A national cohort study and confidential enquiry to investigate ethnic disparities in maternal mortality

Abstract

Summary Background Ethnic disparities in maternal mortality were first documented in the UK in the early 2000s but are known to be widening. This project aimed to describe the women who died in the UK during or up to a year after the end of pregnancy, to compare the quality of care received by women from different aggregated ethnic groups, and to identify any structural or cultural biases or discrimination affecting their care. Methods National surveillance data was used to identify all 1894 women who died during or up to a year after the end of pregnancy between 2009 and 18 in the UK. Their characteristics and causes of death were described. A Confidential Enquiry was undertaken to describe the quality of care women received. The care of a stratified random sample of 54 women who died during or up to a year after the end of pregnancy between 2009 and 18, (18 from the aggregated group of Black women, 19 from the Asian aggregated group and 17 from the White aggregated group) was re-examined specifically to describe any structural or cultural biases or discrimination identified. Findings There were no major differences causes of death between women from different aggregated ethnic groups, with cardiovascular disease the leading cause of death in all groups. Multiple areas of bias were identified in the care women received, including lack of nuanced care (notable amongst women from Black aggregated ethnic groups who died), microaggressions (most prominent in the care of women from Asian aggregated ethnic groups who died) and clinical, social and cultural complexity (evident across all ethnic groups). Interpretation This confidential enquiry suggests that multiple structural and other biases exist in UK maternity care. Further research on the role of microaggressions is warranted. Funding This research is funded by the (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217–21,202. MK is an NIHR Senior Investigator. SK is part funded and FCS fully funded by the (NIHR) Applied Research Centre (ARC) West Midlands. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

COVID-19 vaccine hesitancy: a midwifery survey into attitudes towards the COVID-19 vaccine

“…In the UK, racial and ethnic disparities in maternal mortality are widening [ 35 ]. A recent independent enquiry into racial and ethnic disparities in maternal mortality identifies systemic bias in cases where Black women died [ 36 ]. These included the lack of nuanced care and microaggression, defined as ‘brief and commonplace daily verbal, behavioural, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults’ [ 37 ].…”

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“…13 Information on women who died, or who had stillbirths or neonatal deaths, was cross-checked with data from the organisation responsible for maternal and perinatal death surveillance in the UK (MBRRACE-UK). 14 As individual-level SARS-CoV-2 variant data were not recorded in medical records, the data collection time period was restricted to the period in which the Omicron SARS-CoV-2 variant was the dominant circulating strain in the UK. The cut-off at December 15 was chosen since the variant then represented 50% or more of sequenced new cases from Public Health England.…”

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“…A recent national cohort study and confidential enquiry from the UK compared the quality of care received by women from different racial and ethnic groups and found multiple areas of bias including microaggressions affecting their care. 9 Recently, there have also been reports of Indigenous pregnant women in Canada experiencing mistreatment and racism and not receiving adequate and timely care resulting in maternal and infant deaths. 10,11 Actionable steps Below we present six areas for action.…”

“…The recent national cohort study and confidential enquiry from the UK identified lack of individualized care as a contributor to maternal mortality and found that racial and ethnic minority women were treated inappropriately due to deliberate and/ or unintentional lack of recognition of their cultural needs. 9 When delivering care to racial and ethnic minority women, we need to consider the broader sociopolitical environment within which they live, and the role of their families and community networks in optimizing their health and wellbeing. For example, birthing on or near traditional territories in the presence of family and community is of foundational cultural and social importance for Indigenous Peoples in Canada yet long-distance travel for birth is a reality for many because of closures of obstetrical services in rural areas.…”