Black maternal health

The causes of the appalling disparity in maternal deaths are multiple, complex and still not fully understood. Fixating on any one cause risks over-simplifying the problem and placing blame on the very women who are most at risk. Too many Black women have experienced treatment that falls short of acceptable standards, and we are concerned that the Government and NHS leadership have underestimated the extent to which racism plays a role. The maternity workforce must be properly equipped to understand and recognise the significant disparities that exist, and to use that knowledge to deliver personalised, effective and respectful care. Health Education England must lead a co-ordinated review involving the National Midwifery Council, General Medical Council, Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, to ensure that both the training curricula and continuing professional development requirements for all maternity staff include evidence-based learning on maternal health disparities, its possible causes, and how to deliver culturally competent, personalised and evidence-led care.

Continuity of carer is a cornerstone of the Government and NHS commitment to deliver safer maternity services for all women. It is simply not possible to implement it safely, however, due to the considerable staffing shortages across maternity services. 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 and endorsed by the final Ockenden report in March 2022. The Government should commit to increasing the annual budget for maternity services to £200–350 million from the next financial year.

We note that, at the time of writing this report, the Maternity Disparities Taskforce has not met for nine months. If it continues, it must have tangible metrics to measure its success. The Government should publish measures for gauging the success of the Maternity Disparities Taskforce. It should commit to publishing the dates of meetings in advance, and the minutes of the meetings soon after. The Taskforce should update this Committee on a six-monthly basis on the progress the Taskforce has made to tackling maternal health disparities.

It is unclear how the Equity and Equality guidance will be implemented and monitored. In response to this report, NHS England should set out their approach for assessing and monitoring the strategies of local maternity services. The Government should also provide clear timescales for the roll-out of the maternal morbidity indicator.

The main solutions which have been put forward by the Government and NHS are necessary but insufficient to tackle the problem of the disparity in maternal 26 Black maternal health deaths. A target for eliminating the disparity between Black and other minority ethnic women and White women, and the related disparity between those living in the most and least deprived areas, is needed. This will focus minds, help to embed a strategy, and keep the issue firmly on the political and health agenda. Focus on a single number alone is a crude and unhelpful measure. There should be a cross- government target and strategy, led by the Department of Health and Social Care, for eliminating maternal health disparities. The Maternity Disparities Taskforce should be charged with consulting on this strategy within its membership and more widely, and for proposing and developing metrics by which this target can be achieved and measured.

Black women are regularly underrepresented in research or data and therefore in policymaking. Ethnicity data held by trusts is incomplete or inaccurate. Crucial data is delivered too slowly to the National Perinatal Epidemiology Unit, which delays MBRRACE-UK releasing the data and impedes their ability to evaluate progress on tackling disparities. We recommend that: • The Office for National Statistics, NHS England, hospital trusts and all relevant stakeholders should work with the National Perinatal Epidemiology Unit (NPEU) to minimise delays in the delivery of data. The NPEU should provide us with a progress update on this work within 12 months of the date of publication of this report. • NHS England and NHS Improvement (NHSEI) and NHS Digital must prioritise the accurate and complete capture of ethnicity data and ensure their new system for ethnicity data captures granular level data on ethnicity. NHSEI should provide us with a progress update on the implementation of this system within 12 months of the date of publication of this report. • The Maternity Disparities Taskforce must ensure a minimum number of seats or spaces at each meeting is reserved for representatives of organisations run by and for Black women. Part of the Taskforce’s focus over the next 12 months should be on working with stakeholders to ensure Black women can be better represented in maternal health research; both as participants and researchers.