‘National disgrace’: Black mothers in England twice as likely to have NHS birth screening

The births of babies born to black mothers are almost twice as likely to be investigated for potential failings in NHS safety, a shocking disparity that has been branded a “national disgrace”.

Between 2020 and 2023, the UK’s maternal safety watchdog completed more than 2,300 investigations into, among other things, the tragic deaths of babies before, during and shortly after birth, and the deaths of expectant or new mothers.

Research by The Guardian found that for every 1,000 deliveries, 2.3 tests were required for black women, compared to 1.3 for white women.

The head of the Royal College of Midwives (RCM) said the problem was “purely due to institutional racism”. The Labour government has promised to prioritise improvements in maternity care, including tackling the stark racial disparities.

Maternity and Newborn Safety Investigations (MNSI), part of the Care Quality Commission (CQC), is a safety programme that investigates serious cases of maternal or newborn death, stillbirth and babies born with severe brain injuries in the NHS in England.

All NHS trusts must notify the MNSI of certain patient safety incidents so that an independent investigation can be carried out. The regulatory body is part of a national strategy to improve maternal safety.

Between 2020 and 2023, the MNSI completed 2,334 investigations into pregnancy incidents referred to it. It investigates cases where a baby dies during labour and before birth, when a baby lives but dies in the first week of life, and when a baby is born with a potentially serious brain injury that is detected in the first seven days of life. Cases where a mother dies during pregnancy or within 42 days of the end of pregnancy are also investigated.

Freedom of information requests and research by the Guardian show that black women are almost twice as likely to be the subject of pregnancy tests than white women.

Black mothers are also three times as likely to be the subject of an investigation into a case of maternal death and just over twice as likely to be the subject of an investigation into cases of intrapartum stillbirthswhen the baby dies after labor has started.

The higher number of tests reflects the greater risk black women face of maternal death, stillbirth and babies born with severe brain injuries.

Black women in the UK are four times more likely to die during pregnancy and childbirth, and are also more likely to suffer the most serious complications of childbirth.

Bell Ribeiro-Addy, chair of the Labour parliamentary group for black maternal health, said the figures were shocking.

“It’s always shocking to hear figures like that, but they’re figures we’ve heard quite consistently over the last few years and the previous government did absolutely nothing to address this,” she said.

“The idea that the colour of your skin at birth could have such a huge impact, and potentially fatal impact, on your outcomes is a national disgrace. I am pleased that the current Labour government, in one of their manifestos, has set a target to reduce the disparity in black maternal health, and I hope to see details of that soon.”

Gill Walton, the RCM’s chief executive, said the problem was “purely down to institutional racism”.

“This shouldn’t be the case in the 21st century: a baby’s or a mother’s chance of survival is determined by the colour of their skin or where they were born,” she said. “But sadly, that’s the experience of too many families. It’s not enough to express our shock and sadness: we need to take action. All of us involved in commissioning and delivering maternity care, from governments to midwives, need to work together to address these disparities.”

“We know that the new government in Westminster shares our ambition to get to a point where outcomes for pregnant women and their babies are no longer determined by their ethnicity or their background. We have already written to the new Health Secretary outlining our willingness to work with him on this issue as a matter of urgency. (The inequality) is purely due to institutional racism and much needs to be done to address that.”

The RCM noted that efforts have been made to ensure that the midwifery curriculum focuses on the care of women from ethnic minorities. The RCM has also launched a tool to help midwives and other health care providers assess the needs of pregnant women and provide the most appropriate care.

Sandy Lewis, director of the MNSI’s maternity research programme, said the figures “confirm what we already knew” about ethnic differences in maternal care.

“These figures tell the same story, that black women and women from ethnic minorities experience worse outcomes than white women, that’s what we know and our research absolutely says that and shows that,” she said. “I think it’s really clear to me that this is about fair outcomes, so we need to make sure that care is individualised and supportive of women and birthing people.

“I think the challenging question for all of us is to understand the ‘why,’ and that’s the area where we need to do a lot more research.”

Donna Ockenden, a midwifery expert who led a groundbreaking investigation into the Shrewbury and Telford Hospital NHS trust, said: “We hear far too often about racial inequalities and disparities in healthcare delivery, particularly within midwifery care in England.

“It is alarming to hear that black mothers are almost three times more likely to have a maternal death investigation, and twice as likely to have a stillbirth investigation. This highlights the issue of inequality in the standard of perinatal care provided to families across England and must be addressed immediately.”

NHS England said: “It is unacceptable that black mothers and their babies experience inequality in care. While the NHS has made improvements in maternity care over the past decade, we know much more work is needed to tackle inequality and ensure all women and families receive high-quality care before, during and after their pregnancy. All local health systems have published plans to support their local populations and we will work with government, royal colleges and others to deliver these effectively.”