[Relevant Document: e-petition 301079, Improve Maternal Mortality Rates and Health Care for Black Women in the UK.]
On a point of order, Mr Gray. I do not want to take too long on my point of order, but I thought it would be helpful for the Chamber to note the fact that it is Wednesday morning and that we are delighted to be here for this debate secured by the hon. Member for Streatham (Bell Ribeiro-Addy). I suspect that the hon. Lady will have quite a lot to say over the course of the morning, and I am just keen to ensure that we are all ready to take part in the debate.
That is very gracious of the hon. Gentleman. It is not actually a point of order. None the less, I am grateful to him for saying it. I think the hon. Member for Streatham has nearly caught her breath, in which case I would like to call her to speak.
On a point of order, Mr Gray. Obviously, this is a subject matter of much importance, and we should be aware of that. I am sure that the shadow Minister and the Minister are preparing copious replies for the hon. Member for Streatham (Bell Ribeiro-Addy), after she has had a chance to address this really important matter. Mr Gray, you and I and everyone else in the Chamber understand that this debate is vital. Perhaps the hon. Member for Streatham is now ready.
Again, that is very creditable of the hon. Gentleman, but it is not a point of order. It is worth recording that the hon. Gentleman has made known to me that in this particular debate, uniquely, he does not intend to speak. This is the first occasion I can remember chairing a debate in Westminster Hall when we did not benefit from his words of wisdom. We note that, and we are grateful to him for being here. We now come to the debate on Black Maternal Health Awareness Week, and I call Bell Ribeiro-Addy to move the motion.
I beg to move,
That this House has considered Black maternal health awareness week.
Thank you very much, Mr Gray; it is a pleasure to serve under your chairmanship. I thank my colleagues for their kind points of order. I am thankful, as always, that this debate has been awarded, so that we can once again have this vital discussion about the issues surrounding black maternal health.
Whenever I discuss black maternal health, I always take time to repeat the statistics around black maternal mortality. The reason I do that is twofold. First, the statistics are harrowing, and it is only by confronting them that we can truly begin to address the issue. Secondly, the statistics have not changed at all—the findings that I repeat have not improved, despite this issue having been raised for a number of years. I know that it may take time before we see a real change in statistics, but the Government are yet to introduce any meaningful measures that give us confidence that the statistics will change any time soon. Most notably, they will not even look at producing a target.
I repeat it for everyone who may not have heard that black women are four times more likely to die in pregnancy or childbirth, women of mixed heritage are three times more likely to die in pregnancy or childbirth, and Asian women are twice as likely to die in pregnancy or childbirth. Black babies have a 121% increased risk of stillbirth and a 50% increased risk of neonatal death. Asian babies have a 55% increased risk of stillbirth and a 66% increased risk of neonatal mortality. Black women have a 43% higher risk of miscarriage, and black ethnicity is now regarded as a risk factor for miscarriage.
The last time we had this debate, one of the key themes that kept coming up was data, whether it was Members such as myself raising the fact that the data exists and research has been done—we just need the Government to engage with it—or the Minister who responded, the right hon. Member for Mid Bedfordshire (Ms Dorries), stating that black women are under-represented in the Government’s data. I am pleased to say to the Minister responding today that there is now even more research out there.
Since the last time we had this debate, Five X More has carried out and released the findings of its black maternal experiences survey. This is the largest survey of black women’s maternal experiences ever conducted in the UK. It gathered responses from over 1,300 women and looked at their experience of maternal care. The report highlights all the negative interactions that women experienced with healthcare professionals, from feeling discriminated against in their care to receiving a poor standard of care, which put their safety at risk, and being denied pain relief because of the ridiculous trope that black women are less likely to feel pain.
The report goes on to reveal how the discriminatory behaviour and attitudes that black, Asian and ethnic minority women face have been shown negatively to impact women’s clinical outcomes and their experiences of care. More than half the respondents reported facing those challenges with healthcare professionals during maternity care, and 43% of women reported feeling discriminated against, while 42% of women reported feeling that the standard of care they received during childbirth was poor or very poor, and 36% reported feeling dissatisfied with how their concerns during labour were addressed by professionals.
Further to that, 42% of respondents reported feeling that their safety had been put at risk by professionals during labour or during the recovery period. Of the women who experienced negative maternity outcomes, 61% reported that they were not even offered additional support to deal with the outcome of their pregnancy.
I am pleased that the hon. Lady has brought this debate to Westminster Hall, and although there might not be big numbers here today to discuss the matter, it is of great importance. Does she not agree that health trusts, which she has referred to, must ensure that no matter the level of the black, Asian and minority ethnic population, staff are adequately trained to deal with the differences with respect to different ethnic groups? Does she further agree that the messaging that comes from the Minister and the Department in this debate is the most important tool that health trusts have to ensure that women of all ages and all ethnic groups are clearly understood and supported, no matter where they are and no matter what the statistics and numbers may be?
I thank the hon. Member for his intervention, and he is absolutely right. I will come to training soon enough, and to what I believe individual trusts should be doing.
In addition to the Five X More report, Birthrights has recently published the findings of its inquiry into racial injustice and human rights in maternity care. The report uncovers the stories behind the statistics and demonstrates that it is racism—not broken bodies, as we are often told—that is the root of many of the inequalities of maternity outcomes and experiences. The study found that on a number of occasions, black women’s safety was put at risk while they were receiving care. They were ignored or their pain was dismissed, and they experienced direct or indirect racism from care givers. They were subject to dehumanisation. Their right to informed consent was violated and they faced structural barriers to receiving healthcare. Those women were going through one of the most painful experiences of their lives—one that can leave them at their most vulnerable—yet they faced institutional racism that impacted their health and the health of their babies.
During a debate on this subject last year, I called on the Government to launch an inquiry into institutional racism and racial bias in the NHS, as well as in the field of medical education. I reiterate that call today and hope the Minister will address the issue of systemic racism in medical care.
In addition to those two reports, the Muslim Women’s Network recently published a study that reviewed the experiences of Muslim women in maternity care. The report encompasses the maternity experiences of over 1,000 Muslim women, and it once again revealed that a huge proportion of respondents received poor or very poor quality care. There are many examples of substandard care by health professionals, such as dismissing concerns and, again, pain; not offering treatment to relieve symptoms; inconsistency in the way that foetal growth was measured; substandard clinical knowledge; and vital signs being missed, which contributed to poor healthcare.
Some 57% of women felt that they were not treated with respect and dignity in the way they were spoken to or in other acts of care giving, but perhaps the most shocking finding of the report was that 1% of the women who responded reported that their baby had died before or during labour, or within 28 days of birth. In a sample of this size, that equates to 10 women, which is way higher than the three to four who should have been expected.
Those statistics are shocking, but the stories are even more shocking. Each of those reports includes harrowing stories of women being neglected, and of their pain being ignored and their concerns dismissed, resulting in a near miss or, indeed, the loss of their baby. In one account, a woman was not believed when she informed the midwife that she was ready to push. It states that when she eventually began to push,
“Her baby came out still enveloped in the placenta. Several doctors came and she was taken to theatre as it became an emergency situation. It was touch and go but she survived. Due to heavy blood loss she was in a coma for three days. Her baby had to be given intensive care.”
In another account, a woman reports that her baby was struggling to breathe after birth. She says:
“I was told that it was a normal thing for newborns. No checks were done to put my mind at ease. After about 20 mins, my baby stopped breathing. Efforts were made to resuscitate her, but she later died in NICU.”
One woman recalled that during her first check-up, a nurse said that she was shocked that she knew who the father of her baby was because people like her do not usually know.
There are thousands of similar stories of black, Asian and minority ethnic women having negative experiences with healthcare professionals and maternity care. There is an urgent need to address the crisis in maternity care, and I sincerely hope that the Minister will set out concrete steps that her Department and the Government will take to address the problem.
I sincerely hope those measures will look beyond treating black, Asian and minority ethnic women as a problem. We are not the problem and our bodies are not broken. There is no flaw in our genetics and we do not need to be dealt with in a way that reduces negative statistics by just pushing the problem away. The suggestion that black women should be induced earlier because a lot of these issues present after 40 weeks is ridiculous.
The solutions need to address the distinct problems in maternity care; all the evidence suggests institutional racism. We must address biases and assumptions about black women, train medical staff to recognise common symptoms in black women, and tackle the barriers that prevent black women from receiving the quality of maternity care they deserve. That is where the problems lie, and we will overcome them by directly addressing racial disparities.
Last year when we debated this subject, the responding Minister asked me and others to continue to hold her feet to the fire on this issue. I thought they were really receptive and that we were finally going to see some meaningful steps to tackle maternal health disparities. I left the debate feeling slightly hopeful because so much awareness had been raised by the fantastic campaign groups I mentioned earlier, and there was a lot of support across the House. I was therefore really surprised and quite deflated when the next day the Minister moved Departments in a reshuffle. I know Cabinet reshuffles happen all the time—
They are a standard part of government, but we have lost count of the Health Secretaries and Ministers covering this brief. Today, we have a Minister from a different Department addressing us. I know it may seem like I am making a party political point, but regardless of reshuffles, Government priorities and resignations, the problems in maternity care continue. Although we cannot have continuity in Government for whatever reason, we need continuity in care and a strategy for dealing with racial disparities in maternity care.
It is hard to see the Government taking action when things are changing so frequently, but I sincerely hope the Minister will assure us that the Government are focused on this issue, regardless of the changes, and that her time in this role will be spent tackling black maternal health disparities.
Black women cannot afford to wait any longer for action to be taken. I do not want to have to stand up in another debate and cite exactly the same statistics without any improvement. I know things take time, but it would be sensational to come back next year and report that at least something had changed. The best way for Ministers to exact that change is to set out clearly what the Government are doing and set a clear target.
The answer I have been given in the past when I have asked for a target is that this does not happen to that many women, so a target does not need to be set. I would flip that round: if it is not that many women, surely we can set a target to address it.
Thank you—Sir James?
That is a terrible omission. It is a pleasure to serve under your chairmanship, Mr Gray. I thank the hon. Member for Streatham (Bell Ribeiro-Addy) for leading this debate on a crucial issue.
The Women and Equalities Committee has twice held one-off evidence sessions—although there is a slight conundrum in twice having one-off sessions—looking at black maternal health. It has taken evidence from campaign groups, such as Five X More, and experts in obstetrics and gynaecology, yet the picture does not change. Looking at the evidence, we have known that there is a disparity in the health outcomes for black mothers since the early 2000s. For 20 years, we have known that there is a problem, yet still it continues. It has been a huge privilege for me to serve on panels alongside people such as Clo and Tinuke from Five X More, who have done so much incredible campaigning to highlight the issue, as has the hon. Member for Streatham. It is crucial that we begin to see progress; we cannot, 12 months or 10 years down the line, continue to have the same debate.
Raising awareness in Parliament is vital, but what we actually need is Government action. The hon. Member for Streatham made a slight dig about Government reshuffles. I am delighted to see the Minister in her place; this is an issue on which we have engaged before and she takes it seriously. I hope that the Secretary of State for Health will himself grasp the issue, and ensure that we drive it forward to see progress.
We have heard that one of the challenges is data, and the lack of specific data being collected on maternal health outcomes for black and Asian women. I pay tribute to Five X More, which carried out its own experiences survey that included 2,000 women—a huge number—reporting their experiences and findings. The thing that really hits home for me is the repeated use of the phrases, “I didn’t feel listened to,” “We weren’t listened to,” and, “What I was experiencing was being ignored.”
I am loth to say that we sometimes have very gendered healthcare, but look at the evidence. Look at the fact that when there is medical research, it is almost exclusively carried out on men; look at the fact that drug trials are carried out on men; look at the fact that some of the highest backlogs as we come out of the pandemic are in health conditions predominantly affecting women. Whether it is in cardiac, obstetrics or another sphere of medicine, too often the experience is, “I didn’t think they were listening to me.” I am sure every Member hears that from their constituents, and that has been my experience as a constituency MP. I hear from my constituents that, specifically in the area of maternity, “I wasn’t listened to. Nobody paid attention. It was my body, and I knew something was wrong.”
Only last week, I received an email from a constituent who had lost his daughter-in-law moments after she gave birth. He was with his son, helping to bring up a baby and pursue a complaints procedure against the hospital in question. Throughout his email, he kept making the point that they had not been listened to. His daughter-in-law had been a midwife, and even she was not listened to.
Talking to black and particularly Muslim women—I should declare an interest as chair of the all-party parliamentary group on Muslim women—they feel that their voices are doubly ignored, and that there is that intersectionality. Whenever I talk to journalists about intersectionality, they look at me and say, “Please don’t use that word. Nobody understands that word.” It is imperative that we all understand that word. You will be discriminated against if you are a woman, and you will be discriminated against if you are a woman from a black, Asian or other minority ethnic group; when the two come together, as we find in maternity units in particular, women’s voices are not heard or listened to.
When we talk to the Royal College of Obstetricians and Gynaecologists, as the hon. Member for Streatham has done, it calls for specific targets for black maternal health outcomes, and it is right to do so. Although it may be a small number as a percentage of births every year, it is still a significant number. The loss of one mother is one too many.
It is always a pleasure to listen to the right hon. Lady; she brings lots of wisdom and knowledge to these debates. Ministers in other debates we have had in Westminster Hall, in different positions in the Department of Health and Social Care, have always spoken about the issue of data. The hon. Lady is outlining examples of where data could be used to formulate a Government and ministerial response. Does she agree that the Government really need to grasp the data issue? They can then prioritise their strategy to respond.
I thank the hon. Gentleman for his intervention. I did not think he would be entirely able to resist speaking in the debate. He is right: policies must be data-driven and evidenced, but the evidence is there and has been for many years. We are augmenting and adding to that body of evidence the whole time.
I will not be entirely negative, because we have some great opportunities. I was pleased to see Dame Lesley Regan appointed women’s health ambassador earlier this year. I welcome, reinforce, champion and offer anything I can to help the women’s health strategy. Finally, we have one of those, and I pay tribute to the Minister who was instrumental in getting that published. What we now need from the strategy is outcomes. That has to be the focus. What is happening to drive outcomes, and to ensure that the disparities we know exist are recognised, acted on and reduced? Our goal has to be to reduce that horrendous figure of four times as many maternal deaths for black women. We have to improve the outcomes for black babies, so that there is not, as I think the hon. Member for Streatham said, a more than 100% likelihood of stillbirth—
Increased risk. The hon. Lady is absolutely right to highlight that as an imperative. We must ensure that we reduce the inequity, of which there are many drivers. She was with me when the Women and Equalities Committee took evidence from Professor Sir Michael Marmot, who talks so compellingly about health inequalities and their drivers.
I will not say that there is anything wrong with black women’s bodies—there is not—but we have to look at housing conditions, air quality and the areas where they live. Air quality is a significant driver of poor health outcomes. We have to look at what we are doing around smoking cessation, which is good for not just black women, but all women. We have to look at obesity, which is, again, a crucial factor for all women.
I look forward to seeing, in the remainder of this Parliament, focused and determined action around obesity, smoking cessation and air quality. There are targets on all those things, but—how can I put this gently?—there has been a little backsliding on some of them. Targets have been pushed into the dim and distant future, and there is less commitment around drives to reduce obesity and smoking, which are incredible drivers of poor health outcomes across the population. We should double down on our commitment to those targets.
I hope that in due course—I get fed up of saying “in due course”, which is a standard ministerial answer—to see a White Paper on health disparities. It is imperative that we get that done, and that the women’s health strategy is seen as a driver to ensure that we improve outcomes. First and foremost, I reiterate the calls from the hon. Member for Streatham for targets. I am never a great fan of targets if they are just there for the collection of targets, but if they work, and we see that in many instances they do, we should have them.
We should have time-limited targets, so that in maybe three years we can look and say, “Nothing has changed.” Looking at the data and the evidence from campaign groups, I see that over 20 years, nothing has changed. I do not want to be here in 20 years’ time giving the same speech on this important issue, feeling that nothing has changed. I look forward to the Minister’s comments, and reiterate my congratulations to the hon. Member for Streatham on calling for today’s debate.
It is a pleasure to serve under your chairship, Mr Gray, and to be in this debate, although I hope that in future there will be no need for one, because we will have solved these issues, and women using maternity services can expect the same care and equal outcomes. That is why I was keen to be here, and I congratulate my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) on bringing forward the debate and on pursuing this issue. I look forward to hearing the Minister’s response because it needs to be a priority.
In Wandsworth, 30% of residents are from black and ethnic minority backgrounds, and black maternal health is a big issue for us in Putney. We have a group called Putney Black Lives Matter. We meet to discuss important local issues, and black maternal health was highlighted as an issue of major importance. We are few here today, but across the country it is a big issue for many people: last year’s petition to improve maternal mortality rates and healthcare for black women was signed by 187,520 people, of whom 200 were from Putney.
I thank the campaign groups that have raised the issue so strongly: the Five X More campaign, Bliss, Sands, Birthrights, and the Royal College of Obstetricians and Gynaecologists. They have raised the issues of systemic racism and structural barriers, which lead to the appalling statistics read out by my hon. Friend the Member for Streatham. The statistics are worth reiterating, because they are at the heart of the issue. Black babies have a 50% increased risk of neonatal death and a 121% increased risk of stillbirth. Black women have a 43% higher risk of miscarriage, and are four times more likely to die during pregnancy or up to six weeks post-partum. Women of mixed heritage are three times more likely to die during pregnancy, and Asian women twice as likely. Those are horrendous statistics. Each loss of life is a tragedy, but it is also a gross injustice about which we should all care deeply. The statistics need to be understood, and need to change.
It is important to place those awful statistics in the wider picture of health inequalities. Black women face disparities when it comes to stillbirth, cancer diagnosis and outcomes, and access to fertility treatment. That is entrenched and deep-rooted inequality, racism and sexism. It will be hard to turn that around. The Minister will need to come back to this again and again, and to knock heads together in different Departments across Government to change it. But it must be done.
I have a lovely list of seven things on which I want to see action, and I hope that the Minister will respond to it. First, we need a whole-Government approach that recognises inequalities and their links to wider Government policies, as was mentioned by the Chair of the Women and Equalities Committee, the right hon. Member for Romsey and Southampton North (Caroline Nokes). We need the White Paper on health disparities, which will look across Departments. We need a new tobacco control plan for England, public health measures to address obesity, and a new air equality target for England, because those are all factors in increased black maternal mortality figures.
Black communities in the UK have an increased risk of poorer maternal and perinatal outcomes, including stillbirth and miscarriage. There are also inequalities in exposure to air pollution; that is the link between air pollution and maternal health inequalities. We must commit to reaching the interim World Health Organisation targets by 2030, rather than 2040; we can speed that up. What gets counted counts, and if there is a target, people strain to reach it more strongly. Dangerous levels of air pollution, especially in our urban areas, must be addressed.
The second issue is the continuity of carer. I pay tribute to the NHS South West London Clinical Commissioning Group—now the NHS South West London Integrated Care Board—and its chief nurse for what they do to tackle black maternal inequalities, especially in the area of continuity of carer. Women need the same team throughout pregnancy. I also pay tribute to our wonderful Emerald midwifery team from the St George’s University Hospitals NHS Foundation Trust. Where there is continuity of carer, women are 16% less likely to lose their babies. That is a major focus for change in south-west London. Local maternity systems across the country have been asked to implement equity and action plans, which include the target of 75% of women from black, Asian and mixed ethnic groups receiving continuity of carer by 2024. I hope that we can increase that figure. Progress is being made towards the target. However, we must look at the target, find out whether there is enough data to measure it, and ensure that across the country, no matter where people live, we strive towards it. Will the Minister comment on the status of the continuity of carer target?
In their response to the Health and Social Care Committee report on the safety of maternity services in England, the Government accepted the recommendation on training for continuity of carer teams. It is essential that there be training across the board and implementation of continuity of carer teams, but obviously that relies on there being enough staff, which depends on the midwife workforce having enough funding.
Thirdly, I would like an end to charging migrant women for maternity care. Charging for care deters many women from seeking vital antenatal care, and it is shocking that the MBRRACE-UK confidential inquiry on maternal death identified that three women who died may have been reluctant to seek care because of cost. It is shocking that that happens in this day and age, in our communities—that women may be afraid to seek care because of their immigration, asylum seeker or migrant status.
My fourth point is about further evidence, research and data, which was mentioned by other hon. Members. Differences in outcomes and the reasons for them are unclear and under-researched, but we know that what gets counted counts. I join campaigners in calling for an annual maternity survey of black women, and increased research to identify the conditions that disproportionately affect black women. We should improve the ethnic coding of health records, and the system through which women submit feedback, so their voices are heard. It should be as easy as possible for them to provide feedback while they are still in hospital or under maternity care, so that we can hear those voices and they can feed into the survey data.
My fifth point is about maternity bereavement services. As was highlighted last week during the debate on baby loss, there is a difference in bereavement services across the country. On whether there are adequate bereavement services for those women who, sadly, suffer bereavement, the figures are shocking. St George’s University Hospitals NHS Foundation Trust, of which Queen Mary’s Hospital in my constituency is part, now has two bereavement midwives, two specialist consultants and one part-time psychotherapist in the maternity bereavement team. There are dedicated places for those who have suffered bereavement in maternity services across the NHS South West London Integrated Care Board area, which is to be welcomed. However, is this happening across the whole country? That is questionable. That support is very important at the time of loss, but also during care in future pregnancies.
Sixthly, I request, as others have, a White Paper on health disparities. That is important if we are to tackle the issue and look at the many other underlying reasons for the statistics. Seventhly, I ask for a target. In any ministerial meetings on this important issue, I hope that a target will be the Minister’s No.1 ask. We need one, followed by a concentrated effort to achieve it. I hope that will lead to the change we need.
In conclusion, black women cannot afford to wait any longer for action. There needs to be a clear action plan, data, transparency and a target. I look forward to hearing the Minister’s response, but I look forward even more to action. I thank all the midwives, in maternity services throughout the country, who give extraordinary care, and who go above and beyond.
You are very kind, Mr Gray, and it is an honour to serve under your chairship. I thank the hon. Member for Streatham (Bell Ribeiro-Addy) for securing this vital debate.
The health of our nation is reflected in the health of our mothers, and the shocking statistics paint a picture of nothing short of gross negligence. I thank Tinuke and Clo for producing the groundbreaking “Black Maternity Experience Report”. Their platform, Five X More, helped to spread information about the survey. I also thank the participants for sharing their powerful testimonies, and the all-party parliamentary group on black maternal health for demanding an urgent solution to the crisis.
It is worth repeating that black mothers are four times more likely to lose their life during childbirth, and they are up to twice as likely to have severe pregnancy complications. Some 42% of women surveyed in the Five X More report felt that the standard of care they received during childbirth was poor or very poor. Successive Governments since at least the 1970s have systematically failed to address the shocking statistics on black maternal health, including on the standard of care they receive during childbirth. The “Black Maternity Experiences” report reveals that, even today, professionals still display racist and white supremacist attitudes and insensitivity towards black mothers without remorse. Black mothers suffer in silence through fear of reprisals, and fear that their care will become worse if they complain.
If ever there was a need for the Government’s long-promised White Paper on health inequalities, it is now. Will the Minister urge for it to be put back on the agenda? Shelving the health disparities White Paper only compounds the suffering and pain of black mothers. Without it, any progress made by the newly appointed maternity disparities taskforce will be slowed.
There is a crisis in midwifery up and down the country. Home birth teams are underfunded, delivery suites are closing, and the maternity workforce have seen management changes that prevent them from doing their jobs effectively. The disproportionate number of deaths of black mothers and their babies cannot simply be reduced to genetic or cultural factors. Equity in access to first-class healthcare is a must, and that means setting targets and specific funding for highly trained healthcare professionals, as outlined in the Five X More report. We know that black women are poorer, live in inadequate housing and suffer disproportionate environmental pollution, and that their educational chances and outcomes are disproportionately lower. Wealth inequalities are rampant.
The fiscal shortfall of £35 billion that was recently announced by the new Chancellor will drive the Government’s tax-and-spend plans; the Government are looking at 101 ways to cut spending. This is the worst news possible for black maternal healthcare. It demonstrates a callous ideology that seeks to cut spending instead of taxing earth-shattering levels of idle wealth—an ideology that risks further harm to black women and other racialised groups by avoiding wholesale investment in healthcare.
As we know, all mothers are superheroes who nurture babies, children and society, but black mothers have to overcome systemic barriers put in place by successive Governments, which result in black women’s wealth, health, education and environmental access not being equal to that of their counterparts. Alongside improving treatment and care, we have to start having frank conversations about the racialised distribution of wealth in the UK and what we need to do to tackle it and eradicate race inequalities in health outcomes. Mr Gray, I am sure you will agree that black mothers cannot wait any longer. The time for action is now.
It is a pleasure to serve under your chairmanship, Mr Gray. I, too, congratulate the hon. Member for Streatham (Bell Ribeiro-Addy) on securing the debate and on opening it so well.
I was not due to speak in this debate on behalf of the Scottish National party; it was supposed to be my constituency neighbour and hon. Friend the Member for Glasgow North East (Anne McLaughlin), who has sadly been incapacitated and remains in Glasgow. I hope that those present will bear with me.
I speak primarily from my position as chair of the all-party parliamentary group on premature and sick babies, because our APPG has looked into the issue of racial disparities in maternal healthcare, as well as inequalities more generally in maternal healthcare and neonatal services. These topics merit more attention from the Government. As hon. Members have said, there have been numerous debates, questions, early-day motions and all those kinds of things on this topic. The benchmark for whether the Government are getting this right is whether we will be back in this Chamber in 10 or 15 years’ time to have the same conversation. I certainly hope we will not.
The Birthrights report, “Systemic racism, not broken bodies”, outlines the systematic racism in maternity services. That report confirms the devastating fact that black, Asian and mixed-ethnicity women are more likely to experience baby loss and illness, or to become seriously ill, and have worse experiences of care during pregnancy and throughout childbirth. I want to advocate for the report’s conclusion, which calls for a commitment to anti-racism by all maternity and neonatal services, and a commitment to ensuring that there are more black and brown women and birthing people decision makers in the wider maternity system. We have to look at the ticking time bomb in the neonatal and maternity workforce; that absolutely has to be in the mix. The report also calls for a safe and inclusive maternity and birthing experience for all parents, which I think we would all want to get behind.
Healthcare is devolved in Scotland, which is largely why I do not want to impose too much in this debate. However, the SNP Scottish Government believe that there needs to be an open and honest conversation about race and institutional racism right across these islands—Scotland is not immune—in order to identify solutions that will lead to equality and positive outcomes for black and minority ethnic communities. Members have asked a number of questions of the Government; for the sake of brevity, and so as not to repeat what has been said, I will just say that I would like to hear the Minister respond to those, particularly the seven points made by the hon. Member for Putney (Fleur Anderson).
I am very grateful to the hon. Member for Streatham for securing this debate and giving us an opportunity to focus on this issue. Most importantly, I am looking forward to hearing what the Government have to say, and to seeing what best practice can be rolled out in Scotland, because no part of these islands have a monopoly of wisdom or ideas.
It is a pleasure to serve under your chairmanship, Mr Gray. I thank my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for obtaining this debate, and for all the work she has been doing on this issue for many years. I also thank the incredible campaigners who continue to work tirelessly to end black maternal health inequalities.
Maternal health inequalities exist throughout our country. It is very much a case of hit and miss: in some parts of the country the statistics are good, while in others they are not. However, black maternal health inequalities do seem to persist throughout our country. I also thank the right hon. Member for Romsey and Southampton North (Caroline Nokes), the Chair of the Women and Equalities Committee, who talked about the work that her Committee has done, but also noted that although this issue has been discussed for so many years, not much progress has been made on many of the concerns. My hon. Friend the Member for Putney (Fleur Anderson) spoke eloquently about the issues in Wandsworth and generally. In particular, she touched on bereavement services, the quality of which varies across the country as well. I thank the hon. Member for Leicester East (Claudia Webbe) for the very passionate speech she made. I agree with her: all mothers are superheroes. I do not think any debate would be complete without an intervention or speech from the hon. Member for Strangford (Jim Shannon), who is not in his place; I thank him for his intervention as well.
As we have heard repeatedly in this debate, it is shameful that black women continue to be over four times as likely, and Asian women over twice as likely, to die in childbirth or pregnancy than white women. I am very grateful for the work of campaigners, obstetricians, midwives, and black and Asian women with lived experience of maternal health complications for sharing their experiences and expertise on the issue. They are clear that socioeconomic determinants and comorbidity only partially explain those disparities in treatment. Black and Asian women and their partners are not being listened to, they are not being respected and they are certainly not being cared for. When they voice pain or concern during pregnancy or childbirth, they are often branded as aggressive or angry, while dangerous stereotypes about the strong black woman mean that they are often not offered the same treatment as white women. Meanwhile, the lack of cultural competency in medical training in our country means that many complications are not spotted early enough.
That structural inequality exists both inside and outside our health services. Many black, Asian and ethnic minority women experience it long before and long after pregnancy. However, the Government have done nothing to address this outrageous inequality. In fact, on their watch over the last 12 years, maternal mortality for black women has actually increased from 28 deaths per 100,000 in 2013 to 2015, to 34 per 100,000 in the years 2016 to 2018.
Gynaecology wait times are very high. A survey from the charity Five X More found that 27% of women surveyed felt that they received a poor or very poor standard of care during pregnancy, labour and postnatal care. Also, 42% of women repeatedly felt discriminated against during their maternity care, with the most common reasons given being race, at 51%, ethnicity, at 18%, age, at 17%, and class, at 7% of respondents. More than half the women reported facing challenges with healthcare professionals during their maternity care, while over half the black women reported not receiving their preferred method of pain relief.
Where is the Government’s action on this? In the last 18 months alone, we have seen their response to the Commission on Race and Ethnic Disparities fail to address black maternal inequality, as well as a women’s health strategy that completely fails to establish what concrete action the Government will take to protect the lives of black, Asian and ethnic minority mothers. It is hardly a surprise that the women’s health strategy has failed black, Asian and ethnic minority women, given that just 2% of the respondents who were surveyed were Asian and 3% were black. I am not trying to be party political here, but while the Government are busy crashing the economy and causing chaos at a time of national crisis, black, Asian and ethnic minority women continue to face the consequences of their inertia and ineptitude.
Last year, in passing the Health and Care Act 2022, the Government had an opportunity to prioritise the health of black, Asian and ethnic minority women by voting for Labour’s amendment to mandate the Secretary of State to prepare and publish a report on disparities in the quality and safety of England’s maternal services, including maternal mortality rates. However, the Government chose to vote against it. It was a very simple measure that could have helped, but no, they voted against it. The Labour party has committed to setting a target to end the horrendous inequality faced by black, Asian and ethnic minority women as soon as we are in government.
That will be part of our commitment to end structural inequality at the root, with a landmark race equality Act to be introduced by the next Labour Government. We are committed to pulling the NHS out of crisis so that it can deliver for everyone, including black, Asian and ethnic minority mothers. We will enact the biggest extension of medical school places in history. We will double the number of district nurses, train 5,000 new health visitors and, crucially for maternal health, introduce an extra 10,000 nursing and midwifery clinical placements each year. Our fully costed plan will be funded by ending the non-domicile tax status regime, which, it is estimated, would raise more than £3.2 billion every year. Growing the NHS will also grow the economy and eradicate these inequalities once and for all.
I welcome the Minister to her new position. Like me, she has just recently joined this brief. While we wait for these changes, what is being done to address structural inequalities and build trust in maternity services for BME mothers, their partners and midwives from ethnic minority backgrounds? Additionally, what plan does the Minister have to improve cultural competency and unconscious bias training in medical schools and the health service?
There is also the huge issue of the lack of available data, which has not been tackled in either the women’s health strategy or the Government’s response to the Commission on Race and Ethnic Disparities. As we have heard, accurate data disaggregated by ethnicity is central to closing the gap in maternal mortalities. Will the Minister commit to ensuring that all maternity services record the specific ethnicity of all mothers? Fatalities are just the tip of the iceberg, with many women speaking of near misses and poor treatment, so will the Minister commit to collecting and publishing that data?
Some midwives also consider that the continuity of carer model could help to end these inequalities. A 2016 study found that women who see the same midwife throughout their pregnancy are 16% less likely to lose their baby. Despite that, the NHS has recently been forced to drop targets included in the NHS long-term plan to ensure continuity of carer for 75% of BME women by 2024 as a result of staffing shortages. It is clear that the Government are failing these women. What steps is the Minister taking to end the staffing shortages in maternity care so that those targets can be reintroduced and met by 2024?
I have to say, it is scandalous that the Government have not yet even set a target to end this inequality. They have been in power for 12 years—that is a very long time in which to have comprehensively changed the system. Will they now commit to doing so immediately? We did it for stillbirths. Why has black maternity mortality not been a priority for the Government?
This is an avoidable inequality. There are many steps we could be taking to end these awful disparities. Instead, the Government have done nothing while the issue has got worse. The Government must take action to address maternal health inequalities. We need a national strategy to tackle health inequality as a matter of urgency, which must include a commitment to eradicating the mortality gap between black, Asian and ethnic minority women and white women. Only Labour can deliver that strategy as part of our plan to tackle structural inequality at the root and lift the NHS out of crisis.
I hope that the Minister will answer some of those questions today and commit to specific action that will be taken, because this cannot go on. These appalling statistics—the fact that black women have four times the mortality rates of others—are not acceptable in a decent, civilised society.
It is a pleasure to serve under your chairmanship, Mr Gray. I thank the hon. Member for Streatham (Bell Ribeiro-Addy) for securing this debate. As she highlighted, we had a similar debate recently. I hope that my comments reassure her that we are taking action and making progress in this area.
I take the issue of maternal disparities very seriously; that is why when I was in post previously I set up the maternity disparities taskforce, which has brought together a range of specialists and campaigners. We have heard from groups such as Five X More and the Muslim Women’s Network to hear their views on what is going wrong right now, what systems we need to put in place to improve outcomes and also the experiences of black women in maternity services.
The data shows the disparities in black maternal health. We have heard about them clearly this morning, and I do not think anyone is in any disagreement about the scale of the problem we are facing. As the hon. Member for Streatham said, it is harrowing to hear those figures. The MBRRACE annual surveillance report shows that women of black ethnicity are four times more likely to die from pregnancy and birth compared with white women. I do not think there is a dispute about that; we fully acknowledge it and we want to reverse that trend as quickly as possible.
I want to make a quick point about MBRRACE and the data. Data collection remains tricky, with some hospitals not reporting women’s deaths—not necessarily maternal deaths—until up to 500 days after they have happened. Then there is a delay with the medical records and notes, which might indicate the reasons for that. What reassurance can the Minister give that she will work to reduce those times?
My right hon. Friend is absolutely right. Although Five X More does its surveys about the experience of women, the data on outcomes is very delayed. When we put measures in place, we cannot see the difference they make until the data comes through, roughly 18 months to two years later, as my right hon. Friend said. That lag does not help us determine whether the measures we are putting in place are actually making a difference. Getting that on track is a key priority for me so that we can accurately measure what is happening.
From the data that we do have, The Lancet series in April last year found that black women have an increased relative risk of 40% of miscarriage compared with white women, and the stillbirth rate in England for black babies is 6.3 per 1,000 births, compared with 3.2 per 1,000 births for white women. That is completely unacceptable, and as the hon. Member for Streatham said, we cannot come back here, debate after debate, without seeing those figures move. One potential cause for optimism is that we do not have up-to-date data on the benefits of the interventions that we have put in place, so it might be better than we think. However, we absolutely need that data, not only to measure what is happening, but to know whether we are heading in the right direction if we set targets in the future.
To reassure Members, I want to clarify the point about not setting a target because the problem is too small. I do not agree that the problem is too small; it is a significant problem. Even if it is affecting one or two women, it is a significant problem, so that is not a reason not to set a target. As the hon. Member for Putney (Fleur Anderson) pointed out, there are multiple factors in why black women often face poorer outcomes in pregnancy and birth, and for their babies. It is a mix of personal, social, economic and environmental factors. Air quality, which the hon. Member touched on, also has an impact on overall health. The maternity disparities taskforce found that being in a lower socioeconomic group has a significant effect on maternal outcomes, and black and ethnic women are often in those groups and so face a double whammy in terms of their likely outcomes.
We cannot just fix this in isolation at the Department of Health and Social Care. That is why I am pleased that in my role for women’s health—I am also the Minister for Women, across the board—I can bring in other Departments, because we need to take a cross-Government approach to this issue. Whether it is the Department for Environment, Food and Rural Affairs on air quality, the Department for Levelling Up, Housing and Communities on housing, or the Department for Work and Pensions on employment, we need to work together so that all the factors affecting black maternal health are addressed in tandem to address this issue.
We know from a health perspective that pregnant black women are more likely to suffer from some chronic diseases that will affect their maternity outcomes, and in particular cause poorer mental health. There are health initiatives that we can put in place to ensure that we improve the outcomes for black women, but that cannot be done in isolation from the other factors that also negatively affect them.
Given the risks that such conditions pose in pregnancy, there is a need for safe personalised care for black women and women from ethnic backgrounds, because the needs of women from each and every community are so different. Just nationally introducing blanket systems will not address some of the problems; there is no one single solution that will improve the statistics and improve the outcomes for women.
The issue is not just the outcomes from maternity services. As we heard from the hon. Member for Streatham, the Five X More survey also reflects the general experience by black women of the healthcare system. Although black women are often at a more difficult point to start with, when they engage with health services they often have a very negative experience. We have seen that in the recent publication of the East Kent maternity report and in the Ockenden maternity review, which highlighted that there is racial discrimination present in some parts of the maternity services.
We cannot allow that to continue, because if we want black women to come and engage with services and to come forward when they have concerns, if they feel that they are not being listened to or if they raise concerns and they are dismissed, why would we be surprised when they do not engage with services in the future? Regarding the East Kent report in particular, I will look at the calls for action on how we improve black women’s experience of the healthcare system and considering how we can address those issues as urgently as possible.
When we consider the actions that we are putting in place, and I will touch on some of the ones that have already started, I am very much a supporter of Professor Marmot’s idea of proportionate universalism, whereby we introduce good services across the country but then we target those people who are most in need; in the case of black maternal health, that is clearly women from the black community. We need to go to them rather than expecting them to come to the health service: we have a universal offer, but ensure that it is targeted specifically at those who do not experience the best outcomes.
On targets, as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) touched on earlier, we have an issue with data collection across the board in health services, including in maternity services. Black women often experience the worst outcomes, although some of the data that we are seeing is from 2020. For some of the initiatives that we have put in place in the last year or 18 months, we are not yet seeing the benefit of those initiatives in terms of outcomes. I am being very candid here: we have not got a handle on what is making a difference, or on which parts of the country are doing well—as was acknowledged by the hon. Member for Bolton South East (Yasmin Qureshi), the shadow Minister, there are some very good practices in place—and which parts of the country are still not supporting women in the way that women want.
We are working with NHS England, the Office for National Statistics, MBRRACE-UK and the National Neonatal Research Database, because there are also multiple sources of data. We need to pull all the data together and get it as close to real-time data as we can, so that when we introduce interventions and measures we can know whether they work.
As part of the maternity disparities taskforce, I am also keen to make sure that we include black women more in the national patient survey, because the shadow Minister was quite right that we had over 100,000 responses to the women’s health strategy but only a small percentage of those responses came from black and ethnic minority women. That illustrates the problem that we are talking about—that black women do not feel represented, or do not feel engaged with the process. So we have to change things and work is being done to address that situation.
We are introducing some measures. First, we have set guidance that each local maternity system is now working in partnership with women and their families and their local areas to draw up equity and equality action plans. For each local maternity system’s local area, there has to be a plan in place about how to improve the outcomes for women. The plans are agreed by the local maternity systems and the new integrated care boards, which were set up in the summer. They were published last week, so I encourage hon. Members to look at their local action plans to see what they are putting forward and to challenge them if they feel that they are not meeting local community needs. That is why they are done on a local basis: what is appropriate in my constituency of Lewes may be different to what is needed in Streatham, Putney, Leicester East, or Romsey and Southampton North. It is really important that we look at those action plans to make sure that they address the problems that we are concerned about. Every plan is being reviewed by NHS England, which will identify areas of good practice and the support that is needed to drive them forward.
In addition, we have also commissioned 14 maternal medicine networks covering the whole of England, which will ensure that women have access to specialist management. We know that black women are more at risk of high blood pressure, diabetes and sickle cell anaemia and yet many of those risk factors for their pregnancy and birth are not dealt with or managed. The maternal medicines network will bring in specialists so that, at an early stage of their pregnancy, those women can access those specialists to help them manage their pregnancy. They will also be offered pre-conception advice for further pregnancies. We have never done that before. We are targeting the risk factors of black women, and all women who are at risk, to make sure that they get the medical support and advice that they need during and after their pregnancy.
The Department also launched the £7.6 million health and wellbeing fund last year, which is supporting 19 projects throughout England to try to generate best practice guidelines that we can introduce to help reduce disparities. These projects include supporting expectant young black fathers in child development and providing perinatal mental health support for black mothers. If we can get some evidence-based best practice, we can look to roll that out across the country in the coming months and years. There is a lot of work going on.
I will touch on the issue of racial discrimination. It is clearly unacceptable that black, Asian and ethnic minority women feel that the health service is not accessible or not responsive to their needs. There is education and training for NHS staff on health disparities to eliminate bias and racism in obstetrics and gynaecology. The Royal College of Obstetricians and Gynaecologists’ race equality taskforce has developed e-learning cultural competencies. They now form part of the colleges’ members continuing professional development. The Nursing and Midwifery Council is also looking at how to promote and embed equality and respect in professional practice, so that they can create an environment where everyone feels that they can access the services they need. We will obviously continue to look at this with the maternity disparities taskforce, which is bringing in campaigners, experts and professionals to try to drive momentum on this issue.
Data is the key. I can give a commitment here that has been highlighted already. We need that data. We cannot be working with data that is two years old to see if we are making a difference because, if we are, we will not know about it for two years and will not be able to roll out good practice in other parts of the country. In my brief as the Minister for Women, I am aiming to bring that across other Departments as well.
I hope I have reassured hon. and right hon. Members in today’s debate that I am committed to continuing the work to tackle the disparities in outcomes to ensure that everyone has the opportunity to live a long and happy life. I am happy to work with the APPG on black maternal health, which is chaired by the hon. Member for Streatham, because it is only by working together to identify good practice and raising it when things are not working well that we can eliminate the disparity: it is unacceptable that black women are four times more likely to die during pregnancy simply because they are black women.
I thank all Members for participating in the debate and adding their voices to all those that are calling for steps to be taken to end racial disparities in maternity care. It is always reassuring to hear just how much support there is across the House when the issues are raised. I thank the hon. Member for Strangford (Jim Shannon), who is always a huge support in a range of different debates, but who has been particularly helpful today. I also thank the right hon. Member for Romsey and Southampton North (Caroline Nokes), who does fantastic work as the Chair of the Women and Equalities Committee and also as the chair of the APPG on Muslim women.
I will point out some of the disparities that she has touched on, including those detailed in a report from the Muslim Women’s Network. That report showed that Muslim Somali women who had given birth in other parts of Europe found that, although they faced worse discrimination in society in those other parts of Europe, they received much better maternal care in hospitals in those other European countries, namely Norway and Sweden, than they did in the UK. They had better outcomes as well. That is definitely something for us to look at.
My hon. Friend the Member for Putney (Fleur Anderson) and the right hon. Member for Romsey and Southampton North pointed out the different factors that affect black maternal health outcomes, which all come full circle to point to the institutional racism that black women face across society. I thank the hon. Member for Leicester East (Claudia Webbe) very much for raising the issue of the health disparities White Paper. We absolutely need to see the White Paper soon. Without it, I am not sure how we are going to set a benchmark for things changing overall.
The hon. Member for Glasgow North East (Anne McLaughlin) is not here, but she is hugely supportive, and I hope she feels better soon. The hon. Member for Glasgow East (David Linden) did some great work with the all-party parliamentary group on premature and sick babies, and I was pleased to see the group calling for anti-racism across care. That has been particularly important.
Yesterday, we had a lobby in Parliament in which Five X More lobbied parliamentarians. I thank all those who signed the pledge calling on the Government to use existing data to close the gap and to address overall disparities in maternal outcomes. Tinuke and Clo from Five X More continue to punch well above their weight. Five X More is the only black maternal health charity focused specifically on the outcomes for black women, and also the only such charity that I can think of that receives no funding. It has been able to do all this work off its own bat, which is testament to Tinuke and Clo and their dedication to resolving these disparities.
How could I forget my hon. Friend the Member for Bolton South East (Yasmin Qureshi)? I welcome her to her new post of shadow equalities Minister, and I was very pleased to hear her commit the Labour party to bringing about that target. That was very clear, and it shows that the party is listening to what black women have asked for over the past few years when these issues have arisen.
The research has already been done and we simply want the Government to engage with it. While we are calling for more data to be captured, we want the Government to engage with the data that already exists. That is key because so much work has gone on with other organisations, including the Muslim Women’s Network and Birthrights, to produce the reports that we have referenced today, and to lobby and campaign. Those things exist and they need to be acted on.
Those organisations have gone out and spoken to a great many women—sadly, women who did not want to engage with the Government’s surveys, which is worrying and something that needs to change. I pay tribute to all those women because it is difficult to relive your trauma in that way and to recount all those awful things that have happened. I know it has been for me, but I thank all those women who came forward to share their stories. They need to understand, as I am sure they do, that that makes a difference moving forward.
I thank the Minister for her response to the debate and the detail about what is already being done. That is really helpful, and I am pleased to hear a change in attitude as to how these issues are addressed. I have been concerned in the past, particularly with respect to the Commission on Race and Ethnic Disparities report and some of the responses that I have received personally, about the willingness of Ministers to admit that racial disparities exist and to focus on those, rather than saying that they do not exist. I would encourage you to read all the reports I have referenced today, but you say you have, which is great. Not only the statistics, but the personal accounts, do not make for easy reading, but they definitely make for a greater understanding of what has been happening.
I want to touch on one thing or two things that the Minister said specifically. You are absolutely right that people’s socioeconomic status has a direct effect on health outcomes, but the Five X More report, and the other two reports, found that black women report the same disparities regardless of their level of education and socioeconomic status. We need to look closely at that and acknowledge that the issue is purely racism: institutional racism goes far beyond all the other factors that we would usually expect to have an impact.
I want to leave the Minister with a few more suggestions about things that you might wish to introduce.
I understand the Minister’s reasoning for not having a target. It may appear logical, but given that the data shows that those women’s children have a 43% increased chance of being miscarried, and a 121% increased chance of being stillborn, I do not understand how the Government can say that they will look at all these measures surrounding the issue but will not specifically set a target to bring it to an end. That is not acceptable, and I do not believe that the women who continuously campaign for a target will accept that, so I ask the Minister to look at it again.
I understand that there are great challenges in looking at disparities across the board. All those things need to be addressed and different Departments need to be brought in, but as I said in relation to socioeconomic status and other factors, there is a culture of institutional racism in our NHS, which needs to be resolved. Obviously, that will start with data. The NHS must improve the quality of ethnic coding and ensure that the data is accurately recorded. I am really concerned about how skewed the recording is.
At our APPG meeting yesterday, we heard that even when it comes to simple things such as trying to find out how many women have claimed compensation for things that have happened, the women’s age and the area they have come from is recorded, but their race is not. That seems like a major oversight, especially when other pieces of data are being gathered.
I support Five X More’s call for the Government to introduce an annual maternity survey targeted specifically at black women, similar to the Care Quality Commission’s maternity survey, because I believe that its results could be used to inform public and parliamentary accountability and improve maternity health services. Although few women contributed to the Government’s survey, there is a willingness among black, Asian and minority ethnic women to record their issues and experiences, as the other campaigns have proved.
I reiterate the call for an inquiry into institutional racism in the NHS. That is the only way that we will change some of the outcomes, especially given the information that has been gathered on what the issues are. Yes, we have to look at air quality and other co-morbidities, but until we address racial bias, assumptions among medical staff, and teaching and training, certain things will just not change.
Finally, please engage with the campaigners. I understand that there is a lot of listening going on. In the past few years, there have been more conversations, and they are more likely to be included in working groups, but it is one thing to say, “Yes, we have to look at this. This is really awful,” and another thing entirely to engage with them, work with them across different issues and show that the things they are asking for are being met within the NHS’s plan. Please do engage with the campaigners. They know what they are talking about and have the data that the Government have not been able to collect from women. They understand the issues and are making the right calls about what we need to do to bring this horrible disparity to an end, to close this racial divide and ensure that black women, Asian women and women of mixed heritage have safe births.
Question put and agreed to.
That this House has considered Black Maternal Health Awareness Week.