New report highlights persistent inequalities and continued inequitable care for pregnant women

Published on Thursday, 11 November 2021 Tweet

Today, the MBRRACE-UK collaboration, based at (NPEU), has published the results of their latest UK Confidential Enquiry into Maternal Deaths and Morbidity. These annual rigorous reports are recognised as a gold standard in identifying key improvements needed for maternity services. The latest Saving Lives, Improving Mothers' Care study examines in detail the care of all women who died during, or up to one year after, pregnancy between 2017 and 2019 in the UK.

Key findings:

• Pregnancy remains very safe in the UK, with the overall maternal death rate showing a slight decrease. Among 2,173,810 women who gave birth in 2017-2019, 191 died during or up to six weeks after pregnancy, and 495 during or up to one year after their pregnancy.
• Nevertheless, the findings show a continued inequality in the mortality rates for women of different ethnic backgrounds, ages, and socio-economic circumstances.
• Heart disease remains the largest single cause of all maternal deaths during or up to six weeks after pregnancy. Neurological causes (epilepsy and stroke) are the second most common cause of maternal death, followed by sepsis and blood clots.
• The maternal death rate from pre-eclampsia and eclampsia continues to be low but remains higher than the lowest rate, in 2012-14.
• Cancer is the most frequent indirect cause of death for pregnant women between six weeks and a year after the end of pregnancy.
• Maternal suicide remains the leading direct (pregnancy-related) cause of death over the first year after pregnancy. Of concern, the number of teenage suicide deaths has increased: 11 per 100,000 teenagers giving birth, up from 2.5 in 2014-2016.
• Women from Black ethnic groups are four times more likely to die in pregnancy than women from White groups, and women from Asian ethnic backgrounds almost twice as likely.
• Pregnant women living in the most deprived areas are twice as likely to die than those living in the most affluent areas.
• The maternal mortality rate is almost four-fold higher for women aged 40 or over, compared with women aged 20-24 years.
• The average age at first childbirth continues to increase, yet fewer than a third of mothers who gave birth over the age of 45 receive the recommended care for older mothers. In particular, few women have discussions when planning their pregnancy about potential risks.

According to the research team, the findings reflect how pregnant women are being put at greater risk due to clinicians focusing on their pregnancy, rather than the woman's own health. This is particularly the case for the women who died from cancer, with their symptoms often being attributed to pregnancy and not further investigated.

In addition, the report highlights the need for greater coordination in the care of women facing socio-economic adversity and/or poor mental health. The report's authors concluded that improvements in care might have made a difference in outcome for 67% of women who died by suicide, 29% who died from substance misuse and 18% of those who died by homicide.

Professor Marian Knight (NPEU), who led the study, said 'This report demonstrates that there are persisting inequalities in maternal deaths, besides recurring structural biases affecting women's care on the basis of their pregnancy. Addressing these systemic issues is more urgent than ever, particularly as we continue to see the same biases affecting the care of pregnant women with COVID-19.'

Specific recommendations from the report include:

• Health professionals must be aware that women's risks before, during and after pregnancy are not static; for instance, mental health can deteriorate rapidly following a pregnancy loss.
• A pregnant woman who reports symptoms of concern must be treated the same as a non-pregnant person unless there is a very clear reason not to.
• There needs to be greater coordination between care services – including GPs, maternal services and mental health services – to offer individualised care, particularly for women experiencing adversity and/or poor mental health.
• Older mothers (45 years +) should receive age-appropriate guidance, including the need to continue treatments for existing conditions, and individualised assessments of the risks to themselves and their unborn child.
• Reducing obesity and overweight is a clear target for reducing maternal deaths. Obesity is a major risk factor for both heart disease and blood clots.

To read more you can download the full report, lay summary and the infographic on the MBRRACE webpages.