Black Maternal Healthcare and Mortality

[Sir Gary Streeter in the Chair]

Welcome, everyone, to this important debate. I remind hon. Members that some changes have been made to normal practice, to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There will be a suspension between each debate. I remind Members participating physically and virtually that they must arrive for the start of debates. Members are expected to remain for the entire debate.

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Before I call Catherine McKinnell to move the motion, I must say that we have 12 Back-Bench speakers. We normally allow 10 minutes for each Front-Bench speaker. If Catherine speaks for about 10 minutes, that should allow for in the region of four minutes for each Back-Bench speaker. I will not impose a formal time limit, but I ask everyone to try to deliver your speech within four minutes. That would be most helpful.

I beg to move,

That this House has considered e-petition 301079, relating to Black maternal healthcare and mortality.

It is an honour to speak under your chairmanship, Sir Gary. I am also honoured to open this debate on behalf of the Petitions Committee and the more than 187,000 people who signed the petition organised by campaigners Tinuke Awe and Clo Abe.

The petition highlights the shameful fact that in 21st-century Britain, the colour of a woman’s skin affects how safe she and her child are during pregnancy and birth. That is one of the starkest examples of racial health inequalities in this country. As Tinuke and Clo have pointed out, the latest data show that black women are more than four times more likely than white women to die during pregnancy or in the six weeks after giving birth. Women from Asian backgrounds are twice as likely as white women to die during pregnancy. To put that into context, I should state from the outset that the UK is one of the safest countries in the world to give birth. Deaths during pregnancy are very rare. I am sure the Minister will reiterate that in her response.

Around one in 10,000 pregnant women dies every year from causes related to their pregnancy. Every single one of those deaths is a tragedy, but they are a very small proportion of all pregnancies. The situation has also improved slightly over the last 10 years. Those figures mask the underlying, long-standing and shocking inequalities in maternal mortality, yet we do not have a base of research and evidence to fully explain their root causes and to point the way forward. There is still no Government target to eliminate the gap. That needs to be addressed urgently.

What do we know about women who die during or shortly after pregnancy? Pregnancy alters the way the body works. Two thirds of all pregnant women who die fall victim to complications such as heart disease or the care they receive while pregnant. Most do not die during childbirth itself. Dr Christine Ekechi, co-chair of the race equality taskforce at the Royal College of Obstetricians and Gynaecologists, points out that black women are more likely to have pre-existing health conditions that lead to greater risks during pregnancy. However, she also highlights that the obvious question to ask is why black non-transmissible health issues such as cardiac disease and high blood pressure are more prevalent in the first place. If it is a result of existing social and economic inequalities, that must be addressed.

I thank the members and Chair of the Petitions Committee for choosing this subject for debate. My constituency contributed the second highest number of signatures to this petition, which reflects the concerns of both black and white people in my constituency.

It is particularly tragic when a new mother dies. She will die early in life, leaving behind a newborn or other children. Everyone in maternity services wants maternity care to be a properly resourced and highly professional team. A black woman is four or five times more likely than a white woman to die during childbirth or shortly thereafter, and nobody wants that to be the case. It is a dreadful situation and it must be addressed. I have four proposals for the Minister. I know that she understands this issue very well, having worked in the health service. She cares about it, so I look forward to hearing her response.

First, the monitoring must be clear and publicly accessible. The publication of covid statistics has provided a real example of this. It has shown how, when information needs to be brought into focus and targeted at the public and everybody in the health service, the regular and consistent publication of statistics can enjoin us all in a public effort. Coherent statistics must, therefore, be published.

Secondly, as my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) has said, we must have a target to end this black maternal mortality gap, with milestones set for progress year by year. The Joint Committee on Human Rights, which I chair, heard evidence from the chief midwifery officer that there is a great deal of concern about this issue but no targets have been set. We know that the NHS works to targets and to milestones. Good intentions are not enough.

Thirdly, we have to reduce health inequalities—this is a general but important point—and income inequalities, which mean that if someone is black they are more likely to have a low income, and if they are on a low income they are more likely to have poorer health.

Finally, we must recognise that this is not just about the health status of the mother; it is also about the delivery of care. We have to face up to a difficult truth. Polling by the Joint Committee on Human Rights found that 60% of black people felt that they were not likely to get equal care in the NHS, and 78% of black women felt that the NHS would not give them equal treatment. For white people, those are shocking statistics, particularly as so many black women and men play such a crucial part in providing NHS services. Those figures are based on the experiences and expectations of black women in a society where black people are not treated equally.

It is an honour to serve under your chairmanship, Sir Gary. First, I congratulate Tinuke and Clo, the co-founders of Five X More, on working tirelessly to change black women’s maternal health outcomes, and on putting forward this petition, which gained over 187,000 signatures.

The racial disparities in maternal mortality rates are completely unacceptable. A black woman is four times more likely than a white woman to die in the UK due to pregnancy or childbirth. Just think about that—that is four times as many women passing away well before their time, and four times as many families suffering the pain and grief of losing a loved one.

It is not just those women who have sadly died who have been victims of this disparity. Research by the Nuffield Department of Population Health has shown that women of black African and black Caribbean heritage are, respectively, 83% and 80% more likely than white European women to suffer a near miss of maternal death. That reflects, and is the consequence of, the wider disparities in care, which countless women have recounted from their experiences. As well as the socioeconomic inequality that disproportionately affects black people, a study by MBRRACE-UK showed that only 29% of women who died during pregnancy and childbirth were deemed to have received good care, with improvements in care being judged to have potentially made a difference to the outcome in 51% of those cases—evidence that there are clearly improvements to be made.

The attention shone on this issue in recent months, and highlighted by the sheer number of people who have signed the petition, must be used as a spur for the Government and the NHS to develop a clear action plan. Furthermore, it highlights the damaging nature of the Government’s recent race report, which sought to sideline almost any suggestion that racism could be a factor in the different outcomes experienced by people in Britain today. Racism is not just a perception or historical experience, as Tony Sewell wrote in his foreword to the recent report.

This is not about a chip on our shoulder; it is about addressing the real inequality of black maternal mortality rates, which result in women unnecessarily passing away. It is a disparity that requires the Government to take seriously racial and ethnic disparities. Therefore, what we are asking today, and what the campaigners have been asking the Government to do, is to listen and to really take the data seriously. I hope the Minister will introduce an NHS target to end this disgusting disparity.

It is a pleasure to serve under your chairmanship, Sir Gary. I thank the campaigners for bringing this really important issue to Parliament and for raising awareness on behalf of all women. Over 1,186 Vauxhall constituents signed the petition that has led to this important debate.

As the mother of two young children born just over the road from Parliament, at St Thomas’ Hospital, I know that giving birth should be one of the most natural and exciting experiences that any mother can have. I think back to my first pregnancy—the fear, excitement and mixture of emotions. Like many women from a black or minority ethnic community, I was not aware that I suffered from a disease called fibroids until I had my first maternal scan. That brought additional fear and anxiety around my childbirth, but for far too many women, pregnancy and childbirth can be complicated and dangerous. When I got pregnant, I also realised that I was a sickle cell carrier.

We have known for some time that maternal and perinatal mortality rates are significantly higher for women of black, Asian and mixed heritage and their babies. That is why we have to do everything we can to ensure that pregnancy and childbirth is as safe as it can be for all women in this country. We have the data. We know that the death rate in childbirth for black women is five times that for white women. In 2021, that cannot be acceptable.

To tackle the problem, we must first acknowledge the structural and institutional racism that exists in our healthcare system. We know that black and minority ethnic women are sometimes not listened to during the course of their care, and this can be subject to unconscious bias and microaggression. As a result, their symptoms are dismissed as normal during pregnancy, whereas they should be investigated a lot further.

The NHS is aware of the disparity, but it has no target to end it. I hope that by raising awareness of this issue, we will help to kickstart a national debate that will lead to the Government taking real action to address it. My colleagues have already asked the Minister to respond by looking at those key targets. We need to work with the NHS to implement the Joint Committee on Human Rights’ recommendations, which are clear. They are about reducing racial disparities in black and minority ethnic maternal health outcomes, and specifically about introducing those targets, so that we can measure those protections.

It is a pleasure to serve under your chairship, Sir Gary. I thank the right hon. Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee, for asking me to respond on behalf of the Committee. Too often our Parliament is viewed as old, with blind spots on issues such as the health inequalities that affect black people, and black women in particular, so I am grateful to each of the nearly 200,000 people who signed the petition.

We have already heard that black women in the UK are four times more likely to die during pregnancy or childbirth than other women, and up to twice as likely to experience a stillbirth than white women. This is not coincidence or fluke. We see in the available data and in people’s experiences how health services, designed disproportionately by non-black people, fail to meet the needs of black people. It is an institutional problem.

The Select Committee is currently looking into the safety of maternity services in England. The brilliant Tinuke and Clo from Five X More came to speak to us and share their experiences, and I thank them for leading this petition and for their campaigning work. Clo told the Committee that there needs to be greater investment to understand the huge disparity in health outcomes for black women. We currently do not collect data on near misses, morbidity, illnesses or poor outcomes for black women. I hope the Minister announces some changes to that.

Clo also told us that only once we uncover the experiences of black women going through maternity services and set targets to do better will we have better outcomes for all black women. The same sentiment was echoed when I met Mars Lord, a doula and birth activist working on the Black Mums Matter Too campaign, which is not only highlighting the shocking inequality facing black women and their children relating to maternal mortality, but taking action to save lives. Mars is working with Peppy Baby, which gives black birth parents free expert support, delivered remotely via an app.

It is a pleasure to serve under your chairmanship, Sir Gary. I start by paying tribute to Tinuke and Clo from Five X More, who have been leading the charge in calling for action on black maternal health. Black women are four times more likely to die in pregnancy and childbirth—we have heard that many times today, and we will probably hear it some more, but I really want it to hit home. We know this, but we have no target to end it.

During my own pregnancy, it was not hard to find instances where, as a black woman, how I was perceived or believed drastically impacted the care I received, from complaints about how I was feeling to being denied scans. We know that black women are perceived to experience less pain. We know this, and we have no target to end it.

Things went from bad to worse for me. I was swollen. My blood pressure would get so high that I would feel dizzy and my nose would bleed. My doctor eventually had me rushed to the hospital for further tests and scans, and I was admitted to the hospital with pre-eclampsia. My last conversation with the consultants was harrowing. They said that my pregnancy had become very dangerous and there were only two outcomes: my child would die, or both myself and my child would die. My diagnosis was too late for any intervention, and simple steps—which I soon found were simple things such as taking aspirin—were no longer an option for me. The consultants’ advice was for a late termination and a delivery to save myself. They also explained that my condition was deteriorating so quickly that I would immediately have to nominate someone to make the decision for me if I should become unconscious.

Some 83% of women of African origin, like myself, and 80% of Caribbean women suffer a near miss in pregnancy and childbirth. Not only do we not have a target to end this, but we do not have information about the health issues that black women go on to face. I did not have to make this decision, because a scan scheduled the day after that meeting showed that my baby’s heart had stopped beating. I was induced, and after something like 18 hours of labour, she was born. As a person of faith, even then, I still had faith that maybe the doctors were wrong and everything would be okay, but she did not move, she did not cry, and there was no miracle. Black babies have a 50% increased risk of neonatal death, and a 121% increased risk of stillbirth, like my own daughter. With figures like that, I wonder how much of a chance she really had. We know this, and we have no target to end it.

It is a pleasure to serve under your chairmanship, Sir Gary. I thank my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) for bringing this e-petition debate on black maternity healthcare and mortality before the House. I also thank Tinuke and Clo, the founders of the Five X More campaign, who have been fighting to get this issue taken seriously.

Other Members have touched on these heartbreaking and stark statistics, but they bear repeating: black women are four times more likely to die during pregnancy or up to six weeks postpartum, women of mixed heritage are three times more likely to die, and Asian women are twice as likely to die. Each loss of life is a tragedy, and that disparity is unacceptable. It needs to be understood and it needs to change.

I also want to mention the Royal College of Obstetricians and Gynaecologists’ term “near misses”. The numbers of women who survive childbirth and are left with long-term morbidity are currently not recorded, but are part of a wider health picture. They must be taken into account. For the past year, covid has exacerbated many of these issues. In fact, even when other factors such as age, obesity and location were taken into account, black and Asian women are more likely than white women to be hospitalised. We need to understand why that is the case, because the statistics can only tell us so much. A commitment to looking into how and why that is the case is urgently needed. I am sure that all of us in the debate today would welcome that.

These tragic deaths are part of a wider picture, a story of health inequality, with black women facing disparities when it comes to stillbirths, cancer diagnoses and outcomes, and access to fertility treatment, among other things. We must recognise that disparities in health outcomes are driven by social factors—poverty, education and housing—as well as discrimination. None of that is new. It is not earth-shattering. It is not changing, either. That simply is not good enough. So we need action, and we need action now.

The Government must commit to a target to reduce the disparity in mortality rates. The Government must support Five X More pledges, including the recommendations relating to black maternity health in the report “Black people, racism and human rights” produced by the Joint Committee on Human Rights. There needs to be a full and independent review that seeks to end the disparity once and for all. The NHS must commit to robust data collection to aid the understanding of these outcomes. For a start, we need to move beyond the term BME. When women are dying, it is not good enough use data catch-all terms. We need to do more to deliver a workforce that reflects the diversity of the communities it serves.

I am pleased to be speaking today on such an important but also disturbing issue. I commend my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for sharing such a personal, moving story that is so relevant to the debate.

Every death in maternity is a tragedy, but it is wrong that we are having to speak on the issue of black women dying during pregnancy or soon after giving birth in the UK. It is unacceptable that the disparity exists between women from different ethnic backgrounds. It is most distressing that when a mother dies, a child or children are left motherless, not to mention the loss to their partner or spouse and to the wider community. Too many unanswered questions need to be asked, and too many changes need to be made, and that is why we request that the Government work with the NHS to improve maternal health outcomes of black women, women of mixed heritage and Asian women.

As we have already heard, compared with white European women, black women in the UK are four times more likely to die in pregnancy and childbirth, women of mixed heritage are three times more likely to die, and Asian women are two times more likely to die. African women are 83% more likely to suffer a near miss in childbirth, and black Caribbean women are 80% more likely to do so. That is all happening in the UK. It is shameful and outrageous. How and why is it happening? It is a huge concern regarding equality of care. Why are non-white women’s experiences so different compared with those of white women? Change needs to happen, and it is this Government’s responsibility to make the change happen.

These babies are 121% more at risk of stillbirth. Their life chances are limited before they are even born. Do these little black lives matter? I think they do, and I know that many Members in this Chamber agree with that. Immediate interim changes and safeguards need to be put in place now for these vulnerable women to protect their lives: the lives of the mothers and children.

I call on the Government to implement the recommendations in the Joint Committee on Human Rights report on black maternal health, “Black people, racism and human rights”, to ensure that all health professionals record and identify those who are most at risk of poor outcomes, so that protective factors are implemented. I also call on the Government to ensure that there is increased support for at-risk pregnant women. I ask the Secretary of State for Health and Social Care to introduce a plan and target to improve maternal outcomes for black women. Professor Maggie Rae, president of the Faculty of Public Health, has said:

It is a pleasure to serve under your chairmanship, Sir Gary. May I associate myself with all the comments that have been made? I commend in particular my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for the courage and bravery with which she spoke.

The disparity of maternity care outcomes in England is already well known. Black women are four to five times more likely than white women to die during pregnancy, birth and the postpartum period, while our Asian women, most of whom are from Pakistani and Bangladeshi backgrounds, are two to three times more likely than white women to die during those periods. Those statistics have been known for many years, but in the last 20 years or so they seem to have gone the wrong way and got worse.

We must find out why black and south Asian women and their babies are more likely to die. In addition, we need to find out why black women and then south Asian women are most likely have an emergency C-section. Why are black women and then south Asian women most likely to have excessive bleeding? Are those factors contributing to their deaths? Are those women receiving the right care at the right time? We need to look further into all those questions, because most of the deaths are likely to be preventable.

Why do racial and ethnic variations in health outcomes occur? The Government’s latest report suggests that institutional or structural forms of racism just do not exist, and that, in fact, they are just in our minds, or they are narratives pushed by groups that lobby on racism. I would be really grateful if the Minister explained why, if there is no racism, those disparities exist.

I am co-chair of the all-party parliamentary group on Muslim women, which is currently conducting research to find out about Muslim women with babies and maternity care, so that lessons can be learned to mitigate existing inequalities. Muslim women are from diverse ethnicities, and in the UK they are mostly from black and south Asian backgrounds, but we wanted to take an intersectional approach to find out how overlapping factors, such as ethnicity and faith, could affect their healthcare. The aim is to find out why those women have poor health outcomes, and to understand their perspectives and experiences of the healthcare during and after pregnancy. The findings of the inquiry are set to be published in the autumn.

It is a pleasure to serve under your chairmanship, Sir Gary. I congratulate the campaign group Five X More, and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) on securing this hugely important debate, as well as the nearly 200,000 UK residents who signed the petition. The debate could hardly be more important, as it shines a light on a devastating and long-neglected area of institutional racism.

The latest UK data shows that black women are five times more likely to die in pregnancy, or up to six weeks after giving birth, compared with white women, yet there is no target to end that. This difference has almost doubled since 2011, with a 121% increased risk for stillbirth and a 50% increased risk for neonatal death, but there is no target to end this. It is not true that black women are superhuman. They do not have a higher pain threshold.

The maternal mortality for women from Asian backgrounds is double that for white women. There is also a concerning increase in the maternal mortality rate for women from mixed ethnic backgrounds, who now have a three times higher risk compared with white women, yet there is no target to end any of this. There is no doubt that health disparities within maternity care settings have been amplified by the coronavirus pandemic. Indeed, African, African-Caribbean, Asian and minority ethnic women made up 56% of all pregnant women hospitalised in the early months of the pandemic.

Discrimination is ingrained in the social, political and economic structures of our economic system. According to the Office for National Statistics, key workers are more likely to be from black, Asian or minority ethnic communities, to be women, to be born outside the UK and to be paid less than the average UK income. These inequalities are grounded in class inequality and reflect the severe racial disparities in our economy. African, Asian and minority ethnic women are also more likely to be in insecure work, which can leave them without basic maternity rights and more exposed to discrimination when it comes to hospital treatment.

That said, we cannot ignore the issue of racism and implicit racial bias in our healthcare system, which can negatively influence diagnosis and treatment options provided by clinicians, including pain management, and indirectly affect medical interactions, through loss of patient-centredness in treatment and the removal of patient autonomy. That has a corrosive effect on trust in services, which creates a downward spiral of healthcare outcomes.

The demonisation and mistreatment of migrants and those with unsettled status must also end. Migrant women with insecure status face charges of £7,000 or more for NHS maternity care, which can deter women from accessing essential services. The Government cannot be serious about reducing maternal health inequalities unless they abolish the “no recourse to public funds” policy.

I am grateful that we are debating this important petition today and pay tribute to the women who have bravely shared their stories, from those involved in the “Dispatches” documentary to the Five X More campaigners to some of my own constituents in Bath.

The disparity in maternal health outcomes between black and Asian women and white women is one of the most frightening elements of systemic racism in today’s society. The statistics revealed in the MBRRACE report should shock and horrify us all. It should go without saying that health outcomes should never be determined by race, but for too many women this is the awful reality when accessing healthcare. One of my constituents said:

“I have two dual heritage daughters. As things stand, they are three times more likely to die during pregnancy and childbirth than my white friends’ daughters.”

Another wrote to me to share her concern that her race affected the way she was treated.

She felt she was not properly informed about the options open to her, her concerns were not taken seriously, and she could not say no when she felt uncomfortable.

Closing the gap between maternal health outcomes for white women and for women of colour must be a priority for the Government. It is not enough merely to recognise the disparity; we need a specific target to dramatically cut the rate of maternal deaths among black women. I urge the Minister to ensure that targets are in place to halve the disparity in the next five years. We need more and properly funded investigations into maternal death, with recommendations that are actioned. We need national accreditation for those who provide language support in maternity care, and we need to look at health outcomes for those new mothers who have no recourse to public funds because of insecure immigration status.

On top of that, if we are serious about eliminating maternal health inequalities, we must tackle the inequalities that exist in all areas of society. We know that the pandemic has made all inequalities much worse. Women from ethnic minority backgrounds made up 56% of all pregnant women having to go to hospital in the early months of the pandemic. Women from ethnic minority backgrounds are more likely to be key workers, giving them an increased risk of contracting the virus. They are more likely to be in insecure employment, which leaves them without basic maternity rights. They are at risk of higher exposure to discrimination and poor treatment at work, affecting their mental health. Once again, I urge the Treasury to look at Maternity Action’s proposals for amending the furlough scheme. It would allow employers to claim 100% of the cost of maternity suspension for women who are over 28 weeks pregnant, or pregnant women with underlying health conditions—we have heard today that underlying health conditions make it much more risky for pregnant women from different ethnic backgrounds.

It is a pleasure to serve under your chairmanship, Sir Gary. I pay tribute to Tinuke and Clo for their vital work campaigning on black maternal health under the banner Five X More . I also pay tribute to my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for sharing her devastating experience so bravely and powerfully.

The statistics on maternal mortality are truly shocking. Skin colour should have no correlation with maternal health, yet in the UK, black women are over four times more likely than white women to die during pregnancy or childbirth; women of mixed heritage are three times more likely; and Asian women are twice as likely. What is even more shocking is that the gap has been widening—not for a short period of time, but for more than a decade.

The factors contributing to maternal mortality rates are complex and multiple. Social and economic factors have a strong influence on underlying health. Pressures such as insecure work, low income and fear of losing employment force some women into unsafe situations. Implicit racial bias in healthcare can lead to assumptions being made and some women not being listened to. The extent to which women are listened to, respected and empowered throughout pregnancy and childbirth has a vital bearing on ultimate outcomes.

The most shocking aspect is that every organisation concerned with maternal mortality says that more research is needed to understand why black women are at greater risk of death. After a decade of increasing black maternal health disparity, we still need more action to understand why there is such appalling racial healthcare inequality, so that action can be taken to stop it. That means better data collection, clear and measurable targets, and more funding for research.

We have to ask why those appalling statistics have been of so little concern to the Government that they have failed to undertake any major inquiry or fund significant research. There is a gender and ethnicity gap in medical research, and that must change. The Government must now commission an independent review of the ethnic disparity in maternal mortality, looking in detail at the data and capturing the lived experience of black women, Asian women and women of mixed heritage.

It is a pleasure to serve under your chairship, Sir Gary. I, too, would like to begin by thanking the Five X More campaign for raising awareness and bringing this important debate to Parliament, and my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for her bravery in sharing her devastating story with us all tonight.

I am a black mother of twins and I had a very positive experience, but sadly, too many black women are dying needlessly in childbirth. In today’s historic debate, we have already heard incredibly personal and heartfelt stories, and I pay tribute to my sisters’ strength and bravery in sharing their experience to help to bring about change.

The rate for black mothers dying during or just after childbirth is five times that of white mothers in the UK; and black babies have a 121% increased risk of a stillbirth. It is estimated that for every instance of maternal mortality, there are 100 severe maternal morbidities or near misses. Behind every one of these statistics is a story, and behind every one of these mothers who dies is a group of women who had a near miss.

The report by the Joint Committee on Human Rights, which was published last year, highlighted the lack of an NHS target to end this obscene disparity and urged the Government to introduce one. I call on the Government today to rectify that urgently and set ambitious targets to address and eliminate these inequalities, including to halve the number of black maternal deaths by 2023.

The 2019 MBRRACE-UK report revealed that almost all those who died during or after pregnancy had multiple issues such as mental or physical health problems or were victims of domestic abuse or were living in a deprived area. More than half of those who died were overweight or obese. Black women are more likely to have conditions that can put them at greater risk, including cardiac disease, diabetes and high blood pressure. We must ask the deeper question of why black and Asian women are more likely to have those pre-existing health conditions in the first place. There is no specific genetic connection between all black people. Many of these pre-existing conditions are non-communicable diseases that are driven by social determinants of health, such as poverty, education and housing. Women living in the most deprived areas were three times more likely to die than those living in more affluent areas. Social services were involved in the lives of 20% of the women who died.

I am happy to speak under your chairmanship today, Sir Gary, although what we are discussing is a very unhappy set of circumstances. I thank Five X More for the petition and the debate, and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for leading it. I confess—I know I am not alone in this—I knew very little about this subject until hearing from Five X More , and I am someone with a long-term interest in racial inequality, so I thank it sincerely. Many hon. Members have spoken powerfully today. I pay particular respect to the courage of the hon. Member for Streatham (Bell Ribeiro-Addy).

In the UK, almost 800,000 women give birth every year. That is 800,000 interactions with their national health service, making childbirth the No. 1 reason for engagement with the NHS. For a large proportion of women, it is their first adult contact with health services, and maternity care should be a unique opportunity to mitigate some of the factors that perpetuate health and social inequalities. I have no doubt that for many it is, regardless of ethnicity. I also have no doubt that the vast majority of healthcare workers care deeply about the people they work with. This debate is more about the system itself and the structural inbuilt inequalities.

We are hearing through heartbreaking testimony and alarming reports that these inequalities are very much there, putting black mothers and babies at a significantly higher risk of maternal and perinatal death. It is worth repeating again and again that black women are four times more likely to die during pregnancy or shortly after giving birth than white women. Women from mixed-race backgrounds are three times as likely and Asian women twice as likely. Most alarming to me is the fact that this inequality and disparity in maternal and newborn health has been highlighted for several years, yet there is still no target to end this. Why on earth not?

I want to pay tribute to MBRRACE-UK for the work that it has done in the confidential inquiry into maternal deaths. There is a coldness to research and statistics that often lets us forget what MBRRACE-UK points out: behind each number is a mother, a father, a baby, a family and a community left devastated by these events. Five X More has published a comprehensive list of suggestions for the Government to act on, as many hon. Members have noted today. I will note just one: the advice to listen to the voices and experiences of black women. Listen!

It is a pleasure to serve with you in the Chair, Sir Gary. I am grateful to my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) for leading the debate on behalf of the Petitions Committee. I also congratulate the formidable campaigners Tinuke and Clo, the founders of the Five X More campaign, who got the petition debate in Parliament today. The petition received more than 180,000 signatures. It is not before time that such a huge injustice is finally receiving the attention it deserves.

We have heard some powerful contributions from right hon. and hon. Members this evening, including my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), the Chair of the Joint Committee on Human Rights. Just last year, the Committee published its report “Black People, Racism and Human Rights”, which contains shocking findings, particularly that the care that many black people receive is unequal to what is given to white people. I urge the Minister to accept all the recommendations of that report.

My hon. Friend the Member for Edmonton (Kate Osamor) highlighted, as others have done, the choice made in the report of the Commission on Race and Ethnic Disparities to sideline the institutional and structural racism that exists across society, but more so in the health service. My hon. Friend the Member for Streatham (Bell Ribeiro-Addy) made a powerful contribution sharing her lived experience. I thank her for doing so, but also for her tireless campaigning on the issue. She has been brave, and I thank her for that.

More importantly, my hon. Friend the Member for Vauxhall (Florence Eshalomi) highlighted some of the issues related to underlying health conditions in her own experience of being diagnosed with fibroids and also of being a sickle cell carrier. I also urge the Minister to listen to my hon. Friend the Member for Luton North (Sarah Owen), to give 20 minutes of her time to her and her constituent and to hear their experiences.

I also want to mention the contribution of my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes), who highlighted the fact that we need to focus more on issues relating to research. Unless we do the work, we will not move forward and bring an end to this crisis.

Order. Does any Member present have to go to vote physically, or is everyone on a proxy vote? If everyone is happy, let us continue.

Last week I met campaigners, obstetricians, midwives and black, Asian and ethnic minority women with lived experience of maternal health complications. They were very clear that socioeconomic determinants such as income, housing and occupation and comorbidities only partially explain the inequalities affecting black maternal health. It is absolutely clear that structural racism is a driver of disparities in treatment, and it is a missed opportunity that the Commission on Race and Ethnic Disparities chose to sideline that important issue. I hope the Minister will choose to ignore and reject that view.

Black and Asian women, and their partners, regardless of their socioeconomic status, are not being listened to, not being respected and not being cared for. When they voice pain or concern during pregnancy or childbirth, they are branded as “aggressive” or “angry”, while dangerous stereotypes about “strong black women” mean that black women are often not offered the same treatment as white women.

It is outrageous that racist myths about black women having higher pain thresholds than other women continue to affect their treatment. Meanwhile, the lack of cultural competency in medical training means that complications experienced by black women are not spotted early enough. For example, black women have shared accounts of how their anaemia was not picked up soon enough because of the colour of their skin.

So I ask the Minister what action she is taking to tackle structural racism and to build trust in maternity services for black, Asian and ethnic minority mothers and their partners and for healthcare professionals, including midwives, as many have shared their experiences of occupational discrimination, as was highlighted in the Public Health England report last year. I would really like the Minister to address this issue. Additionally, cultural competency and unconscious bias training is an essential part of ending these inequalities, so will she commit to improving training in the health service and in medical schools?

I thank all Members of the House who have taken the time to attend and speak in today’s debate, and particularly the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for having secured the debate. Along with everyone else, I also thank the co-founders of the Five X More campaign, Clo and Tinuke, for their incredible work. Their petition to Parliament has generated a huge amount of interest and support, and their work to improve maternity mortality rates and healthcare outcomes for black British women is inspiring and brings this deeply important issue the attention it deserves.

Every woman deserves to have safe care, to feel that her voice has been heard and to be an informed decision maker in her own care. The NHS is one of the safest places in the world to have a baby. Few women in the UK die during childbirth. Between 2016 and 2018, 217 out of 2.2 million women died during, or up to six weeks after, pregnancy from causes associated with their pregnancy. That equates to 9.7 maternal deaths per 100,000 pregnancies. We also know from the MBRRACE-UK maternal mortality reports that some of these deaths could have been prevented. Sadly, evidence shows that, currently, there remains a more than fourfold difference between maternal mortality rates among women from black ethnic backgrounds and among white women in England. There also remains an almost twofold difference between women from Asian ethnic backgrounds and white women. Those disparities are worrying and must be addressed, and I have heard all of the calls to do that today.

However, let me address the points that have been raised by speakers today—many of which have been raised repeatedly—beginning with the right hon. and learned Member for Camberwell and Peckham (Ms Harman). We need to fundamentally understand why this issue occurs and why we have these disparities. The statistics tell only part of the story: the lived experiences of black women need to be understood, appreciated and heard for us to really gain an understanding of the full picture. I think it was the hon. Member for Liverpool, Riverside (Kim Johnson) who read out some of the reasons for these disparities that are given in the report. As we know, and as we could tell from that report and from the list that she read, which was just the tip of the iceberg, the reasons are incredibly complex.

The issue is that there is a need for a target. When a target is set, work can take place towards a reduction. The Minister says it might be difficult to record the figures by ethnicity. Could she explain why it would be difficult?

I will go further and explain what we are hoping to do to make a difference. We know that for every woman who dies, 100 women have a severe pregnancy complication or a near miss. That has been mentioned a number of times. When that woman survives, she will often have long-term health problems. Disparities in the number of women experiencing a near miss also exist between women from different ethnic groups. Because near misses are more common than maternal deaths, we can investigate those disparities at local and regional level, to better understand the reasons for disparity, to assess local variation and to identify areas with less disparity and, hence, best practice.

Is it not clear from everything we hear that black women and women from ethnic minorities feel that the health system does not communicate appropriately, so they do not understand all the choices available to them? Is that not a way of getting to the bottom of what is going wrong?

That is certainly one of the many issues highlighted in the report, but it is not the only one. We have commissioned the policy research unit in maternal and neonatal health and care at the University of Oxford to undertake research into the disparities in the near misses, and to develop an English maternal morbidity outcome indicator. The research will explore whether the indicator is sufficiently sensitive to detect whether the changes made to clinical care are resulting in better health outcomes. Five X More called for that in its list of 10 requests.

We are putting the research in. We have found a way to look at the research in order to make the differences that need to be made. We can do that by examining the near misses. What happened in those cases and in those women’s experiences? What went wrong? Do the women feel that they were not listened to? Was it a matter of treatment? Was it a lack of understanding? We need to understand that by looking at the near misses. The research is being undertaken, but it will take some time. Hopefully, when that is reported, we will be able to make progress on the issue of setting targets.

This Government are no strangers to setting targets. On the very sad issue of baby loss, we set a target to reduce neonatal stillbirth and neonatal mortality rates by 20% by 2020. We have reached almost 25%. We have smashed that target and are still pushing forward to improve that situation even more. We are not afraid of setting targets, but when we are setting them we have to know how to achieve better outcomes. The hon. Member for Battersea (Marsha De Cordova) mentioned continuity of carer. She is absolutely right about those figures. We know that continuity of carer works incredibly well, particularly for black women and women from ethnic minorities. Having the same midwife throughout the process of pregnancy makes a huge difference. That is being rolled out across the country. I am sure that the hon. Lady has spoken to the chief midwifery officer, who is a huge supporter of the policy. We are continuing to roll it out and make progress with it. It has been slightly more difficult during the 12 months of the covid pandemic, particularly because many trusts did not continue with home births.

Order. Will the Minister kindly leave two minutes for Catherine McKinnell at the very end?

I will end there, but if any hon. Members wish to speak with me about the work we are doing and the research we have undertaken with Oxford University, we are happy to share more. I say in response to the hon. Member for Luton North (Sarah Owen) that very few personal meetings have taken place, but I would be happy to meet her and her constituent.

Thank you very much, Minister. It is very important that Catherine McKinnell has the final word.

Thank you, Sir Gary. I thank the Minister for her response, and everybody who has contributed to the debate, which has been very moving and powerful, and also very painful. I thank in particular my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for sharing such a powerful personal story.

I hope that the debate has helped to raise awareness and understanding of why the issue must be urgently addressed, and I hope that we have done justice to the passionate and powerful campaigning of Clo and Tinuke. I know that they and we all want to see change, so I hope that the Government and NHS leaders have heard that call today. I urge the Minister to meet those who are affected, to continue to listen and to ensure that data continues to be collected and that changes are made to put an end to the five times more statistic for good.

That this House has considered e-petition 301079, relating to Black maternal healthcare and mortality.