On a point of order, Mr Gray. I do not want to take too long on my point of order, but I thought it would be helpful for the Chamber to note the fact that it is Wednesday morning and that we are delighted to be here for this debate secured by the hon. Member for Streatham (Bell Ribeiro-Addy). I suspect that the hon. Lady will have quite a lot to say over the course of the morning, and I am just keen to ensure that we are all ready to take part in the debate.
James Gray (in the Chair)
That is very gracious of the hon. Gentleman. It is not actually a point of order. None the less, I am grateful to him for saying it. I think the hon. Member for Streatham has nearly caught her breath, in which case I would like to call her to speak.
On a point of order, Mr Gray. Obviously, this is a subject matter of much importance, and we should be aware of that. I am sure that the shadow Minister and the Minister are preparing copious replies for the hon. Member for Streatham (Bell Ribeiro-Addy), after she has had a chance to address this really important matter. Mr Gray, you and I and everyone else in the Chamber understand that this debate is vital. Perhaps the hon. Member for Streatham is now ready.
James Gray (in the Chair)
Again, that is very creditable of the hon. Gentleman, but it is not a point of order. It is worth recording that the hon. Gentleman has made known to me that in this particular debate, uniquely, he does not intend to speak. This is the first occasion I can remember chairing a debate in Westminster Hall when we did not benefit from his words of wisdom. We note that, and we are grateful to him for being here. We now come to the debate on Black Maternal Health Awareness Week, and I call Bell Ribeiro-Addy to move the motion.
That this House has considered Black maternal health awareness week.
Thank you very much, Mr Gray; it is a pleasure to serve under your chairmanship. I thank my colleagues for their kind points of order. I am thankful, as always, that this debate has been awarded, so that we can once again have this vital discussion about the issues surrounding black maternal health.
Whenever I discuss black maternal health, I always take time to repeat the statistics around black maternal mortality. The reason I do that is twofold. First, the statistics are harrowing, and it is only by confronting them that we can truly begin to address the issue. Secondly, the statistics have not changed at all—the findings that I repeat have not improved, despite this issue having been raised for a number of years. I know that it may take time before we see a real change in statistics, but the Government are yet to introduce any meaningful measures that give us confidence that the statistics will change any time soon. Most notably, they will not even look at producing a target.
I repeat it for everyone who may not have heard that black women are four times more likely to die in pregnancy or childbirth, women of mixed heritage are three times more likely to die in pregnancy or childbirth, and Asian women are twice as likely to die in pregnancy or childbirth. Black babies have a 121% increased risk of stillbirth and a 50% increased risk of neonatal death. Asian babies have a 55% increased risk of stillbirth and a 66% increased risk of neonatal mortality. Black women have a 43% higher risk of miscarriage, and black ethnicity is now regarded as a risk factor for miscarriage.
The last time we had this debate, one of the key themes that kept coming up was data, whether it was Members such as myself raising the fact that the data exists and research has been done—we just need the Government to engage with it—or the Minister who responded, the right hon. Member for Mid Bedfordshire (Ms Dorries), stating that black women are under-represented in the Government’s data. I am pleased to say to the Minister responding today that there is now even more research out there.
I am pleased that the hon. Lady has brought this debate to Westminster Hall, and although there might not be big numbers here today to discuss the matter, it is of great importance. Does she not agree that health trusts, which she has referred to, must ensure that no matter the level of the black, Asian and minority ethnic population, staff are adequately trained to deal with the differences with respect to different ethnic groups? Does she further agree that the messaging that comes from the Minister and the Department in this debate is the most important tool that health trusts have to ensure that women of all ages and all ethnic groups are clearly understood and supported, no matter where they are and no matter what the statistics and numbers may be?
I thank the hon. Member for his intervention, and he is absolutely right. I will come to training soon enough, and to what I believe individual trusts should be doing.
In addition to the Five X More report, Birthrights has recently published the findings of its inquiry into racial injustice and human rights in maternity care. The report uncovers the stories behind the statistics and demonstrates that it is racism—not broken bodies, as we are often told—that is the root of many of the inequalities of maternity outcomes and experiences. The study found that on a number of occasions, black women’s safety was put at risk while they were receiving care. They were ignored or their pain was dismissed, and they experienced direct or indirect racism from care givers. They were subject to dehumanisation. Their right to informed consent was violated and they faced structural barriers to receiving healthcare. Those women were going through one of the most painful experiences of their lives—one that can leave them at their most vulnerable—yet they faced institutional racism that impacted their health and the health of their babies.
During a debate on this subject last year, I called on the Government to launch an inquiry into institutional racism and racial bias in the NHS, as well as in the field of medical education. I reiterate that call today and hope the Minister will address the issue of systemic racism in medical care.
In addition to those two reports, the Muslim Women’s Network recently published a study that reviewed the experiences of Muslim women in maternity care. The report encompasses the maternity experiences of over 1,000 Muslim women, and it once again revealed that a huge proportion of respondents received poor or very poor quality care. There are many examples of substandard care by health professionals, such as dismissing concerns and, again, pain; not offering treatment to relieve symptoms; inconsistency in the way that foetal growth was measured; substandard clinical knowledge; and vital signs being missed, which contributed to poor healthcare.
They are a standard part of government, but we have lost count of the Health Secretaries and Ministers covering this brief. Today, we have a Minister from a different Department addressing us. I know it may seem like I am making a party political point, but regardless of reshuffles, Government priorities and resignations, the problems in maternity care continue. Although we cannot have continuity in Government for whatever reason, we need continuity in care and a strategy for dealing with racial disparities in maternity care.
It is hard to see the Government taking action when things are changing so frequently, but I sincerely hope the Minister will assure us that the Government are focused on this issue, regardless of the changes, and that her time in this role will be spent tackling black maternal health disparities.
Black women cannot afford to wait any longer for action to be taken. I do not want to have to stand up in another debate and cite exactly the same statistics without any improvement. I know things take time, but it would be sensational to come back next year and report that at least something had changed. The best way for Ministers to exact that change is to set out clearly what the Government are doing and set a clear target.
The answer I have been given in the past when I have asked for a target is that this does not happen to that many women, so a target does not need to be set. I would flip that round: if it is not that many women, surely we can set a target to address it.
That is a terrible omission. It is a pleasure to serve under your chairmanship, Mr Gray. I thank the hon. Member for Streatham (Bell Ribeiro-Addy) for leading this debate on a crucial issue.
The Women and Equalities Committee has twice held one-off evidence sessions—although there is a slight conundrum in twice having one-off sessions—looking at black maternal health. It has taken evidence from campaign groups, such as Five X More, and experts in obstetrics and gynaecology, yet the picture does not change. Looking at the evidence, we have known that there is a disparity in the health outcomes for black mothers since the early 2000s. For 20 years, we have known that there is a problem, yet still it continues. It has been a huge privilege for me to serve on panels alongside people such as Clo and Tinuke from Five X More, who have done so much incredible campaigning to highlight the issue, as has the hon. Member for Streatham. It is crucial that we begin to see progress; we cannot, 12 months or 10 years down the line, continue to have the same debate.
Raising awareness in Parliament is vital, but what we actually need is Government action. The hon. Member for Streatham made a slight dig about Government reshuffles. I am delighted to see the Minister in her place; this is an issue on which we have engaged before and she takes it seriously. I hope that the Secretary of State for Health will himself grasp the issue, and ensure that we drive it forward to see progress.
We have heard that one of the challenges is data, and the lack of specific data being collected on maternal health outcomes for black and Asian women. I pay tribute to Five X More, which carried out its own experiences survey that included 2,000 women—a huge number—reporting their experiences and findings. The thing that really hits home for me is the repeated use of the phrases, “I didn’t feel listened to,” “We weren’t listened to,” and, “What I was experiencing was being ignored.”
It is always a pleasure to listen to the right hon. Lady; she brings lots of wisdom and knowledge to these debates. Ministers in other debates we have had in Westminster Hall, in different positions in the Department of Health and Social Care, have always spoken about the issue of data. The hon. Lady is outlining examples of where data could be used to formulate a Government and ministerial response. Does she agree that the Government really need to grasp the data issue? They can then prioritise their strategy to respond.
I thank the hon. Gentleman for his intervention. I did not think he would be entirely able to resist speaking in the debate. He is right: policies must be data-driven and evidenced, but the evidence is there and has been for many years. We are augmenting and adding to that body of evidence the whole time.
I will not be entirely negative, because we have some great opportunities. I was pleased to see Dame Lesley Regan appointed women’s health ambassador earlier this year. I welcome, reinforce, champion and offer anything I can to help the women’s health strategy. Finally, we have one of those, and I pay tribute to the Minister who was instrumental in getting that published. What we now need from the strategy is outcomes. That has to be the focus. What is happening to drive outcomes, and to ensure that the disparities we know exist are recognised, acted on and reduced? Our goal has to be to reduce that horrendous figure of four times as many maternal deaths for black women. We have to improve the outcomes for black babies, so that there is not, as I think the hon. Member for Streatham said, a more than 100% likelihood of stillbirth—
Increased risk. The hon. Lady is absolutely right to highlight that as an imperative. We must ensure that we reduce the inequity, of which there are many drivers. She was with me when the Women and Equalities Committee took evidence from Professor Sir Michael Marmot, who talks so compellingly about health inequalities and their drivers.
I will not say that there is anything wrong with black women’s bodies—there is not—but we have to look at housing conditions, air quality and the areas where they live. Air quality is a significant driver of poor health outcomes. We have to look at what we are doing around smoking cessation, which is good for not just black women, but all women. We have to look at obesity, which is, again, a crucial factor for all women.
I look forward to seeing, in the remainder of this Parliament, focused and determined action around obesity, smoking cessation and air quality. There are targets on all those things, but—how can I put this gently?—there has been a little backsliding on some of them. Targets have been pushed into the dim and distant future, and there is less commitment around drives to reduce obesity and smoking, which are incredible drivers of poor health outcomes across the population. We should double down on our commitment to those targets.
I hope that in due course—I get fed up of saying “in due course”, which is a standard ministerial answer—to see a White Paper on health disparities. It is imperative that we get that done, and that the women’s health strategy is seen as a driver to ensure that we improve outcomes. First and foremost, I reiterate the calls from the hon. Member for Streatham for targets. I am never a great fan of targets if they are just there for the collection of targets, but if they work, and we see that in many instances they do, we should have them.
We should have time-limited targets, so that in maybe three years we can look and say, “Nothing has changed.” Looking at the data and the evidence from campaign groups, I see that over 20 years, nothing has changed. I do not want to be here in 20 years’ time giving the same speech on this important issue, feeling that nothing has changed. I look forward to the Minister’s comments, and reiterate my congratulations to the hon. Member for Streatham on calling for today’s debate.
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Since the last time we had this debate, Five X More has carried out and released the findings of its black maternal experiences survey. This is the largest survey of black women’s maternal experiences ever conducted in the UK. It gathered responses from over 1,300 women and looked at their experience of maternal care. The report highlights all the negative interactions that women experienced with healthcare professionals, from feeling discriminated against in their care to receiving a poor standard of care, which put their safety at risk, and being denied pain relief because of the ridiculous trope that black women are less likely to feel pain.
The report goes on to reveal how the discriminatory behaviour and attitudes that black, Asian and ethnic minority women face have been shown negatively to impact women’s clinical outcomes and their experiences of care. More than half the respondents reported facing those challenges with healthcare professionals during maternity care, and 43% of women reported feeling discriminated against, while 42% of women reported feeling that the standard of care they received during childbirth was poor or very poor, and 36% reported feeling dissatisfied with how their concerns during labour were addressed by professionals.
Further to that, 42% of respondents reported feeling that their safety had been put at risk by professionals during labour or during the recovery period. Of the women who experienced negative maternity outcomes, 61% reported that they were not even offered additional support to deal with the outcome of their pregnancy.
Some 57% of women felt that they were not treated with respect and dignity in the way they were spoken to or in other acts of care giving, but perhaps the most shocking finding of the report was that 1% of the women who responded reported that their baby had died before or during labour, or within 28 days of birth. In a sample of this size, that equates to 10 women, which is way higher than the three to four who should have been expected.
Those statistics are shocking, but the stories are even more shocking. Each of those reports includes harrowing stories of women being neglected, and of their pain being ignored and their concerns dismissed, resulting in a near miss or, indeed, the loss of their baby. In one account, a woman was not believed when she informed the midwife that she was ready to push. It states that when she eventually began to push,
“Her baby came out still enveloped in the placenta. Several doctors came and she was taken to theatre as it became an emergency situation. It was touch and go but she survived. Due to heavy blood loss she was in a coma for three days. Her baby had to be given intensive care.”
In another account, a woman reports that her baby was struggling to breathe after birth. She says:
“I was told that it was a normal thing for newborns. No checks were done to put my mind at ease. After about 20 mins, my baby stopped breathing. Efforts were made to resuscitate her, but she later died in NICU.”
One woman recalled that during her first check-up, a nurse said that she was shocked that she knew who the father of her baby was because people like her do not usually know.
There are thousands of similar stories of black, Asian and minority ethnic women having negative experiences with healthcare professionals and maternity care. There is an urgent need to address the crisis in maternity care, and I sincerely hope that the Minister will set out concrete steps that her Department and the Government will take to address the problem.
I sincerely hope those measures will look beyond treating black, Asian and minority ethnic women as a problem. We are not the problem and our bodies are not broken. There is no flaw in our genetics and we do not need to be dealt with in a way that reduces negative statistics by just pushing the problem away. The suggestion that black women should be induced earlier because a lot of these issues present after 40 weeks is ridiculous.
The solutions need to address the distinct problems in maternity care; all the evidence suggests institutional racism. We must address biases and assumptions about black women, train medical staff to recognise common symptoms in black women, and tackle the barriers that prevent black women from receiving the quality of maternity care they deserve. That is where the problems lie, and we will overcome them by directly addressing racial disparities.
Last year when we debated this subject, the responding Minister asked me and others to continue to hold her feet to the fire on this issue. I thought they were really receptive and that we were finally going to see some meaningful steps to tackle maternal health disparities. I left the debate feeling slightly hopeful because so much awareness had been raised by the fantastic campaign groups I mentioned earlier, and there was a lot of support across the House. I was therefore really surprised and quite deflated when the next day the Minister moved Departments in a reshuffle. I know Cabinet reshuffles happen all the time—
I am loth to say that we sometimes have very gendered healthcare, but look at the evidence. Look at the fact that when there is medical research, it is almost exclusively carried out on men; look at the fact that drug trials are carried out on men; look at the fact that some of the highest backlogs as we come out of the pandemic are in health conditions predominantly affecting women. Whether it is in cardiac, obstetrics or another sphere of medicine, too often the experience is, “I didn’t think they were listening to me.” I am sure every Member hears that from their constituents, and that has been my experience as a constituency MP. I hear from my constituents that, specifically in the area of maternity, “I wasn’t listened to. Nobody paid attention. It was my body, and I knew something was wrong.”
Only last week, I received an email from a constituent who had lost his daughter-in-law moments after she gave birth. He was with his son, helping to bring up a baby and pursue a complaints procedure against the hospital in question. Throughout his email, he kept making the point that they had not been listened to. His daughter-in-law had been a midwife, and even she was not listened to.
Talking to black and particularly Muslim women—I should declare an interest as chair of the all-party parliamentary group on Muslim women—they feel that their voices are doubly ignored, and that there is that intersectionality. Whenever I talk to journalists about intersectionality, they look at me and say, “Please don’t use that word. Nobody understands that word.” It is imperative that we all understand that word. You will be discriminated against if you are a woman, and you will be discriminated against if you are a woman from a black, Asian or other minority ethnic group; when the two come together, as we find in maternity units in particular, women’s voices are not heard or listened to.
When we talk to the Royal College of Obstetricians and Gynaecologists, as the hon. Member for Streatham has done, it calls for specific targets for black maternal health outcomes, and it is right to do so. Although it may be a small number as a percentage of births every year, it is still a significant number. The loss of one mother is one too many.