Following the Baby Loss Awareness Week debate on 23 September 2021, I wish to update the House on progress with work to improve safe and equitable outcomes for women and families using maternity services.
The Government’s maternity ambition is to halve the 2010 rates of stillbirth, neonatal and maternal deaths and brain injuries in babies occurring during or soon after birth by 2025. The ambition also includes reducing the rate of pre-term births from 8% to 6%. Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) have published several reports which provide some insight on progress towards meeting our ambition.
The last two years have been challenging but I am pleased to report on the good progress made with reducing stillbirths and neonatal deaths. According to Office for National Statistics data, the stillbirth rate has fallen 25% from 5.1 stillbirths per 1,000 in 2010 to 3.8 stillbirths per 1,000 births in 2020—unchanged since 2019—and the neonatal mortality rate for babies born from 24 weeks gestation has fallen 36% from 2.0 deaths per 1,000 live births in 2010 to 1.3 deaths per 1,000 live births in 2020.
In their perinatal mortality report published on 14 October 2021, MBRRACE-UK analysis has shown that the variation in stillbirth rates between NHS trusts has significantly reduced with 97% of trusts in England having stabilised and adjusted stillbirth rates within 5% of other trusts of similar size and case mix. The report suggested that this demonstrates “equitable healthcare provision across providers”.
Maternity services are also getting better at improving and learning from cases of perinatal deaths. The MBRRACE-UK third annual report on use of the perinatal mortality review tool (PMRT), published on 13 October 2021, that the proportion of deaths reviewed has increased with an estimated 83% of cases of babies who died in the perinatal period having been reviewed during March 2020 to February 2021. The report also found an increase of multidisciplinary teams carrying out reviews and an increase in parent engagement during the reviews.
The MBRRACE-UK maternal mortality report, “Saving Lives, Improving Mothers’ Care 2021: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries in Maternal Death and Morbidity 2017-2019”, published on 11 November 2021, found that the maternal mortality rate in the UK was 8.8 per 100,000 in 2017-19, compared to 10.6 per 100,000, which shows a 17.4% decrease from the 2009-2011 baseline.
More progress is needed to meet our ambition to reduce the rate of brain injuries in babies occurring during or soon after births. On 5 November 2021, I announced that £3 million has been awarded to the Royal College of Obstetricians and Gynaecologists (RCOG) in collaboration with the Royal College of Midwives (RCM) and the Healthcare Improvement Studies Institute at the University of Cambridge (THIS Institute) to deliver the second phase of a brain injury reduction programme.
Phase one of this programme, also being led by the RCOG, RCM and THIS Institute, is focusing on developing national consensus on how best to monitor a baby during labour and to escalate any concerns about deterioration. Phase two will focus on developing the clinical tools and training approaches needed for future implementation to standardise the identification and escalation of a deteriorating baby.
Despite the reductions in stillbirth, neonatal mortality and maternal mortality rates seen since 2010, the MBRRACE-UK surveillance reports show us that women and babies of black or Asian ethnicity or those living in the most deprived areas are more likely to die from causes linked to pregnancy and birth compared to women and babies of white ethnicity or those living in the least deprived areas.
I am committed to tackling disparities in health outcomes and experience of care. On 6 September 2021, equity and equality guidance was published which includes an analysis of evidence, interventions to improve equity and equality, resources, indicators and metrics. The guidance asks local maternity systems to submit an equity and equality analysis—covering health outcomes, community assets and staff experience—and co-produce equity and equality action plans.
In conjunction with the guidance, four pledges for women, babies and staff were also published. The four pledges include:
Pledge 1: The NHS will take action to improve equity for mothers and babies and race equality for NHS staff.
Pledge 2: Local Maternity Systems will set out plans to improve equity and equality.
Pledge 3: Local Maternity Systems will receive support to improve equity and equality.
Pledge 4: the NHS will measure progress towards the equity aims.
I am also pleased to announce that I am establishing a maternity disparities taskforce to tackle disparities and reduce maternal and neonatal deaths by improving access to effective preconception and maternity care for women from ethnic minorities and those living in the most deprived areas. This taskforce will also aim to address the wider social determinants that are linked to poorer outcomes such as poverty, housing and smoking, drinking and obesity in pregnancy.
We know that improving women’s health in the run-up to pregnancy and improving the support they receive are vital to improving health outcomes for mothers and their babies. The taskforce will bring together experts from across the health system, Government Departments and the voluntary sector to address disparities in maternal and neonatal outcomes. The taskforce will work to consider and support evidence-based individual, community, and targeted population interventions to tackle disparities and will develop key priorities that will be included as commitments in the women’s health strategy.
I hope to hold the first meeting of the taskforce in early March, and plan to hold the meetings every two months afterwards to maintain progress with delivery of actions and interventions to tackle disparities in maternal and neonatal outcomes.
Finally, as a nurse who worked during the pandemic, I know how incredibly challenging the last two years have been. Therefore, I would like to say a personal thank you to all maternity staff for their hard work and dedication throughout the covid-19 pandemic to provide safe and personalised care for all mothers and their babies.
I hope to update the House again regarding the progress towards the Government maternity ambition and progress of the maternity disparities taskforce in due course.
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