MBRRACE-UK (a project run by a multi-disciplinary research team based at Oxford University) have published their annual report on the death of babies before, during or soon after birth.
The MBRRACE-UK team also published the 2020 report which highlighted that Black women are five times more likely to die in childbirth than white women.
Their latest report, which was published in mid-December 2020, highlights yet more disparities for Black and Brown people.
The 2020 Perinatal Mortality Surveillance report
There are a couple of important things to know before I discuss the report itself. First, the 2020 Perinatal Mortality Surveillance report actually publishes and analyses details of cases from 2018. That’s because it always takes a while to gather, organise, analyse and write about data. It will take a couple of years to see the real effects that the current pandemic is having on these figures.
Let me also share a couple of key definitions so that you’ll know how researchers define the terms that they are using.
A stillbirth is defined as a death that occurs before or during birth once a pregnancy has reached 24 weeks.
A neonatal death is defined as a baby born at any gestation who lives, even briefly, but dies within 4 weeks of birth.
When we add the numbers of both of these groups of babies together, the researchers use the term “extended perinatal mortality.”
The 2020 findings
The 2020 report shows that, overall, extended perinatal mortality has decreased by 15% between 2013 and 2018. That is being hailed as good news by some people, but stark disparities are highlighted by the same data.
As the report’s writers note,
“Black and Black British, and Asian and Asian British babies are up to twice as likely to be stillborn or die neonatally. Rates of death are falling more slowly among these babies compared with White babies, suggesting national safety initiatives are failing to reach many women from higher risk ethnicities.” Draper et al (2020)
This isn’t the only disparity that the report highlights.
“The connection between risk and poverty is also clear, with women living in the most deprived areas at an 80% higher risk of their baby dying. These disparities are stark and unacceptable, yet they have been known about for years.” Draper et al (2020)
The report’s authors make a number of recommendations and conclude that, “Investment is urgently needed in new programmes that address the needs of pregnant Black and Asian women, ensuring the delivery of care is personalised and tailored to the needs of every woman and baby. Given the economic impact of COVID-19, the imperative to provide joined-up support for women from poorer households through pregnancy, birth and early parenting, is ever more urgent.” Draper et al (2020)
I wish I felt confident that new programmes were the answer. But I’m sceptical. The current UK government and those who organise the maternity services are not known for being responsive to the needs of women, babies and families. This year marks thirty years since I became a student midwife, and I tell you that only because it puts into context my observation that some of the issues that we were trying to address then – around choice, control and continuity – are still just as problematic today. Yes, some areas of the world are markedly better than others. But bodily autonomy is still an issue. Coercion and paternalism still exist. Conveyor belt care remains the experience of many. There is a gulf between the rhetoric and the reality.
We have a multitude of recommendations and action points, both in relation to maternity care, health care, racial disparities and many related issues. At the time of writing this blog post, for example, the Grenfell recommendations have still not become law. And successive recommendations to improve maternity care for all remain unimplemented. It would be lovely to think that new programmes will make a difference, and that I will not be writing a similar blog post this time next year. But, having seen what has happened to many of the women who I am in touch with during the pandemic, I’m not holding my breath.
Just so those of you who do your annual updates with me in our online courses know, I’m including a section called, “We need to talk about race” in this year’s Gathering in the Knowledge 2021 course. Not because I’m any kind of expert. Certainly not because I think I have gone far enough in my own learning on this topic. Far from it. But because we do need to talk about race. And keep talking about it. And then doing something about it. Until we no longer see results like this every time a perinatal or maternal mortality report comes out.
Draper ES, Gallimore ID, Smith LK et al, on behalf of the MBRRACE-UK collaboration (2020). MBRRACE-UK Perinatal Mortality Surveillance Report UK Perinatal Deaths for Births from January to December 2018. Oxford: National Perinatal Epidemiology Unit.