My Lords, I am pleased and honoured to lead the debate today on the Preterm Birth Committee report. Before I do so, I thank most sincerely all those who gave evidence to the committee and, in particular, the mothers and parents of children born pre term who told us of their experiences, as well as the perspective of adults who were born premature. It is their powerful evidence that forms the backbone of our report and its recommendations, and I will come back to that. My sincere thanks go too to the specialist advisers, including Eleri Adams, consultant neonatologist and president of the British Association of Perinatal Medicine.
I give my and the committee’s thanks to the dedicated committee staff who supported us and did so brilliantly—Eleanor Clements, committee clerk; Babak Winstanley-Sharples, policy analyst; Mark Gladwell, committee operations manager; and Alec Brand, media and communications officer—a huge thank you to them all for their hard work and support.
I give my personal thanks to all the committee members. It was a privilege and fun to be their chair because of their dedication and help in making sure that we delivered an evidence-based report that helps improve the lives of mothers, parents and the families of children born pre term.
Thanks go also to the noble Baroness, Lady Bertin—I am pleased that she will speak today, and I look forward to her speech—who could not join us as a member of the committee but was instrumental in persuading the Liaison Committee to set up the inquiry. I enthusiastically look forward to the speeches of all noble Lords taking part today, including the Minister.
A committee was set up in 2024 to consider the prevention and consequences of preterm birth. The title of the report, Preterm Birth: Reducing Risks and Improving Lives, summarises it all. I declare my interest, which is probably no longer relevant, of 39 years’ experience of being an obstetrician who delivered a lot of preterm babies.
By definition, preterm births are babies born before 37 weeks, and the current incidence is 7.9% of all births. It is the main cause of neonatal deaths in the UK. Around 75% of neonatal deaths are in babies born pre term, mostly the very pre term. For most babies born pre term, the outcome is good. For many, it is not. Some 4.2% of those born preterm end up having a severe disability at age 18 and 18.5% have a mild to moderate disability. Children born pre term have a higher prevalence of need for special education: the lower the gestation at birth, the higher the incidence. Some 82.6% of those born at or near 24 weeks have a need for special education. Children born pre term also have lower educational attainment.
While advances in obstetrics and neonatal care have led to improved survival, there has not been a corresponding improvement in neurodevelopmental outcomes. Incidence of brain injury, for example, is 26 per 1,000 births in those born pre term compared with 3.5 per 1,000 births in those born to term. It results in disability, cognitive impairment, memory loss and other functions. Adults born pre term told us that issues they experience could be subtle but multiple. Added to this, a lack of awareness within the healthcare system of the long-term effects of prematurity means that informed or specialist support is difficult to access.
My Lords, I thank the noble Lord, Lord Patel, and the members of the committee for this really important report, and for the time at which it has come, because the situation in this country for pregnant women, babies and preterm babies is a huge risk. This is the future of our country and the future of the world, and we do not treat the situation in the way it should be treated.
I will remind Members of a few points. The report is titled Reducing Risks and Improving Lives; to do that, we have to work much harder than we are working at the moment. Women’s health is at the worst position that it has ever been. I helped launch a report recently in the House of Lords—some Members were there—where we set out a manifesto for women’s health. The Minister was extremely helpful at that meeting and has helped us since.
As for the current landscape for preterm births in England, in 2022 some 7.9% of births in England were pre term, with 45% of babies born before 37 weeks. Those babies will need a lot of help and support not just in the very beginning but for the whole of their lives, certainly until they are through the whole of secondary school and into university. They also need to have proper checks as adults as well. When you are born and not fully developed, it affects the lungs, the brain—it affects everything. So, it is really important that we have a way in which people are checked regularly.
A number of preterm babies are born to mothers who have pre-eclampsia. Pre-eclampsia has a huge effect on the mother not only while she is pregnant but in the long-term, including heart conditions and other conditions. All mothers who have had pre-eclampsia should be seen by their doctors every 12 months, having heart checks as well. They are the future too—they are looking after children and keeping homes—so it is really important that we look at the state of mothers.
Preterm birth is the leading cause of neonatal morbidity in the UK. Outcomes for preterm infants remain uneven across the country. In most places, it is not registered when a child starts nursery or school; it should be, so that teachers have an understanding of what the issue may be if a child is not doing well, and how that can be helped.
My Lords, I cannot tell noble Lords how delighted I was when this issue was selected to be the subject of a special committee. I had witnessed families, including friends of mine, go through utter heartbreak. Many women can lose so many babies due to preterm birth. Of course, there is huge joy at the babies that do survive, but their general outcomes are not talked about enough nor about the journey that those families have to go on. So, I give huge praise to the committee. What a credit to this House that there was a committee with such huge expertise, which the noble Lord, Lord Patel, led remarkably. I also praise the staff who worked on the committee as well.
I was very disappointed not to be able to sit on the committee myself. Regrettably, I had started work for the Government on my harmful pornography review, so I felt that I could not do both, but I am very grateful to my noble friend Lady Wyld for keeping me very much updated on the progress of the report. I praise the report; it is so powerful. I welcome and support the many recommendations put forth by the committee, particularly those focused on improving long-term outcomes for babies and families. The noble Baroness, Lady Goudie, raised so many brilliant points about the emotional toll that this takes.
As the report rightly highlights, the devastating consequences of preterm birth do not end at the hospital doors. For many families, that is only the beginning. With one in 10 preterm babies going on to develop a permanent disability, life often becomes far more complex, both for the child and for their parents. Many developmental delays and long-term health conditions emerge only over time and, as has been mentioned in previous speeches, can be identified only through regular, structured follow-up by clinicians and community health professionals, particularly health visitors.
Yet, we are witnessing a troubling decline in the number of community health visitors—a workforce that is critical in identifying early signs of difficulty and providing support in the home environment. I feel personally about this, as it happened to me. I am lucky in that I have had three children, but I did not see a health visitor with my third baby at all; I had to push and push to see one, and I can remember thinking to myself that there were lots of problems with this. Luckily, I knew what I was doing, I was not having any postnatal depression or issues and I knew my baby was roughly hitting his milestones. But I can remember thinking, “My God, for new, fragile, mothers—particularly those who have been through a very difficult time—that would be unacceptable”. It absolutely has to be raised. These checks are not optional extras; they are lifelines, and without them, early developmental problems are missed and the window for effective intervention begins to close.
My Lords, I pay tribute to my noble friend—to misuse the convention—Lord Patel, who, as usual, was an outstanding chairman, as he has so often been for the past inquiries with which I have been associated. I thank him very much indeed.
There is no point in making a treatment unless you can make a diagnosis, and the diagnosis must depend on the understanding of the cause. The problem, frankly, is that various causes have been postulated for over 40 years in this area. I will take a slightly different line, because, otherwise, I will only repeat what the report said and what will be said by others in this debate. I suggest that we need to link much more closely the loss of babies in the uterus well before term, in the early stages of pregnancy—namely, miscarriage—with preterm birth, because the causes are almost certainly related and important. I will discuss this in my short speech.
So many causes have been suggested: chromosome abnormality; changes in the DNA; different genetic predispositions; abnormalities of gene expression; hormone imbalances; metabolic problems; immune changes; molecules that affect implantation; the insufficiency of the placenta or afterbirth; anatomic abnormalities of the genital tract; failure of the eggs to mature properly; blood flow abnormalities; vaginal, oral, uterine and gut bacteria; and infections by either viruses or bacteria and parasitic infections. The fact is that it is very difficult to decipher where we are going with this research. I regret to say that much of the scientific evidence we have received has been rather confusing. The evidence has not been well focused, and we need to consider why that is the case.
There are also associations with the environmental factors that my noble friend Lord Patel mentioned, including pesticides; pollution; smoking; poor diet; alcohol; ingestive toxins; aberrant weight, such as obesity; male and female age; and, obviously, the link with infertility, which is the area in which I am particularly interested. We do not understand why it is more common in some animals than others. We know, for example, that it is not particularly common to lose pregnancies in primates. That seems to be associated with stress in primates and may be related to changes in family circumstances, particularly with the dominant male, which is quite interesting. I am not pretending to suggest that it is relevant here; the point is that it is just another example of why we are very much at a loss.
My Lords, I add my thanks to the noble Lord, Lord Patel. The committee could not have wished for anybody better qualified to be our chair. He did it with his unique blend of professional brilliance and deep compassion, and we were very lucky to have him. I thank my noble friend Lady Bertin, who proposed the committee. As we have heard, she challenged your Lordships’ House to show ambition in its approach to this issue, and I know she made me even more determined to fight for better outcomes for women, their babies and families. She kept telling me to remember who we were doing this for.
On that note, it has been an absolute privilege for me to get to know some of the parents who gave evidence to us. I want to take a moment to acknowledge the strength it took for those parents to come and tell their stories to a public hearing of a Select Committee and to allow us to question them in order that we could find recommendations that would, we hope, improve the experience for others.
I have three general observations. First, given that, as we have heard, we still do not know enough about preterm labour, we owe it to women to do better research, as the noble Lord, Lord Winston, said. Secondly, where we do know a fair bit about ensuring the best possible quality care, women still cannot trust that this will be delivered consistently. Thirdly, as our recommendations show, it should be possible to reduce risk and improve outcomes.
It seems to me that there is a disappointing lack of pace and grip from the Government, despite very warm words in their response to our report. I emphasise that I am very grateful to the Minister for the time that she has given me to discuss these issues. I have said in the national media that I was convinced that the will is there to tackle this issue, and I am very happy to put that on the record here. I accept that the Government are making progress on preventive health care. I was very grateful for the smooth way in which they delivered the regulations to implement the Neonatal Care (Leave and Pay) Bill, which I took through this House in 2023. It is in that spirit that I come to this debate. I will never play politics on this, and I will be delighted if the Minister is able to contradict me in her summing up, because I will now be more critical on the response to our recommendations.
My Lords, I begin by paying tribute to my noble friend Lord Patel for his excellent chairmanship of the Preterm Birth Committee, as well as his huge compassion throughout, and to my noble friend Lady Bertin for proposing the subject of the inquiry.
My time on this committee brought one of the most poignant moments of my time in your Lordships’ House, when the committee had the chance to visit a neonatal unit at a local hospital to gain an insight into the plight of babies born pre term and the experience of their families. Even a year on from my visit, the sight of a tiny baby, born at 23 weeks, in an incubator remains in my mind and emphasises to me the importance of bringing about real, positive change for those born too early. I hope that the work of the committee and the report do justice to those who gave evidence and bravely shared their experiences; I also hope that they can be used by government to improve the lives of those born pre term.
I will focus on a few aspects of the committee’s findings. One thing that struck me most during our evidence sessions was the seeming simplicity of some of the interventions, as well as the frustration that great improvements could be made if those interventions were implemented consistently. On perinatal optimisation interventions, we heard specifically that delayed cord clamping can reduce mortality by up to half for preterm babies, yet it has not been implemented consistently. In a recent briefing, the charity Bliss warned that variation in practice remains rife.
Another example that formed part of the committee’s recommendations—this was highlighted by my noble friend Lady Wyld—is the importance of family integrated care, where parents play a key role in their baby’s care. Evidence from Bliss found that this leads to better outcomes for babies, reducing mortality and morbidity as well as requiring fewer days in neonatal care. Despite the great benefits associated with family integrated care, sadly, it is not always possible due to the lack of facilities for parents and access to overnight accommodation. A 2022 study from Bliss found that 75% of parents did not have access to overnight accommodation when their baby was critically ill. On a visit to a local hospital, the committee saw for itself family integrated care in action and was privileged to speak with parents and hear about their experience. I am pleased that, given the committee’s recommendation, the Government have said that they will publish early next year the findings of the maternity and neonatal estate survey, detailing parental accommodation. However, I would be grateful if the Minister could give a better idea of when this will be.
My Lords, I join in the general and fervent thanks to the noble Lord, Lord Patel, and his committee for this terribly important report. I also thank the noble Lord for his introduction to this debate.
The noble Lord, Lord Patel, mentioned an issue that I would like to start with: the situation of our current final year midwifery students. The Royal College of Midwives did a survey and found that 84% of them said that they are not confident that they are going to find a job after graduating this year. This makes no sense at all. We are in the middle of calculating the formula for exactly how many midwives we need, but, if we look at the figures from the Royal College of Midwives, we see that a survey of members recently found that midwives and maternity support workers were working an estimated 118,000 unpaid hours of overtime each week to meet the needs of their patients. We should be grabbing those graduating midwives with both hands and making sure that they have a secure future because, of course, they now face the enormous weight of student debt, with many of them being previous graduates who are doing this as a second degree. There is a risk that they will go and do something else because they need to put food on the table and keep a roof over their head. Of course, this is a situation that many resident doctors and anaesthesiologists already face; as the Minister will know, I have put down Written Questions on that issue.
I turn to the specific issue of preterm births. Here, I will focus not on the care but on the public health issues. We have heard in this debate a great deal from many expert figures about the fact that, in many cases, we do not know the cause of a preterm delivery. However, one thing we do know is that poverty, inequality and discrimination increase the level of suffering around preterm births. The most recent figures show that the neonatal mortality rates associated with preterm birth in the most deprived areas have just increased for the third year in a row. We are going backwards.
My Lords, this has been an excellent debate so far, based on an excellent report. That is unsurprising, since it has taken place under the expert chairmanship of the noble Lord, Lord Patel. I will focus my remarks on the support that we give to parents who have had preterm babies, but first I want to touch on another aspect of the report—staffing levels.
We have had chronic shortages of maternity and neonatal staff for years, which affects so much of the delivery of what is in this report. The noble Lord, Lord Patel, and the noble Baroness, Lady Bennett, have raised the concerns of the Royal College of Midwives that the current cohort of midwifery graduates are not confident of getting roles in the NHS when they graduate. I know that the Government are refreshing their long-term workforce plan, but when we can expect to see an updated plan? Will it specifically address midwifery? How will abolishing NHS England affect the delivery of that plan? Who will be responsible and accountable for delivery? How will that transition take place?
I turn to my main focus—the support that we give to parents at that very difficult time following a preterm birth. The report makes clear that many parents will spend weeks or months caring for their baby in a neonatal care unit. They have to deal with the alien environment of a neonatal care unit and the feeling of daily amputation in being separated from their babies, but witnesses also emphasised the practical and financial challenges that parents can face in these circumstances. Babies might be being cared for at multiple hospitals, sometimes a long way from home. The charity Bliss found that one in four families with a baby on a neonatal unit have to borrow money or increase their debt to manage. The introduction of neonatal care, leave and pay, which became a right in April this year, was a really important step forward in supporting parents at such a difficult time, and I pay tribute to all those—particularly my noble friend Lady Wyld—who worked to make that a reality.
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It is not only the children born pre term for whom we can do better but the parents who are to care for these children. A survey showed that 24% of parents showed signs of post-traumatic shock. As one mother said:
“Life before the neonatal unit is mostly irrelevant when you find yourself stood, post-partum, next to your baby in an incubator, hoping and wishing that you make it out safely … The vulnerability is beyond crippling”.
The impact of prematurity does not end upon discharge from the neonatal unit. The experience stays with you for life. As this quote demonstrates, preterm birth can be sudden, unexpected and have significant—sometimes lifelong—impact on those born pre term and on their families.
Many parents will spend weeks and months in hospital caring for their babies, often in hospitals that are a long way from home, incurring practical and financial difficulties. A mother of twins, who were born very pre term and cared for in two different hospitals because of lack of capacity of neonatal beds, described vividly to us her daily difficulties and the stress it caused her to travel between two hospitals as she visited and cared for her two tiny babies.
Some 75% of intensive neonatal care units do not have accommodation for parents. Most have poor facilities, even for mothers to express breast milk or rest. Evidence we received clearly showed the benefits of involving parents in the care of their preterm babies—so-called integrated care, where parents and all health professionals are involved in the care of the baby. The involvement of parents in the care of their babies not only improves outcomes but, importantly, gives parents the confidence they need when the time comes to take their baby home. There is a need to make integrated care more widespread.
Although we will not completely prevent preterm birth, our inquiry clearly showed that we can reduce its impact with better policies for the care of babies and support for parents. For example, the Saving Babies’ Lives Care Bundle, developed by NICE and NHS England, has guidelines that would improve outcomes if implemented in full. The evidence we got showed wide variation in the use of these guidelines in important areas such as the timing of the clamping of the umbilical cord—noble Lords might be surprised by the effect that has on the outcome for both preterm and term babies—the timing of the administration of steroids to mothers prior to birth, the use of non-invasive ventilation, and several other areas. The result is poor outcomes for babies. There is an urgent need to implement the guidelines more widely and eliminate the variation in care. What role does the Minister think the Department of Health and Social Care can play to bring about this change?
We also heard of the challenges parents face after discharge from hospital. Community services not only lack capacity but often do not have the training required to be of any help to parents. In his report, the noble Lord, Lord Darzi, highlighted the important role of health visitors in the early years development of children. Shortages of not only health visitors but midwives, specialist neonatal nurses, neonatologists, physiotherapists and clinical psychologists all impact on outcomes for babies born pre term. A recent report from the Royal College of Midwives says that newly qualified midwives are worried about not getting a job; that cannot be right when we want to expand the midwifery workforce. Can the Minister give an assurance that the workforce issue will be addressed in the NHS 10-year plan?
National guidelines stipulate the need for a series of assessments of children born preterm prior to starting school, particularly at ages two and four. Delivery of this is, at best, inconsistent; in the majority of cases, it does not happen at all. Figures show that at age two, 85% of babies born pre term are followed up, but this drops to 6.7 % at the crucial preschool age of four. There is a need to urgently address this issue; I hope the Government will take urgent action to do so.
I come now to the important issue of prevention and reducing the incidence of preterm births. The prediction and prevention of preterm births are challenging because of the wide range of factors that contribute to a woman’s individual risk, with many having no risk. Studies reported to us showed a strong association of preterm birth linked to smoking, the socioeconomic status of parents, and ethnicity. These need urgent attention if we are to reduce the incidence of preterm birth. I hope the Minister will comment on how the Government intend to address each of these issues. We explored the role of screening methods to identify women at risk of preterm birth. We came to the conclusion that better-designed, more focused studies to find the right screening methods are needed, if that can be done.
Despite this, there are opportunities to reduce the incidence of preterm birth. When will the Government revise the maternity safety targets and focus efforts to reduce the rate of preterm births across all groups of women? Do the Government have a target reduction for the preterm birth rate? Providing women with information prior to pregnancy about their general health and lifestyle should be an important part of reducing the incidence of preterm birth. Does the Minister agree that this should be part of the Government’s women’s health strategy? There is currently underinvestment in pre-pregnancy advice. The Government’s 2024 manifesto said:
“Labour will prioritise women’s health as we reform the NHS”,
and in her evidence to the committee, the Minister said that the Government intend
“that the health of women is optimised before we get to pregnancy”.
There is an opportunity today for the Minister to say how this will be done.
The consequence of being born pre term, particularly very pre term, weighing as little as 600 grams, with the body organs that sustain healthy life not fully developed, would be death or lifelong disability for many. With the provision of good care, the outcome for not just a few, but many, will be better, so why would we not put policies in place to do so? I beg to move.
There are disparities in the rates of preterm births. Preterm births disproportionately affect marginalised groups. Among black women, the rate is 8.5%; among Asian women, it is 8.3%; and among white women, it is 7.7%. These disparities are rooted in structural inequalities such as poverty and unequal access to proper healthcare for pregnant women. Women should be being seen regularly. They should know that they must keep these appointments, and if they do not, this must be followed through.
Further, we should have much more advertising and education for women and young girls about becoming pregnant, how you must be looked after and how you have to look after yourself. If something is not right when you are pregnant, you know yourself that it is not right. It should not be for the nurses to say, “Oh, go away and come back next week—it’s nothing”. They should let you come in and be checked. I know some people will be more nervous than others, but that would also save lives and prevent other awful things from happening.
There are poorer maternal health outcomes due to unconscious bias in healthcare settings. Addressing preterm birth requires confronting the underlying social determinants of health. We need much more understanding by social workers and counsellors. We also need more understanding of what is needed and for people not to be isolated. Sometimes, if someone has a problem—if they lose a baby or take a baby home that needs help—they are isolated and left on their own, sometimes in pretty terrible accommodation, and they do not see anybody. Again, we should be giving support. The Government should do that, because of the impact it has on families and the other children in the family.
Parents of preterm babies experience high levels of trauma, anxiety and uncertainty, and an increased risk of postnatal depression. That has a terrible effect on the marriage, on the other children and on how the baby is being looked after. Nearly 40% of mothers with preterm infants report clinical symptoms. There are challenges due to separation, impacting emotional and developmental outcomes. People leave them alone. The husband or partner does not always come home because they cannot always understand what is wrong. It is really important that we try and get these clear messages out that everybody needs to support each other.
There is also the financial strain of travelling, as the noble Lord, Lord Patel, mentioned, when babies are miles away from where their parents live. They are kept separately, and their parents are expected to come back and forth, where there is no accommodation for them in the hospital. They should be able to stay at the hospital, even if it is nearby. This is really bad. One has known what this is like—we have all had people we have had to support.
There is the loss of income, and parents get exhausted. They have to apply for extra entitlements, which take a long time to come and with which nobody is very helpful. They have to do it online, but they are not always capable or up to it because, emotionally, they are worried about what is happening to the baby and to themselves. This places additional emotional and administrative pressure on families.
As I said earlier, social isolation is a real problem. We really have to look at pregnancy in a completely different way than it has been looked at in the past. It is not just the case that you have a baby and then you will be fine. Today, we have to give much better care both to the baby and to the mother and father.
We must ensure continuity of care, not only for the children whose life chances depend on timely support in those critical early years but for the parents, who too often bear the troubling impacts of preterm birth in silence. The noble Baroness, Lady Goudie, also discussed relationship breakdowns; I do not know the figures, but I imagine that it puts an enormous strain on relationships, and that then makes the whole situation even more difficult.
Further, I am very pleased that the committee has reiterated what many in the field have long known: despite remarkable advances in neonatal care—which we absolutely must acknowledge—we are failing to make meaningful progress in mitigating the real risks of preterm birth. Without adequate and sustained funding, the field remains fragmented and under-researched. The reality is that pregnant women, quite rightly, do not want to take drugs, so there is not as much money going into the pharmaceutical research element because they cannot sell as many drugs as they might like to. I am not being cynical; that is the reality.
When I first proposed this inquiry, only 2% of the health research budget went towards reproductive health per annum, and I suspect that this figure has not massively shifted in the last two years. Clinicians and researchers continue to find themselves competing for diminishing pots of money, leading to vital projects faltering. This is of course not the only sector that has this issue.
However, there is hope. I draw your Lordships’ attention to the work of the medical research charity, Borne. I declare an interest in that its medical lead, Professor Mark Johnson, delivered my third baby. He has set up an amazing charity that focuses on preterm birth and I am very grateful for its work. It recently launched the Borne Collaborative, an initiative bringing together leading experts from across the globe, not to compete but to co-operate. These experts have given their time and expertise to help set clear strategic priorities for research and investment, helping to deliver evidence-based road maps to prevent preterm birth. I highlight and welcome that work.
This is precisely the kind of strategic direction that we lack at a national level. The current governmental proposals do not yet go far enough. The data speaks for itself. That is why I urge His Majesty’s Government to consider alternative and more rigorous approaches to preterm birth reduction. Among them should be the establishment of a national task force, a central body charged with the oversight of research, prevention, and intervention strategies, and supported by experts. Such a task force could ensure coherence in research funding, reduce variation in care across the regions—we know that there is always a huge postcode lottery—and develop effective therapies and care bundles. With better co-ordination, real-time data collection and resource sharing, we can move from reactive care to proactive prevention, which is what we need. This sort of strategy applies across many issues in government.
We must act now, not just with warm words and symbolic gestures but with meaningful and clear commitments. Without them, women and families will continue to bear the burden of a system that often forgets them.
In 1987, I met a lady called Pamela, who had three preterm babies. They all died. She had one boy who died a few weeks after birth, in addition to the three who died before birth. She also had at least six miscarriages; she thought that she had had more, but she felt that the doctors were not regarding them as miscarriages. She had this constant problem. At one stage, her partner, not surprisingly, left her.
Pamela went on, finally, to deliver James. He was born premature and severely disabled at birth. It became obvious much later, when the medics came to look at him, that there was a genetic disease. The diagnosis of Lesch-Nyhan syndrome, a rare disease which usually affects boys but not girls, was finally diagnosed. Indeed, he was so disabled that he lived strapped in a wheelchair. He was not able to move his arms deliberately, because if he did, he would mutilate himself. Eventually his teeth were extracted because he was biting off his lips and tongue. That is the nature of that disease, which of course causes miscarriage.
After the diagnosis was made, we started to get very concerned about whether we could do some research to understand what was going on. We took three years to identify the diagnosis of Lesch-Nyhan syndrome in embryos. Two embryos were transferred at different stages, but Pamela did not get pregnant. Eventually, she had a normal baby, free of the disease, some four years after we started the research. Her NHS treatments, as noble Lords might imagine, were pretty costly. In fact, the costs of looking after that woman and her children were very considerable. Our research was not funded; in fact, we got our inadequate funding mostly by persuading women to cycle around the world on different bike rides. Those women raised huge sums of money because they felt very compassionately about the cause.
There are at least 23 million miscarriages annually, which means that about 44 pregnancies are lost every minute. The pool of single miscarriages is very high: over 15% of pregnancies are lost in this way. It is a massive medical problem, which is indeed linked to premature birth; sometimes it is a marker for premature birth. That is why we therefore have to consider these things together and why I am focusing on this in my speech today. If you add in premature births, you start to see the colossal consequences in handicap that we have seen, as well as the grave psychological problems that affect people. We need to consider this and ask: why is this happening?
When you look at world figures, it is very puzzling. In the studies of miscarriage, for example, prevalence varies across the world. You might expect it to be much more common in areas with poverty, but let us look at this in detail. Ethiopia is the country with the most serious miscarriage rate that I could find; it is about eight times more common there than it is in the United Kingdom, and the country is certainly very poor. It is also far more common in Guyana and Bolivia. In Eritrea and Zambia, miscarriage is quite prevalent, but in Malawi, which is perhaps the poorest African country of them all, the rate is actually not much dissimilar from that in Britain. That is very interesting, but quite unclear. It is clearly not related to the causes that we imagine are associated with poverty—poor nutrition, smoking and so on. There are a lot of other things going on.
There are many things that we could do which have not been mentioned here. One is this: we have to understand, and have much better recognition of, people who are going through miscarriage, with the proper recording of what is going on and, indeed, with much more investigation at the expense of the health service. I plead with my noble friend Lady Merron that she might see how we could do that. These investigations are not that expensive, but pathology should certainly be part of it. Unfortunately, that is often missed out. We do not look at the products of conception when the miscarriage occurs; they are just ignored. Women come out of hospital without any idea of what has happened, feeling absolutely desperate and bereaved.
It is worth bearing in mind that these women remember the date of the miscarriage years afterwards. They do not have a funeral and they do not have any recognition from other people of what they have gone through; they do not even tell people at work, because of course they cannot. They, along with their partners, have to suffer alone, and sometimes with the very serious problem of continuing infertility, blood loss, and generally feeling really unwell from having had an anaesthetic and an operation, having never been in hospital before for any serious disease. We have to recognise that this is so important.
We have a great opportunity here to do that which we do so well in Britain. We are extremely good at cohort studies. We have, among other things, one of the best examples in Biobank. Biobank is making a massive difference at the moment. If you take the world of ophthalmology, we now begin to understand that Biobank is giving us clues as to the causes of macular degeneration, which has a whole range of causes, just like infertility and other such things. We can now see specific genetic predispositions, which in the next few years is going to lead to much better treatment of this blindness, which prevents people being in work, for example.
I urge the Government to think about this, because this scientific research is much needed. There is a strange paradox here. In the data Bill, we have discussed science, but we have forgotten that science is often due to serendipity; it is not related to careful recognition. Looking at figures in the right way is serendipitous. It is very likely indeed that, if we did that properly, with proper data collection, we would end up with some very useful hypotheses. If we did that then we would be able to focus research on the areas that are most relevant, and we would make real progress in treatment.
This would be so much more than a blanket funding of lots of research. I do not think that that is what is needed. The research councils show that they have been funding up to 35% of grant applications, which is a very high number and much higher than in most other areas of medicine. What we need is much better research, and we need to do it if we are going to change the heartache and suffering, which is so often ignored, with totally healthy women going through this and being ignored. We need to do something about that. It would not mean masses of expense, but it would mean looking at how we do data collection in the NHS a bit better—which we can do—and trying to focus where we are going with better research, which, at the moment, is not in fact present.
Our committee acknowledged the complexity of preterm birth. Witnesses expressed different views about the usefulness of just one overarching target of a reduction to 6% by 2025, which the Minister has acknowledged will be missed. None of this means that, from a policy perspective, preterm births should be put in the “too difficult” category. The Government have rightly accepted the principle that we need to address focus on tackling the stark and unacceptable inequalities, including the rate of preterm births, that exist for black and Asian women and babies, and women and babies from the most deprived backgrounds. The Government therefore need to set out how they intend to get there. Given that it is almost seven months since publication of the report, I would be surprised if the Minister was unable to say where the Government have landed on targets or whether they have come to a view.
I want to focus in the main on several recommendations from chapters 4 and 5 of the report, in which we examined how to improve the outcomes for preterm babies and the experiences of their families. As we have heard, many babies who are born early flourish, but during our committee sessions we heard from witnesses for whom that has not always been the case, including Francesca and Nadia, both mothers of preterm twins. I cannot do justice to that session in the time available today, but their campaigning call for all parents to be properly supported in the care of their babies born in hospital and on their return home must be acted on by the Government.
It seems to me astonishing that so many of us will stand up today in Parliament in 2025 and have to argue the case that all parents must be able to stay overnight with their tiny and unwell babies in neonatal units, including neonatal intensive care. They should be involved in their baby’s care as much as possible and should be able to hold them. They must be listened to when their instinct tells them that something is wrong. The charity Bliss outlined evidence showing that family integrated care leads to a range of benefits, including increased weight gain, improved breastfeeding, and reduced rates of mortality and morbidity.
If the Government and the NHS agree with this, why have they not yet published the review of the NHS maternity and neonatal estate survey, as requested by the committee and promised “early in 2025”? In answer to a Written Question I tabled in April, the DHSC said that NHS England would do this “shortly”, and we are now in June. Is the Minister able to give a definitive date for this to be published? Given that we await the NHS 10-year plan, can she say what consideration has been given to the need to extend and improve accommodation in neonatal units?
As we have heard, we made it clear that the impact of preterm birth does not end once families go home. Despite the fact that up to 40% of mothers experience symptoms of post-traumatic stress disorder six months after a preterm birth, witnesses told us that counselling after a preterm birth is either “not in place” or “not offered as standard.”
I raised the wider issue of perinatal mental health in the House last month. Can the Minister expand on the answers she gave then to address the committee’s recommendation that the Government and NHS England should detail the steps they are taking to ensure equitable access to neonatal outreach and perinatal mental health services for all families who experience preterm birth?
This ties closely to recommendation 8 on the need to develop specialist knowledge of the needs of preterm babies and their families into health visitor training and continuous professional development, with protected training time. As my noble friend Lady Bertin mentioned, it is people and relationships that can help others turn corners.
Finally, I turn to one of the most disappointing findings of the report, which is that the follow-up assessments for children born pre term that are recommended by NICE
“are not being consistently delivered, in particular at age four”,
as was outlined by the noble Lord, Lord Patel. I think I speak for the whole committee in saying that we were highly dismayed that neither NHS England nor the DHSC could explain why this was the case or who was going to grip it. I know that the Government are in the process of an NHS restructure; I am certainly looking not to open up that debate today but, rather, to emphasise the committee’s desire to see swift resolution here. I would be most grateful for a precise answer from the Minister.
To sum up, although there was a huge amount of specialist knowledge and experience in this report, at its core, it is very simple: we can and must do better for babies, mothers and families. The most powerful evidence comes from those parents who have campaigned with a quiet dignity to spare others the pain that they have experienced. I feel a huge responsibility to keep up the momentum to deliver change for them; I reiterate to the Minister my commitment that I will work cross-party to try to do just that.
Finally, I wish to focus on the observation made by the committee around research. During an evidence session, I was particularly surprised by the lack of both research and funding for research taking place into the causes of preterm birth. The committee rightly highlighted the need to push for more research into pregnancy and to further our knowledge of the mechanisms of preterm labour. Not only is greater knowledge of this area critical to improving the life outcomes of those who are born too early but, importantly, from a government perspective, the evidence from economic modelling for England and Wales suggests that, if we could delay preterm birth by one week across gestational ages, it would lead to a cost saving of £1.41 billion per year. The British Association of Perinatal Medicine suggested that investment in simple, low-cost interventions will engender longitudinal cost savings in healthcare and education many times over.
I am pleased with the positive response from the Government on the report’s findings, but it is vital that we continue a watching brief, ensuring that commitments are followed through and recommendations are implemented as quickly as possible to improve the lives of babies born pre term in our society so that they can not only survive but go on to flourish.
The data on preterm birth and neonatal mortality is not nearly good enough, but it is clear that minority communities are suffering a double, intersectional disadvantage. Let me make a statement of the obvious: reducing deprivation and poverty would reduce preterm birth. I do not believe that anyone would disagree with that. Drawing on the Bliss briefing, I ask the Minister this: in terms of the Government’s response to the committee’s first recommendation, what are the future metrics, targets and ambitions? Are the Government making progress in that area?
Most of my speech will address an issue that no noble Lord has yet addressed—nor, I suspect, will address. I am going to focus on One Health and the environmental health aspects that undoubtedly contribute to preterm birth, even if we do not understand the precise details.
Our environment is in a terrible state, and those who are pregnant are particularly vulnerable to that disastrous environment. Our planet has been choked in plastics and soaked in pesticides. We have seen drugs ending up out in the environment, creating antimicrobial resistance and other deleterious medical effects.
I start with a deeply shocking study, which came out after the committee reported. It is only one study, but it is seriously indicative. It was presented to the Society for Maternal-Fetal Medicine’s annual meeting early this year—the pregnancy meeting. Investigators at the University of New Mexico analysed 175 placenta, 100 deliveries at term and 75 pre term. The level of microplastics and nanoplastics in the placenta was significantly higher with the preterm births and much higher than previous levels of microplastics and nanoplastics that have been measured in human blood. Clearly, the placenta is concentrating microplastics and nanoplastics in the maternal blood. However, what is deeply concerning is that the preterm births have higher rates than the full-term births, which is counterintuitive. If this was a gradual accumulation over a time that was not associated with the preterm birth, you would expect the longer-term ones to have more plastic.
I come now to PFASs, generally known as “forever chemicals”. Two studies were published in 2023 showing an association between the level of PFAS in maternal blood and the rate of preterm birth. The study in environmental health, Siwakoti et al, showed that it was particularly affecting male babies, and that the accumulation in male babies was higher than that in female babies. Noble Lords here who are experts will tell us that male babies are more fragile at birth. PFAS is concentrating more in those babies, with potential effects which we do not yet understand but which are deeply concerning. Another study, from the Emory University, found that mothers with higher levels of PFAS in pregnancy are 1.5 times more likely to have a baby born three weeks before their due date or earlier—the preterm babies we are talking about. The early term, one to two weeks before, is also raised.
We also know that we have pesticides all around our environment. Noble Lords might have seen a recent environmental study which showed extraordinarily high levels of glyphosate—the chemical to which we are all very heavily exposed to—in tampons. Glyphosate in maternal blood levels is associated with higher levels of preterm birth. More broadly, on pesticide exposure, a lot of this is uncertain, and all of it is very complicated, but another a meta-analysis suggests some of the ways in which pesticides might be having impacts on preterm birth. They might be triggering inflammation and oxidative stress and disrupting endocrine functions.
Finally, there is the microbiome. The noble Lord, Lord Winston, mentioned our starting to understand that the vaginal microbiome is significant in terms of preterm birth and many other aspects of health. A study from 2023 showed that there was a unique genetic profile in the microbiome of preterm births. There was a higher richness of diversity of microbes and a greater diversity of antimicrobial resistance genes. We have here a real problem with the vaginal microbiome and issues that we do not yet have much understanding of. Unfortunately, the noble Lord, Lord Leong, is not currently in his place, but I cross-reference here the debate that the noble Lord and I had, and an amendment that this House voted on, about regulating period products. An issue that I raised in the context of period products was reusable period products that have high levels of silver and nanosilver, which demonstrably have negative effects on the vaginal microbiome. Also, with the tampons I was talking about earlier, there are the pesticides but there is also evidence of heavy metals, which will have impacts on the vaginal microbiome.
I apologise for this having been a rather depressing speech. However, this situation is not inevitable. Companies are making products that are threatening the health of all of us very broadly, but particularly the most vulnerable in our society—those who are pregnant and the young babies who will be born prematurely. This is an area in which we need urgent government action. I have cited very recent studies, and the knee-jerk reaction to the Government from the Civil Service on these kinds of issues tends to be, “We’ve got to wait for more data and information”. However, if noble Lords look at the list of things that I have gone through, they will see that each one was a case where researchers were looking at one product and one factor, in isolation. No pregnant person is exposed to just one of these factors; everyone is being exposed to all of these as a cocktail, and the levels of all of them are going up all the time. Once we have put them out into the environment, we are unable to take them out. Surely, on preterm birth, on the state of the health of the nation, we need to apply the precautionary principle and take urgent action to rein in the corporates who are exposing us to all these threats.
With any such scheme, there are some limitations. If your baby spends six days or fewer in neonatal care, you do not qualify for any additional leave, despite mum and baby possibly having significant health concerns that need proper support. The leave is paid only at the statutory rate that we have for all parental leave, which is currently at around £187 a week.
Because we have such a poor system of paternity leave in the UK, with fathers entitled to only two weeks of leave, this has a particular impact on dads’ and second parents’ ability to support mothers and their new babies at such a crucial time.
I will give an example from the charity Bliss. A baby is born struggling to maintain their temperature and spends three days receiving transitional care in hospital before being discharged. A few days later they are readmitted, as they are struggling to feed and have jaundice. They receive six days of care in hospital before being discharged. Neither episode of care lasted seven days or more, so no neonatal care leave is accrued. It is perfectly possible that, at precisely this point, a dad’s paternity leave has run out and he has to return to work, despite a premature and vulnerable baby who has had repeat hospitalisations being at home, and despite a mum who may have had a traumatic birth, or even if not, if she had a C-section she will still be in recovery from surgery, being left alone to care for herself and her vulnerable baby.
This is not to criticise neonatal care leave or pay in any way, but to say that parents of preterm babies, and indeed of all babies, would be far better supported if we had a proper system of paternity leave and pay in this country, which neonatal care leave and pay came on top of. We have the worst paternity pay and leave system in Europe, and the biggest barrier to dads taking proper time off when their babies are born is affordability.
As my noble friends Lady Wyld and Lady Owen have highlighted, family integrated care can make a huge difference for babies who are born pre term. But the report notes the potential disparity in access to that family integrated care for those on lower incomes. As a parent advisory group highlighted, fathers and non-birthing parents often have to return to work while their baby is still in neonatal care. Even mothers and birthing parents who are self-employed face this dilemma. This has a detrimental impact on implementing family integrated care and on parent-to-child bonding. If we increase paternity leave to six weeks paid at 90% of salary, with a cap for higher earnings, that will resolve the dilemma for so many families who experience preterm births.
The Employment Rights Bill currently being debated in your Lordships’ House gives us the opportunity to make that change. What is the Minister’s view on the impact that Bill will have on parents, particularly fathers and second parents of preterm babies? I think we have an opportunity to ease the burden for thousands of parents who struggle with the practical as well as emotional impact of having a baby pre term, whether or not they are in neonatal care, and I hope she will join me in seizing it.