Maternal mortality report prompts outcry from all sides

[NOVEMBER SAW THE PUBLICATION of the MBRRACE-UK Saving Lives, Improving Mothers’ Care 2022 report, which looks into the care of women who died during or up to one year after pregnancy between 2018 and 2020 in the UK.

MBRRACE-UK is a collaboration appointed by the Healthcare Quality Improvement Partnership to run the national Maternal, Newborn and Infant Clinical Outcome Review Programme which continues the national programme of work conducting surveillance and investigating the causes of maternal deaths, stillbirths and infant deaths.

The latest report shows stark and widening inequalities linked to poverty and disadvantage. It highlights the fact that women living in the most deprived areas are more than twice as likely to die than those in the most affluent parts of the country. Ethnicity-linked disparities remain stark, but they have narrowed since the previous report.

Reporting on the findings, the charity Birth Companions said: “One in five (20%) of the women who died had involvement from social services, a marker of high levels of vulnerability and trauma. More than one in ten (11%) were recorded as experiencing ‘severe and multiple disadvantage’ based on available data on issues such as a mental health diagnosis, substance use and domestic abuse. This is, as the report states, ‘known to be an underestimate… due to poor data collection on these and other factors’.”

The leading direct cause of death is suicide, which has risen three-fold since 2017-19 among women who are pregnant or within six weeks of a pregnancy ending. Severe mental health issues were a factor in 40% of the deaths between six weeks and a year after pregnancy.

Speaking for the Royal College of Obstetricians and Gynaecologists, its president-elect Dr Ranee Thakar said: “The results of today’s report are worrying, especially the increase in maternal deaths and the increasing impact mental ill health has on mortality rates: 86% of women died in the postnatal period. The report highlights that actions to improve outcomes need to be focused on postnatal care and holistic support in the first year after birth, as well as during pregnancy.

“It is also clear from the report that disparities in society have a clear impact on the likelihood of mortality, with those from more deprived areas being twice as likely to die as women in the wealthiest areas, and only a small decrease in the higher risk of maternal mortality for black and Asian women compared with their white counterparts.”

According to the Royal College of Midwives (RCM), the ‘statistically significant’ increase in maternal deaths is a tragic indication of a lack of government investment in maternity services.

Gill Walton, chief executive of the RCM, said: “Any rise in maternal deaths, however small, is deeply worrying and we are moving backward not forward. Governments must focus efforts on the crucial areas where women are being let down and not getting the care they deserve and should expect.

“They cannot expect services to keep robbing Peter to pay Paul. This is having disastrous consequences for women and families and is impacting staff. We have overstretched midwives and maternity services that have been trying to do too much, with too little, for far too long. This should be a time of great joy for women and families, but tragically for some, it is a time of heartbreak. For all of us, women and their needs should come first and be right at the heart of everything we do.

Dr Ranee Thakar added: “Recognising inequalities is a first step to understanding and challenging the social, economic and political contexts that inform the way we all live our lives and the health choices we make, and we continue to call on the UK Government to commit to a time-specific target to reduce maternal inequities to drive urgent innovation, improvement and investment.” q