Black women are STILL far more likely to die in childbirth

MBRRACE-UK have published the latest report from their United Kingdom’s Confidential Enquiry into Maternal Deaths programme and it shows that Black women are still far more likely to die in childbirth than white women.

Those of mixed race and Asian heritage are also more likely to die than those of white descent. About three times and two times more likely, respectively, although you can see the exact data here.

The 2020 report looks at the outcomes for those giving birth in the United Kingdom between 2016 and 2018.

“In 2016-18, 217 women died during or up to six weeks after pregnancy, from causes associated with their pregnancy, among 2,235,159 women giving birth in the UK. 9.7 women per 100,000 died during pregnancy or up to six weeks after childbirth or the end of pregnancy.”

As the report’s authors note, it’s important to remember that maternal mortality is rare.

“Many women have found these figures very worrying and it is important always to qualify such stark statistics with absolute numbers – in 2016-18 in the UK 34 Black women died among every 100,000 giving birth, 15 Asian women died among every 100,000 giving birth, and 8 white women died among every 100,000 giving birth.” (Knight et al 2020: 1)

But race is still a key issue, and the figures relating to the disparity are “fundamentally unchanged from those documented in the 2019 report.” (Knight et al 2020: 1) Maternal mortality STILL affects Black, mixed race and Asian women and families disproportionately more than it affects white women and families.

What are the findings of the 2020 report?

As is the norm for such reports, the research team have focused on identifying the indirect and direct causes of maternal deaths, so let’s look at their overall findings first.

“Cardiac disease remains the largest single cause of indirect maternal deaths. Neurological causes (epilepsy and stroke) are the second most common indirect cause of maternal death, and the third commonest cause of death overall. There has been a statistically significant increase in maternal mortality due to Sudden Unexpected Death in Epilepsy (SUDEP).” (Knight et al 2020: 13)

As I have noted, they identify continuing disparities between different groups, and here are a few key findings.

“Outcomes for women are not equal. There remain gaps in mortality rates between women from different areas, women of different ages and women from different ethnic groups. This year’s report shows a continued gap between the mortality rates for women from Black, Asian, mixed and white ethnic groups.” (Knight et al 2020: 1)

“These figures [on race disparities] are fundamentally unchanged from those documented in the 2019 report.” (Knight et al 2020: 1)

“This represents a non-significant reduction from the five-fold difference reported last year,” while “an overall tendency showing the inequality gap is increasing.” (Knight et al 2020: 13)

The report shows that other inequalities are growing as well.

“Women living in the most deprived areas are almost three times more likely to die than those who live in the most affluent areas. The number of women who are known to be experiencing multiple disadvantages when they die has increased by a third since the last report, from 6% to 8%. Women in these situations will often face mental ill-health, domestic abuse and/or misuse substances. However these and other issues are poorly recorded, so these figures should be treated as a minimum estimate and warrant urgent further enquiry.” (Knight et al 2020: 13)

A few questions and things to consider

I want to offer just a few notes, particularly for those who won’t be reading the report in full, or who want to read the report but would like a bit of a guide as to how to interpret and think about the data it contains.

The report does shows that, in 2016-2018 that Black women were 4.35 times as likely to die than white women. But, as I have noted above, this figure is “fundamentally unchanged” from the previous report (Knight et al 2020: 1) The report authors have stressed this, as I have noted above. The previous MBRRACE-UK: Saving Lives, Improving Mothers’ Care report (Knight et al 2019) showed that Black women were five times more likely to die in childbirth than white women. The 2020 report shows that this figure has gone down to 4.35. But the reports’ authors found this to be a “non significant difference”. What does that mean? Well, when you’re working with what are thankfully relatively rare events amongst large numbers of people, the addition (or subtraction) of just one or two incidences of something can make the numbers look quite different when actually they’re not.

This report doesn’t include the data on what has happened during the pandemic. We know that the pandemic has disproportionately affected Black and Brown people. See here for more on COVID, pregnancy and birth. The 2020 report also can’t tell us about the effect of recent changes, or whether recent campaigns have made any difference, because it reports on data relating to births that happened between 2016 and 2018. It always takes a while to collect, analyse and write about data. So, while it is positive that we recognise an increased awareness and the changes that have been made, as the authors note, this is something that we are going to need to pay attention to for a good few years yet. Settle in for a long ride.

Dig into the data

We need to remain aware that the way in which race is classified in these reports has changed over the years. And that research like this is based on medical and maternity records. That’s important, because records are only as accurate as those who record (or don’t record) things on the day. Mistakes are inevitable. This is by no means intended as a slight against midwives, doctors and other caregivers. It’s just reality. In the real world, especially when things are busy, data sometimes get entered incorrectly.

Don’t be afraid to ask questions of reports, and to dig into the data. One thing that I will be looking more into is a note on table 2.11 on page 15 of the report. This is the table that gives the figures for the relative differences between groups. It shows that, if someone’s ethnic group wasn’t known, they were classed as white. From a statistical perspective, I can understand why that was done. But if the outcomes of a number of Black, Asian or mixed race women were put into that group because data were lacking in their notes, the difference between white women and women from other backgrounds might be even greater than the current figures suggest.

The researchers aren’t the problem either, by the way. They can only work with the data that’s in people’s notes, and with the standards that are in place. There’s no conspiracy in the data here. Just things to be aware of as we work together to try to understand and change this problem.

The researchers themselves highlight this very point in their summary.

“There is an overall tendency suggesting that the inequality gap is increasing with a number of the RRR increasing from the comparison between 2012-14 and 2015-17 presented in last year’s report (Figure 2.6). As noted in 2018 and 2019, further research is needed to fully understand the reasons for these disparities and hence to develop actions to address them.” (Knight et al 2020: 13)

Indeed.

A better way

I want to make one last point. The outcomes of the Albany midwifery practice demonstrate that poorer outcomes for Black and Brown people are not an inevitability. In research into the Albany model, 57% of the women whose data were included in this study were from Black, Asian and Minority Ethnic communities, and the data from this study shows that good midwifery care can make even more of a difference to these women. But this will require the commitment and change from a government that has, thus far, done very little to help those experiencing inequality.

The report and summaries can be downloaded here.

I’ve written more on these issues here.