Black maternal mortality disparities: 50 years on and we are still “counting” 

By Paul Whiteing, Chief Executive, AvMA 

I was interested to read the report by the House of Commons Women and Equalities Committee on Black maternal health published in the last few days. The Committee open with the stark (but well-known) fact that maternal mortality for Black women is almost four times higher than for White women. A huge amount of work has been done by a range of groups, not least Five X More and Birthrights, to publicise this issue. I am sure they are not alone and that raising this issue is a massive achievement. But having raised the issue, I was struck by reading this report on how, as a nation, we are long on analysis of what drives this significant health disparity and much shorter on practical application of change and improvement.   

The Committee again did what I think was great work in outlining the multiple factors that are likely to drive this disparity and took evidence from experts and senior officials within the health sector about what is being done, or planned to be done, to address these issues.  

But then I turned to the Annex of the Report, which sets out a comprehensive timeline on maternal health disparities. This shows that from as early as 1970-72, information about mothers’ countries of birth was included in the National systems into Maternal Deaths and that it was known that mothers born in what was then called the ‘New Commonwealth’ showed much higher mortality rates than mothers born in the UK. So, to be clear, this issue was first known about 50 years ago. And yet here we still are talking about strategies and plans to rectify this health inequality. So, what else is going on here? I wonder if the verbal evidence given to the Committee by a senior NHSEI official who talked of “growing insights” that there were “some areas where the NHS…could be considered structurally racist” could be significant as caveated as those comments were.  

Of course, I recognise that this term is politically contested, as witnessed recently with the Casey review into the Metropolitan Police, where there was a furore in some areas of the media about suggesting the Met were “institutionally racist”. But as much as I am a supporter of the NHS, I wonder if we need to ask some difficult questions and face into the challenge raised by those comments at the Committee, as qualified as they were. The alternative might otherwise be that this health disparity, along with the many other healthcare disparities that get routinely reported, will continue to be just that… a report that holds up a mirror to the problem, proposes a range of solutions, secures some warm worded commitment from the Government of the day only to find that not much really changes because we never are prepared for a more challenging conversation as to wider root causes.