Black Maternal Health Awareness Week

[Gill Furniss in the Chair]

I beg to move,

That this House has considered Black Maternal Health Week 2025.

It is a pleasure to serve under your chairship, Ms Furniss. Before I get to the crux of this debate, I want to begin by saying that the UK is one of the safest countries in the world for a woman to give birth. I say that at the outset not to diminish the importance of this debate, but to move beyond that platitude—because in the sixth largest economy in the world, this should be one of the safest places to give birth. It is important that we move beyond that and focus on the real and persistent inequalities facing black and minority ethnic women in maternity care. While I am sure it is not the intention to focus on that, it can give the impression that, because the UK is broadly safe, the negative experiences of some women are exceptional and not matters that require significant Government attention. When we detail some of the harrowing experiences of women and hear that response, it can feel as though our concerns are being minimalised, so I hope the Minister will appreciate that I have got that part out of the way. While the UK is among the safest places to give birth, it is by no means perfect, and for many women it is deadly. As always, it is vital to lay out the current state of affairs.

The disparities in maternity care are evident not only in maternal mortality statistics, which show that black and mixed heritage women are three times more likely to die during pregnancy or childbirth as white women, and Asian women twice as likely, but in many other areas. Miscarriage rates are 40% higher in black women, and black ethnicity is now regarded as a risk factor for miscarriage. MBRRACE-UK’s 2023 comparison of care for black and white women who have experienced stillbirth or neonatal death found that the majority of all significant issues were identified in antenatal care for 83% of black women, compared with 69% of white women; 67% of black mothers and babies had a major or significant issue related to pathology, compared with 46% of white mothers and babies; and 75% of black parents and 66% of white parents had significant issues identified during the follow-up or reviews of their and their baby's care.

Public Health England’s 2020 report found that prematurity is a major cause of long-term infant morbidity. Black mothers, particularly those of black Caribbean background, are twice as likely to give birth before 37 weeks. In Five X More’s “Black Maternity Experiences Report 2022”, 27% of the 1,340 survey respondents felt that they received “poor” or “very poor” care during pregnancy and labour, and postnatally. Forty-two per cent of the standard of care during childbirth was “poor” or “very poor”, and I sincerely hope that the findings of Five X More’s next survey, which is currently under way, will show some improvement here.

According to Bliss, many babies born to black mothers require specialist care after birth, particularly due to preterm birth or full term complications, yet significant inequalities persist in neonatal care, admissions, the quality of care received, and outcomes after discharge. Poor care received at such an early stage of life can have critical consequences and lead to long-term health complications for black babies and deepen trauma for their families. Post-natal mental health disparities are also significant; UK studies show that women from black, Asian and minority ethnic backgrounds are more likely to suffer from common mental health disorders, yet are less likely to access treatment.

The Caribbean and African Health Network CIC report reveals that the perinatal mental health services lack spaces where black women can feel safe, seen and supported. Does my hon. Friend, and indeed the Minister, agree that more inclusive, high quality and personalised care is required to meet the needs of all women in maternity care?

I thank my hon. Friend for his intervention; he is absolutely right. I re-emphasise the point that black, Asian and minority ethnic women are more likely to suffer from common mental health disorders, yet are less likely to access treatment. According to MBRRACE-UK’s “Saving Lives, Improving Mothers’ Care” report from last October, deaths from mental health-related causes accounted for 34% of deaths occurring between six weeks and a year after the end of pregnancy. It is vital that all those who experience pregnancy and childbirth receive mental health support, even if they do not necessarily present as struggling with their mental health; but that is especially true of black, Asian and minority ethnic women, who are more likely to have a negative experience during pregnancy and childbirth. Some of these women’s experiences are deeply traumatic and scarring, and can lead to several mental health problems. Despite that, they are less likely to access mental health support, so they are left to try to recover mentally from the experience on their own.

That disparity exists beyond pregnancy and childbirth, and even before conception. According to the Human Fertilisation and Embryology Authority, black women are 25 times less likely to access fertility treatment, and NHS-funded in vitro fertilisation cycles among black patients decreased from 60% in 2019 to 41% in 2021. Black and Asian patients aged 18 to 37 had the lowest IVF success rates compared with white patients in 2020-21, and non-white groups also struggled to access donor eggs, with 89% of egg donors being white, 4% Asian, 3% of mixed heritage and only 3% black.

During the International Women’s Day debate, I highlighted the latest MBRRACE-UK data, which showed a statistically significant increase in the UK’s maternal death rate in the years 2020 to 2022, even when excluding deaths caused by covid-19. Put plainly, more women and babies of all races are dying in the UK now than in the past two decades. This is incredibly worrying, and it means that black women, who often face the worst care, are likely to experience even further deterioration.

I thank my hon. Friend for securing this important debate. Given the complexities and interchangeable disparities that affect maternal health for black women, does she agree that without a national target or framework we are doomed to make the same mistakes again and again? This travesty needs to end, because no mother or child’s health outcome should be determined by the colour of their skin.

My hon. Friend is absolutely right. These figures have been circulating for decades, but it was only after a successful parliamentary petition launched by Five X More that we first debated them in the House. We are now five or six years on and we are still in the same situation. Things have to change.

I will continue to pay tribute to the amazing groups that have been pushing for decades to put the issue on the agenda. Mimosa Midwives is another remarkable group that offers culturally safe, continuous maternity care. It campaigns for a culturally appropriate care model in the NHS and for inclusive training in midwifery education to reflect diverse maternal experiences, because much of our medical training remains centred on white women.

The Motherhood Group is a social enterprise supporting black mothers with peer-led services, training workshops and national campaigns. Its annual black maternal health conference brings together researchers, clinicians and service users to tackle disparities. It also launched the Blackmums app to connect mothers navigating similar challenges.

Other charities such as Bliss, Tommy’s, Birthrights and the Royal College of Midwives also highlight racial disparities in their broader efforts to improve maternity care. Where the Government and the NHS have fallen short, they have taken the time to campaign and to step in.

I will, however, acknowledge the positive steps that the new Government and the NHS have taken. In response to my written parliamentary questions last month, the Government outlined some ongoing measures. Every local maternity system must now publish an equity and equality action plan that sets out tailored actions to reduce disparities, especially for ethnic minority women and those in deprived areas. I welcome the roll-out of version 3 of the Saving Babies’ Lives care bundle, which aims to reduce stillbirth, neonatal death, pre-term birth and brain injury.

Maternal medicine networks are being established to ensure equitable access to specialist care for women at heightened risk. Those efforts are supported by the NHS equality, diversity and inclusion improvement plan, which was launched in 2023. That plan requires NHS organisations to tackle workforce discrimination, improve leadership accountability and foster an inclusive, harassment-free environment. I am also pleased to note that NHS England is developing a respectful and inclusive maternity care toolkit to support inclusive and culturally competent practice. Those are all really welcome developments, but much more is needed.

It is a pleasure to serve under your chairship, Ms Furniss. I congratulate my hon. Friend the Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) on securing today’s important debate. She has highlighted that black women often receive a worse standard of care and that their risk of maternal death is three times higher than for white women.

The situation in Nottinghamshire demonstrates why change must happen quickly. As some in the Chamber will know, there is currently an independent review into maternity services at Nottingham University Hospitals NHS trust, led by Donna Ockenden. I first called for this review when I was a councillor after my experience of giving birth to my son in 2020. I knew then, as I know now, that women accessing services at NUH do not always receive the care they deserve, nor are they listened to when they raise concerns. Ahead of today’s debate, I reached out to Donna Ockenden and her team for their perspective on black maternal health in Nottinghamshire so that I could highlight it here today.

When the Donna Ockenden review was established in Nottingham two years ago, the Nottingham University Hospitals trust could not share a single named contact within the black community, nor did the trust have any meaningful engagement with the many groups across Nottinghamshire. It had no way of reaching into groups of black women who might have been affected by poor maternity care. The translated resources provided by the trust were also very limited. It is therefore unsurprising that trust between black communities and Nottingham University Hospitals trust was at an all-time low.

As Donna Ockenden rightly emphasised to me, that only increased the risk that women and their families would disengage from vital health services and be unable to give informed consent to treatment through their maternity programme. I am pleased to say that the review’s work so far is leading to some improvements in the NHS, and I believe it is important to acknowledge that progress even if there is still so much further to go.

I congratulate the hon. Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) on securing today’s important and timely debate, following Black Maternal Health Awareness Week earlier this month. Her opening remarks were comprehensive and thoughtful. I am always pleased to hear from the hon. Member for Sherwood Forest (Michelle Welsh), who is a passionate advocate for improved maternity services in Nottingham and across the UK; I am pleased to serve on the APPG with her at the helm.

Women are at their most vulnerable during pregnancy, as they carry another human life, and they deserve the very best care. They have more touchpoints with the NHS than they will have for most of their lives. We engage with the NHS when we are born and when we need to access care at the end of our lives. When we are carrying a child, we have more moments in front of medical professionals than for the majority of our lives.

Following its inspection of 131 maternity units, the Care Quality Commission found that 65% were not safe for women to give birth, 47% required improvement on safety, and 18% were inadequate. The commission warned that it is concerned about the potential normalising of serious harm in maternity care. Those risks are particularly stark for women of colour in this country, for whom pregnancy continues to carry an unacceptable level of danger. As the Darzi report highlighted, black women are almost three times as likely as white women to die during childbirth, while neonatal mortality among the most deprived quintile is more than double that among the least deprived. That is nothing less than a national scandal.

Maternity care is an issue close to my heart, having had two very different experiences giving birth in my local hospital in Chichester. I tabled an early-day motion on maternity care and secured a Backbench Business debate in this Chamber on that subject just two months ago. Like the hon. Member for Sherwood Forest, I am in regular contact with Donna Ockenden, who produced the Ockenden report. Her findings, along with those of Dr Bill Kirkup, show that the problems identified at the Shrewsbury and Telford trust and the East Kent trust are not isolated incidents. The same issues are systemic and widespread across many NHS trusts up and down the country.

It is a pleasure to serve under your chairmanship, Ms Furniss. I, too, congratulate the hon. Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) on securing this important debate today. As she said in her opening speech, the UK enjoys some of the best outcomes in the world when it comes to maternity health, but there is always more work to be done to improve our outcomes further. I hope we can all agree that equal access to the best care, for all across our society, should always be our target. That should be based on excellence across the board as standard.

We are considering Black Maternal Health Awareness Week, which is part of National Minority Health Month, and I welcome the opportunity to discuss this topic and exchange views with colleagues from across the House. Colleagues will know that as a clinician myself, I am always guided by data when assessing current healthcare practices and new policy proposals. A 2023 report by the maternal, newborn and infant clinical outcome review programme found that in the period from 2019 to 2021, 241 UK women died during pregnancy or up to six weeks after the end of pregnancy. That equates to a rate of 11.7 women per 100,000 giving birth. Each of those cases represents a tragedy for the woman and baby involved and their family and loved ones, and we must do all we can to prevent them.

The data does, as has been mentioned, also show that women from black backgrounds face a mortality rate much higher than the average; it is equal to 37.2 per 100,000. Women from Asian backgrounds also face a higher rate, at 17.6 per 100,000. Clearly, those figures present a pretty stark picture, but we must exercise care in the interventions that we make, and balance our desire to solve the problem with ensuring that we do that in a way that resolves the problem without risking creating others.

At the outset, it is crucial to ask what the Government are doing to understand the specific causes of these outcome disparities, because if we understand the causes, we will be better able to manage and treat them. The Kirkup and Ockenden reports have already been mentioned. What are the Government doing to ensure that those recommendations are fully implemented, and to develop a strategy to ensure that all women have the opportunity for a safe pregnancy and birth? What kinds of data held by the NHS and the Department of Health and Social Care might cast light on other demographic, economic or geographical patterns that contribute to these numbers, which we may be able to help to resolve?

I just want to check whether the hon. Lady understands that structural racism is about not the number of people within an organisation, but the way the organisation is set up and treats different people. Does she understand that having a high proportion of ethnic minority people does not necessarily mean that an organisation such as the NHS—which, I might add, in its senior levels is run by people mostly not from ethnic minorities—does not discriminate against people in a certain way?

I understand the hon. Lady’s point. I do not dispute that some women, men, boys or children have awful experiences at the hands of bad apples. That will happen within any organisation of that size—the NHS employs more than 1 million people. That is wrong and should be rooted out; it is absolutely clear that that should stop. However, I work in the national health service, and I think the vast majority of people who go to work in it do so to care for the patients in front of them as best they possibly can. Care should be provided on the basis of clinical need and should not be affected by the ability to pay or by any other socioeconomic, ethnic or other demographic data. Although I accept the point that some individuals will have experienced poor care, which is reprehensible, I do not think that is the majority situation by quite some margin. I think most people receive extremely good care in the NHS, and care that is delivered on the basis of their clinical need, not the colour of their skin.

Does the hon. Lady accept that, given that she is not of an ethnic minority and has not looked at the information given by a number of women from ethnic minority backgrounds who have experienced this, she is not really in a position to say that what they say they experienced does not exist?

That is not what I said.

I am just challenging her point. Just because for one or two reasons she may not have seen any institutional racism in the NHS, that does not mean it does not exist. Further, the figures for black maternal mortality are the same in the United States, which has a completely different healthcare system from ours, but they are not the same in countries in Africa or the Caribbean, where black women are the majority. Does she see why that can point only to institutional racism? It is a completely different healthcare system in United States. The only difference is that we are both living in societies where institutional racism is known to be a problem.

I think we can both agree that any examples of racism are reprehensible and should be rooted out and that, in the examples given, people are speaking truthfully of their perceptions and what they have experienced. No one is denying the experiences of individuals or groups who have experienced poor care and that that poor care should stop. I just do not think that that suggests the NHS itself is a racist organisation, because I do not believe that it is. That is our point of difference. I think the staff who work in the NHS are overwhelmingly not racist. They want to care for people on the basis of clinical need to the very best of their ability, regardless of any ethnic minority status.

I did not say that the people in the NHS are racist; I said the NHS has a problem with institutional racism. I hope the hon. Member will accept that there are distinctions between those two things.

I think we have both made our positions clear. I accept that some people will have received poor care and that the people who delivered that poor care need to be hauled over the coals. They need to be called out for what they have done and we must ensure that such care does not happen again. But I do not accept that the NHS is a racist organisation.

Another issue is language barriers. It is well recognised that it is difficult for people who have a language barrier to access health services. Can the Minister tell us what the Government are doing to help with that? In recent years in my medical career I have seen improvements in the delivery of language services, but when I was a more junior doctor an appointment needed to be booked in advance and an interpreter had to attend in person. Sometimes they were available and sometimes they were not. Sometimes other members of staff or family members would be used to interpret, which is a poor standard of care, relatively speaking.

Is it possible for the hon. Member to highlight what part of the NHS she worked in? The reported experiences of interpretation and translation nationally are very different from what she is describing, which does not reflect the factual accounts and certainly does not reflect what has been happening in Nottinghamshire.

I did the junior part of my medical career in Nottinghamshire. I am describing what happened in the junior part of my career, which is about 20 years ago now. My experience 20 years ago was that it was very difficult to get interpreters, and that the people used to interpret were not proper interpreters and not the appropriate people. That should not be happening.

The service is still not perfect, but over time we have seen translation services improve. Many hospitals have instituted new iPad systems where one can choose a country of origin or the language that the person speaks, and a dial-up system of interpreters working from home is used to provide an interpreting system. That is much better—it is more available to the patient than the services we had in the past, which required someone in person—but it is still not perfect. We still see areas across the country where those services and that interpretation are unavailable to people. How will the Minister ensure that women who have difficulties with the English language are able to access interpreters when they need them—not just for appointments, but for out-of-hours emergencies? That is when interpreters are most difficult to obtain, particularly for languages spoken by fewer people in the United Kingdom.

I want to ask about the Government’s plans. The previous Government instituted a three-year plan, which comes to an end next year. When will the Government produce the plan? They talked about their 10-year NHS plan, which they said they would produce in the spring. I believe we are in the spring now—if we look outside, it is a beautiful day; the flowers are out and the lambs have been born. Where is the plan that the Government promised? What targets are they going to set, and when, to improve maternity care for all women, and specifically for black women?

It is a pleasure to serve under your chairmanship, Ms Furniss. Before I begin, I thank my hon. Friend the Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) for securing this important debate during Black Maternal Health Awareness Week. It is so important that we raise awareness of the disproportionate challenges faced by black mothers during pregnancy and after childbirth; debates in weeks such as this are critical to that.

I want to pay tribute to the charities that do so much vital work in this space: the Motherhood Group, Five X More, Black Mums Upfront, which is part of Bliss, and Ebony Bonds, to name just a few. I am taking this debate on behalf of the Minister for women’s health and patient safety, Baroness Merron. I also want to thank all hon. Members for their contributions to this debate. I will seek to pick up and answer all their queries, but if they feel I have not done so by the end of the debate, I ask them to please get in touch and I can ensure we respond.

I want to thank the charity Sands for shining a spotlight on some of the most heartbreaking cases of baby loss in the UK, and for giving a voice to so many black and Asian women who have gone through the nightmare of losing a child. One such case was Amber Lincoln from Woolwich in south-east London. She was miscategorised as low risk when she was pregnant, and nearly died from undetected complications after her delivery. A series of individual and systemic failings led to cancellations and delays, and her twins, Anaya and Mael, were born and died at 22 weeks in November 2022, before she could access the care she needed. Amber said:

“If the NHS just listened to me. And just put my appointment through when I was constantly asking. If they had the notes there properly I wouldn't have been treated that way.”

She said the fact she was mixed race led midwives to focus on diabetes and high blood pressure rather than other high-risk indicators. I wish I could stand here and say that Amber was an isolated case, but her story will sound familiar to black women up and down the country, and it shows in the figures. The latest data from MBRRACE-UK shows maternal mortality rates for women from black ethnic backgrounds are more than double those for white women. Black women and their babies are also at higher risk of stillbirth, neonatal death and miscarriage. That should shame us in modern Britain.

Will the Minister give way on that point?

I will finish what I am saying and then I will give the shadow Minister an opportunity to come back to me.

To clarify, this work is not only about the behaviours that we must tackle in the NHS; it is also about the systems that we create in the NHS and ensuring that those systems do not consciously or subconsciously discriminate against people on the grounds of their race. That is what we mean and that is why we are putting in place training for leaders in our maternity units. We will ensure that they are signed up to the perinatal culture and leadership programme, to ensure that those systems are as equitable as they possibly can be.

I thank the Minister for giving way. I think we all agree that racism is wrong and must be weeded out wherever it happens. Could she say, in answer to the question posed by the hon. Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) at the beginning of her speech, whether she believes that the NHS is structurally racist?

The shadow Minister will know that that is not actually the question that my hon. Friend asked. She asked about systemic racism. We recognise that racism and unconscious bias can play a part both in the behaviours of some people, which must be tackled, and in the way that systems are structured. That is why the training that we are introducing will help to tackle racism. It is not necessarily the case that there is racism throughout the NHS, but we must do everything we possibly can to make sure that NHS systems are as equitable as they can be.

I thank the Minister for giving way again. I confess that I thought I heard the hon. Member for Clapham and Brixton Hill say “structural”. However, if the word she used was “systemic”, does the Minister think the NHS is systemically racist?

I think that we have to do everything possible to make sure that all the systems in the NHS are as equitable as possible.

We have set clear expectations for escalation and accountability through the three-year plan, and all 150 maternity and neonatal units in England have signed up to the perinatal culture and leadership programme. We are supporting staff to hold up their hands when things go wrong through the Freedom to Speak Up initiative. Our approach to tackling inequalities in maternity and neonatal care must be underpinned by evidence, research and—critically—working with women and their families. As my hon. Friend the Member for Sherwood Forest (Michelle Welsh) pointed out, it is crucial that women’s voices, including black women’s voices, are heard.

My hon. Friend the Member for Clapham and Brixton Hill mentioned funding for research. The National Institute for Health and Care Research has launched a £500 million funding call that challenges researchers and policymakers to come up with new ways of tackling maternity inequalities and poor pregnancy outcomes. The NIHR has also invited applications for funding of up to £500,000 for a research project to understand how biases in medical devices used during the pregnancy and neonatal period might be contributing to inequalities for women and babies.

NHSE is working closely with the NHS Race and Health Observatory on the outputs of the learning and action network programme, which aims to address inequalities for women and babies from black, Asian and other ethnic minority backgrounds. Local maternity and neonatal voices partnerships bring together the voices and experiences of women and families to improve maternity and neonatal care. More than a quarter of the partnership leads are from ethnic minority groups. Women’s voices must continue to be at the heart of our improvements to care.

I will be frank with colleagues: although the measures I have set out are important, I do not believe they will be enough to meet the scale of our ambitions. The Government are committed to ensuring that all women and babies, regardless of their ethnicity, background or location, receive the high-quality, equitable care they deserve. Many of these initiatives began under the previous Government, and although there has been some progress across maternity and neonatal care—for example, good progress has been made in reducing the number of stillbirths and neonatal deaths—we have much further to go to improve care and tackle inequalities.

The Minister talks about the importance of setting an achievable target and working on how it will be delivered, but the Government have now been at this for 10 months, and it was a manifesto commitment. Will she at least commit to a date by which it is likely to be set? Nothing will happen until there is a target and a plan. The Government are spending time deciding when to make a target, and all the while women are waiting.

We are working at pace, ensuring that what we do is right and that it is achievable. The shadow Minister will be aware that the Government are developing a 10-year plan for health, and women’s health, including maternity health, will be at the centre of it. We want to ensure that whatever we put in place dovetails with all the other interventions and actions that the Government are putting forward.

The areas identified for intervention so far include the improper management of existing conditions, racism and discrimination, and access to care. We are clear that we want to see innovative and high-impact ideas that will shift the dial. We want to make sure not just that we are coming up with some sort of plan, but that it can be delivered and will be impactful.

Let me assure my hon. Friend the Member for Clapham and Brixton Hill that this issue keeps us up at night. I know that she will continue to hold us to account. I began my speech by referencing Amber’s story. She asked how she could put her trust in a system that let her down so badly, and I completely understand why she felt that way. It is our duty to make sure that women like Amber can trust the system with something as precious as their children, and to prevent what should be one of the most joyful days in their lives from becoming a tragedy.

I thank all Members present in this afternoon’s debate for their thoughtful and balanced contributions. It is not very often in the House that we are generally in agreement, so I am heartened to be joined by Members from different political backgrounds calling for us to improve the state of maternity care.

I was grateful for the intervention from my hon. Friend the Member for Manchester Rusholme (Afzal Khan), who talked about the lack of spaces where black women feel supported and the importance of increasing those for all women in maternity care. My hon. Friend the Member for Croydon East (Natasha Irons) pointed out the need for a national target and framework to challenge these issues. My hon. Friend the Member for Sherwood Forest (Michelle Welsh), the chair of the APPG on maternity, gave a fantastic speech on the significant concerns about the quality and safety of maternity services in the Nottingham University Hospitals Trust. She made very important points on tackling the underlying issues of culture within the NHS. I was also pleased to hear the Liberal Democrat spokesperson, the hon. Member for Chichester (Jess Brown-Fuller), rightly pointing out that this disparity is a national scandal. We are at risk of normalising these issues, and it is so important that we continue to challenge them. Although I do not agree with the shadow Minister on much, she made a very good point about language services.

I thank the Minister for her response and for detailing the steps that the Government are taking to tackle this. I know that the Government have committed to setting a target to end racial disparities in maternity care, and I was pleased to see it as a manifesto commitment, but at times, it can feel as though the issue is being kicked into the long grass, as the target has not yet been set. We are looking forward to that, and there are several campaigns watching the debate this afternoon that will have rejoiced when they heard that the Government have committed to setting a target. Like me, however, they continue to wait in eager anticipation to hear what it is. I hope the Minister will take that on board, and that we will not wait too much longer for the target to be announced.