flow. During pregnancy and in the following six weeks, women are more likely to develop Thrombosis.
MBRRACE-UK outlines that the most common indirect cause of maternal deaths is COVID-19. Following COVID-19, the most common indirect causes of death are cardiac disease and neurological conditions.
The number of maternal deaths for women of colour is significantly higher than those of white women. The risk of maternal death in 2020-22 was statistically almost three times higher among women of colour and women from ethnic minorities. The alarming ethnic disparity in maternal deaths is a prevailing issue, and while the gap has decreased, it is not because fewer women are dying. In fact, the gap in maternal deaths between women of colour and white women has decreased due to an increase in maternal deaths in white women, not because fewer women of colour are dying.
A House of Commons Committee report published in 2023 outlines the following:
“All reports since 2000 have shown a greater risk for mothers from ethnic minority backgrounds compared to White mothers. For example, over the 2000–2002 period, black African women were almost seven times as likely to die than White women. Since the 2012–2014 period, data has only been given for the larger ethnic groups rather than the sub-groups, but black women as a group have consistently remained at the highest risk. The risks have also been elevated for Asian women and women of mixed ethnicity over most of the period since 2012–2014.”
Although women of colour are dying from the same complications during childbirth, they are dying more frequently. Many factors contribute to the disparity, which we can examine. These include pre-existing conditions and co-morbidities, socio-economic factors, and the ignorance, bias, microaggressions and racism affecting the care women receive during pregnancy. A woman’s ethnicity should not negatively impact her experience of the healthcare system, yet it is.
Health inequalities stem from social inequalities, and those without easy access to healthcare are the most vulnerable. According to the Office for National Statistics, a higher proportion of Black, Asian and other ethnic groups were born in deprived areas compared with babies of white ethnic groups. Women living in the most deprived areas have a maternal mortality rate of more than twice as high as women living in the least deprived areas.
The preeclampsia rate is 60% higher for women of colour compared to women of white backgrounds. Preeclampsia is one of the most common and severe disorders that occurs during pregnancy and in the early postpartum period. It affects at least 5-8% of pregnancies, as noted by the Preeclampsia Association. This severe condition has dire and sometimes life-threatening effects, including seizure, stroke, heart disease, infant growth restriction, preterm birth, and maternal and infant death.
Ignorance, bias, microaggressions and racism affect the care women of colour and women from ethnic minority backgrounds receive. MBRRACE’s data displays some of the negative commonalities appearing in the experiences of women from ethnic minority backgrounds during childbirth.
- The women were often viewed as “not like me” by medical and care staff; there was a lack of consideration of cultural factors and women’s socio-economic background to enable the most appropriate individualised care for a woman, rather than a “one size fits all” approach.
- The vast majority of women who die across all ethnic groups have multiple and complex problems. MBRRACE found that the maternity system was not set up for this; for example, women may have to attend different clinics at different hospitals, which were not effectively communicating with each other about the complexities of patients’ cases
- Microaggressions were a factor; for example, health professionals sometimes perpetuated racial or ethnic stereotypes, “such as black women having lower pain thresholds,” and medical records sometimes inaccurately recorded women’s backgrounds to the detriment of that woman’s care.”
There are several ways we can decrease maternal death rates and ensure safe pregnancies. Early recognition of preeclampsia symptoms can save lives, so we must raise awareness and improve access to treatments and perinatal and postpartum care. Making remote monitoring technologies more accessible will help pregnant women in more rural communities without access to traditional health systems. The Preeclampsia Foundation launched The Cuff Kit Project program to provide more remote monitoring technology, blood pressure tracking apps, video tutorials and vital information and resources related to blood pressure and pregnancy health.
More funding is required to make the treatment and resources for combating pregnancy-related illnesses and severe medical conditions (like preeclampsia) more accessible.
We should also strive to improve postnatal care, especially for those belonging to lower socio-economic groups. As outlined by the House of Commons report, continuity of care to postnatal mothers may help to reduce health inequalities.
More funding and staff are required to extend postnatal care.
As outlined by the House of Commons, more healthcare funding and staff are paramount. Staff shortages across the UK healthcare systems continue to have dire consequences.
“A fully staffed, properly funded maternity services workforce is fundamental to delivering safe, personalised care to pregnant women and new mothers, and a prerequisite to rolling out any measures to combat inequalities. Government funding falls short of the £200–350 million per annum recommended by the Health and Social Care Select Committee in July 2021.”
The UK healthcare system urgently needs more funds, resources and staff to ensure women can have safe pregnancies and decrease the number of maternal deaths nationwide. Raising awareness of the issue will help, but the government needs to step in.
As stated above, maternal death rates are, and for a long time have been, higher for black mothers. Click here to learn more.
