Black Maternal Health Awareness Week

[Gill Furniss in the Chair]

14:30:00

I beg to move, That this House has considered Black Maternal Health Week 2025. It is a pleasure to serve under your chairship, Ms Furniss. Before I get to the crux of this debate, I want to begin by saying that the UK is one of the safest countries in the world for a woman to give birth. I say that at the outset not to diminish the importance of this debate, but to move beyond that platitude—because in the sixth largest economy in the world, this should be one of the safest places to give birth. It is important that we move beyond that and focus on the real and persistent inequalities facing black and minority ethnic women in maternity care. While I am sure it is not the intention to focus on that, it can give the impression that, because the UK is broadly safe, the negative experiences of some women are exceptional and not matters that require significant Government attention. When we detail some of the harrowing experiences of women and hear that response, it can feel as though our concerns are being minimalised, so I hope the Minister will appreciate that I have got that part out of the way. While the UK is among the safest places to give birth, it is by no means perfect, and for many women it is deadly. As always, it is vital to lay out the current state of affairs. The disparities in maternity care are evident not only in maternal mortality statistics, which show that black and mixed heritage women are three times more likely to die during pregnancy or childbirth as white women, and Asian women twice as likely, but in many other areas. Miscarriage rates are 40% higher in black women, and black ethnicity is now regarded as a risk factor for miscarriage. MBRRACE-UK’s 2023 comparison of care for black and white women who have experienced stillbirth or neonatal death found that the majority of all significant issues were identified in antenatal care for 83% of black women, compared with 69% of white women; 67% of black mothers and babies had a major or significant issue related to pathology, compared with 46% of white mothers and babies; and 75% of black parents and 66% of white parents had significant issues identified during the follow-up or reviews of their and their baby's care. Public Health England’s 2020 report found that prematurity is a major cause of long-term infant morbidity. Black mothers, particularly those of black Caribbean background, are twice as likely to give birth before 37 weeks. In Five X More’s “Black Maternity Experiences Report 2022”, 27% of the 1,340 survey respondents felt that they received “poor” or “very poor” care during pregnancy and labour, and postnatally. Forty-two per cent of the standard of care during childbirth was “poor” or “very poor”, and I sincerely hope that the findings of Five X More’s next survey, which is currently under way, will show some improvement here. According to Bliss, many babies born to black mothers require specialist care after birth, particularly due to preterm birth or full term complications, yet significant inequalities persist in neonatal care, admissions, the quality of care received, and outcomes after discharge. Poor care received at such an early stage of life can have critical consequences and lead to long-term health complications for black babies and deepen trauma for their families. Post-natal mental health disparities are also significant; UK studies show that women from black, Asian and minority ethnic backgrounds are more likely to suffer from common mental health disorders, yet are less likely to access treatment.

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

I thank my hon. Friend for his intervention; he is absolutely right. I re-emphasise the point that black, Asian and minority ethnic women are more likely to suffer from common mental health disorders, yet are less likely to access treatment. According to MBRRACE-UK’s “Saving Lives, Improving Mothers’ Care” report from last October, deaths from mental health-related causes accounted for 34% of deaths occurring between six weeks and a year after the end of pregnancy. It is vital that all those who experience pregnancy and childbirth receive mental health support, even if they do not necessarily present as struggling with their mental health; but that is especially true of black, Asian and minority ethnic women, who are more likely to have a negative experience during pregnancy and childbirth. Some of these women’s experiences are deeply traumatic and scarring, and can lead to several mental health problems. Despite that, they are less likely to access mental health support, so they are left to try to recover mentally from the experience on their own. That disparity exists beyond pregnancy and childbirth, and even before conception. According to the Human Fertilisation and Embryology Authority, black women are 25 times less likely to access fertility treatment, and NHS-funded in vitro fertilisation cycles among black patients decreased from 60% in 2019 to 41% in 2021. Black and Asian patients aged 18 to 37 had the lowest IVF success rates compared with white patients in 2020-21, and non-white groups also struggled to access donor eggs, with 89% of egg donors being white, 4% Asian, 3% of mixed heritage and only 3% black. During the International Women’s Day debate, I highlighted the latest MBRRACE-UK data, which showed a statistically significant increase in the UK’s maternal death rate in the years 2020 to 2022, even when excluding deaths caused by covid-19. Put plainly, more women and babies of all races are dying in the UK now than in the past two decades. This is incredibly worrying, and it means that black women, who often face the worst care, are likely to experience even further deterioration. When I was researching the latest statistics and figures for this debate, it became increasingly apparent that the data on racial disparities in maternity care is limited and scattered. The data I have cited comes from a collection of reports by various medical bodies and advocacy organisations. Racial disparities are often identified as part of broader studies but, as far as I know, to date there has been no comprehensive medical study dedicated exclusively to racial disparities in maternity care and outcomes, despite the statistics consistently showing how bad things are becoming. The Lancet’s recent study on maternal mortality and MBRRACE-UK’s reports do include racial breakdowns, but they are based on the data that they have, not the data that they need. A single, dedicated study is yet to be conducted. The lack of comprehensive research makes it incredibly difficult to see a full picture of what is happening, so I hope that the Minister will address that point and highlight what the Government are doing to get a clearer picture of the state of maternity care. There is no one driver of the racial disparities in maternity care and outcomes. The causes are multifaceted, but overwhelmingly they are the result of a combination of structural racism, unconscious bias, gaps in culturally competent care and socioeconomic inequalities. The first two are incredibly important to highlight. Without acknowledging that the NHS has an issue with institutional racism and unconscious bias, we cannot address the problem. Those issues feed into the quality of care being delivered for black mothers and their babies. The inaccurate and dog-whistle assumptions around black women’s pain tolerance, for example, can lead to women being denied pain medication during childbirth, or misbelieved when raising concerns about pain felt that signals a severe medical condition. Those beliefs are not taught in medical school or during training, yet so many black women have come across a nurse, midwife or doctor who holds them. They are a direct result of institutional racism in the NHS and have a direct impact on the care that women receive. It is important to note that, although racial disparities in maternity care are experienced regardless of class, occupation, education or geography, socioeconomic inequalities are still a very important factor in determining health outcomes and experiences. Women living in the most deprived areas have a maternal mortality rate more than twice that of women living in the least deprived areas. Black and minority ethnic people are 2.5 times more likely to be in relative poverty and 2.2 times more likely to live in deep poverty. The combination of socioeconomic inequalities and institutional racism in the NHS is having a dual impact on black mothers’ experiences of maternity care and health outcomes. Much of the previous Government’s work to improve maternity care was focused on co-morbidities and socioeconomic drivers of poor health. Indeed, it is crucial that those areas are addressed, but without looking at the structural racism and unconscious bias in the NHS, the problems will persist. I want to recognise the campaign groups that are pushing the issue up the political agenda. In the absence of concrete Government or NHS action, advocacy groups have stepped in to offer their solutions and recommendations. Where they can, they also offer alternative care and training. First—always first—I commend Five X More, which established Black Maternal Health Awareness Week in 2019. Its work empowers black women to make informed decisions during pregnancy, and it advocates for systemic change. It is currently conducting its second national survey, building on its impactful 2022 research. Five X More is calling for a measurable Government target to end racial disparities in maternal death, a commitment that the Labour Government support but have yet to implement. I hope that the Minister will confirm today whether such a target will be set, how it will be measured and when we can expect it. Five X More also advocates for mandatory annual maternity surveys focused on black women’s experiences, compulsory anti-racism and cultural competence training for all maternity professionals, and improved data collection on ethnicity and outcomes.

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

My hon. Friend is absolutely right. These figures have been circulating for decades, but it was only after a successful parliamentary petition launched by Five X More that we first debated them in the House. We are now five or six years on and we are still in the same situation. Things have to change. I will continue to pay tribute to the amazing groups that have been pushing for decades to put the issue on the agenda. Mimosa Midwives is another remarkable group that offers culturally safe, continuous maternity care. It campaigns for a culturally appropriate care model in the NHS and for inclusive training in midwifery education to reflect diverse maternal experiences, because much of our medical training remains centred on white women. The Motherhood Group is a social enterprise supporting black mothers with peer-led services, training workshops and national campaigns. Its annual black maternal health conference brings together researchers, clinicians and service users to tackle disparities. It also launched the Blackmums app to connect mothers navigating similar challenges. Other charities such as Bliss, Tommy’s, Birthrights and the Royal College of Midwives also highlight racial disparities in their broader efforts to improve maternity care. Where the Government and the NHS have fallen short, they have taken the time to campaign and to step in. I will, however, acknowledge the positive steps that the new Government and the NHS have taken. In response to my written parliamentary questions last month, the Government outlined some ongoing measures. Every local maternity system must now publish an equity and equality action plan that sets out tailored actions to reduce disparities, especially for ethnic minority women and those in deprived areas. I welcome the roll-out of version 3 of the Saving Babies’ Lives care bundle, which aims to reduce stillbirth, neonatal death, pre-term birth and brain injury. Maternal medicine networks are being established to ensure equitable access to specialist care for women at heightened risk. Those efforts are supported by the NHS equality, diversity and inclusion improvement plan, which was launched in 2023. That plan requires NHS organisations to tackle workforce discrimination, improve leadership accountability and foster an inclusive, harassment-free environment. I am also pleased to note that NHS England is developing a respectful and inclusive maternity care toolkit to support inclusive and culturally competent practice. Those are all really welcome developments, but much more is needed. I will close with four questions for the Minister. First, will the Government commit to a statutory inquiry into racial disparities in maternity care, including testimony from affected families and frontline providers? Secondly, will the Government fund dedicated research into the medical complications disproportionately affecting black women during pregnancy and childbirth? Thirdly, will the Government commission a review of maternity training across all medical professions, to better equip practitioners in recognising complications and symptoms in black women and babies? Finally, do the Government acknowledge the presence of systemic racism within the NHS? If so, what steps are being taken to confront and eliminate it? It is good that in the past few years, the House has taken the time to acknowledge these issues and allow us to debate them, but even though the Government stated in their manifesto that a target will be set, we now need to see action. We cannot continue to see gaping inequalities in maternal outcomes.

14:45:00

It is a pleasure to serve under your chairship, Ms Furniss. I congratulate my hon. Friend the Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) on securing today’s important debate. She has highlighted that black women often receive a worse standard of care and that their risk of maternal death is three times higher than for white women. The situation in Nottinghamshire demonstrates why change must happen quickly. As some in the Chamber will know, there is currently an independent review into maternity services at Nottingham University Hospitals NHS trust, led by Donna Ockenden. I first called for this review when I was a councillor after my experience of giving birth to my son in 2020. I knew then, as I know now, that women accessing services at NUH do not always receive the care they deserve, nor are they listened to when they raise concerns. Ahead of today’s debate, I reached out to Donna Ockenden and her team for their perspective on black maternal health in Nottinghamshire so that I could highlight it here today. When the Donna Ockenden review was established in Nottingham two years ago, the Nottingham University Hospitals trust could not share a single named contact within the black community, nor did the trust have any meaningful engagement with the many groups across Nottinghamshire. It had no way of reaching into groups of black women who might have been affected by poor maternity care. The translated resources provided by the trust were also very limited. It is therefore unsurprising that trust between black communities and Nottingham University Hospitals trust was at an all-time low. As Donna Ockenden rightly emphasised to me, that only increased the risk that women and their families would disengage from vital health services and be unable to give informed consent to treatment through their maternity programme. I am pleased to say that the review’s work so far is leading to some improvements in the NHS, and I believe it is important to acknowledge that progress even if there is still so much further to go. Since the review began, Donna and her team have met many community groups across Nottinghamshire and attended numerous church services and meetings in the majority black-led churches. They have also appeared on the famous Kemet FM, a local community radio station that focuses on the music, wellbeing and culture of Nottingham’s African and Caribbean communities, broadcasting across the east midlands and the Caribbean. Following that outreach, many black families have come forward to the review, and community engagement has strengthened as the review has progressed. I am pleased to report that these learnings are shared with the trust in bimonthly learning and improvement meetings, although it has taken years to build that relationship with local communities and to establish trust. That is essential not only in providing safe care that is reflective of the population’s needs, but in ensuring that the voices of black women are no longer ignored. It is clear that there had been little or no communication for so long. However, it is important to acknowledge that not every trust has a Donna Ockenden. They do not have somebody reaching out to black communities and black women to find out what is happening and how they are affected by health services. I know that the last 14 years have had a hugely detrimental impact on maternity services across the country. The only way we can begin to fix them is by tackling the underlying issues in the culture of the NHS. It is important to note, as I have just said, that not every NHS trust has a Donna Ockenden and the level of scrutiny that happened in Nottingham. As the newly elected chair of the all-party parliamentary group on maternity, I am committed to working with the Government on a health strategy for maternity services that recognises how inequalities have a huge impact on the care that people receive. I therefore urge the Minister to ensure that the experiences of black women are at the heart of any forthcoming maternity strategy, and that trusts are strongly encouraged to engage with communities so that their voices are no longer ignored. If inequalities are to be addressed, we require a national framework and a maternity strategy that is fit for the future.

14:50:00

I congratulate the hon. Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) on securing today’s important and timely debate, following Black Maternal Health Awareness Week earlier this month. Her opening remarks were comprehensive and thoughtful. I am always pleased to hear from the hon. Member for Sherwood Forest (Michelle Welsh), who is a passionate advocate for improved maternity services in Nottingham and across the UK; I am pleased to serve on the APPG with her at the helm. Women are at their most vulnerable during pregnancy, as they carry another human life, and they deserve the very best care. They have more touchpoints with the NHS than they will have for most of their lives. We engage with the NHS when we are born and when we need to access care at the end of our lives. When we are carrying a child, we have more moments in front of medical professionals than for the majority of our lives. Following its inspection of 131 maternity units, the Care Quality Commission found that 65% were not safe for women to give birth, 47% required improvement on safety, and 18% were inadequate. The commission warned that it is concerned about the potential normalising of serious harm in maternity care. Those risks are particularly stark for women of colour in this country, for whom pregnancy continues to carry an unacceptable level of danger. As the Darzi report highlighted, black women are almost three times as likely as white women to die during childbirth, while neonatal mortality among the most deprived quintile is more than double that among the least deprived. That is nothing less than a national scandal. Maternity care is an issue close to my heart, having had two very different experiences giving birth in my local hospital in Chichester. I tabled an early-day motion on maternity care and secured a Backbench Business debate in this Chamber on that subject just two months ago. Like the hon. Member for Sherwood Forest, I am in regular contact with Donna Ockenden, who produced the Ockenden report. Her findings, along with those of Dr Bill Kirkup, show that the problems identified at the Shrewsbury and Telford trust and the East Kent trust are not isolated incidents. The same issues are systemic and widespread across many NHS trusts up and down the country. In preparation for the previous debate on maternity services as a whole, I spoke to families across the country who had experienced devastating failures in the system. They went into hospital expecting the joyful outcome of going home with a child, but instead they had to return without their baby, carrying the trauma of that experience for the rest of their lives. As the hon. Member for Clapham and Brixton Hill mentioned, the MBRRACE-UK report for 2021 to 2023 confirms that inequalities in maternal mortality rates persist, with a nearly threefold difference among women from black ethnic backgrounds, and an almost twofold difference among women from Asian ethnic backgrounds, compared with white women. Women living in the most deprived areas continue to experience maternal mortality rates that are twice those in the least deprived areas. Care for black women who experience stillbirth or neonatal death is often inadequate. Ethnicity is still not routinely recognised as a risk factor in, for example, the screening and prevention of conditions such as gestational diabetes. Births to black mothers are almost twice as likely to be investigated for NHS safety failings, and black mothers are twice as likely to suffer from perinatal mental illness compared with their white counterparts. I pay tribute to my hon. Friend the Member for Twickenham (Munira Wilson), who has long talked about these disparities. She introduced the Miscarriage and Stillbirth (Black and Asian Women) Bill in 2022, which sought to require the Secretary of State to lay annual reports before Parliament on efforts to reduce miscarriage and stillbirth rates among black and Asian women, but unfortunately it was not carried over into the next Session. When so many of our conversations in this House and in the other place are about the economic pressure we are under as a country, it is worth reflecting that, on top of the enormous human toll of this issue, failure also has a financial cost. Obstetric claims make up just 13% of clinical negligence cases handled by NHS Resolution, but they cost more than £1 billion a year, which is nearly 60% of the total cost. Across the country, families face unbearable grief and trauma because of failures in maternity care, and that burden is falling disproportionately on black women and families. We Liberal Democrats are committed to transforming maternity services to make the UK the safest place in the world to have a baby, and we fully support the work of Black Maternal Health Awareness Week in drawing attention to these critical issues. Our general election manifesto pledged to revolutionise perinatal mental health support, not only for those currently pregnant and for new mothers but for those who have endured miscarriage or stillbirth. We have been clear that the Government must, as a priority of the highest urgency, implement all the immediate and essential actions recommended by the Ockenden report. It is deeply concerning that, years after the tragedies at the Shrewsbury and Telford trust and the East Kent trust, failures are still widespread and efforts to address them appear piecemeal. When my hon. Friend the Member for North Shropshire (Helen Morgan) recently questioned the Department on the implementation of the Ockenden recommendations, it was alarming that it could not confirm whether the actions had been implemented, nor did it appear to have a system for centrally monitoring the progress. The Minister pointed to the three-year delivery plan for maternity and neonatal services as the Department’s main response. Deeper analysis shows serious shortcomings. Many measures in the plan have no meaningful numerical targets, which makes real accountability for the difference made by the plan very hard to track. Targets for expanding access to perinatal mental health support are being missed, even as some improvement is noted, and staff satisfaction indicators remain worryingly low, with some measures still recording fewer than half of staff expressing confidence in educational opportunities or in their management’s response to unsafe practices. The target set in 2010 to halve maternal mortality looks increasingly out of reach. Maternal mortality rates did not fall for a decade, and they actually increased between 2021 and 2023. Worse still, no updated data has been published for the last two years on the rates of serious brain injury, stillbirth, neonatal mortality or preterm birth. Without transparency and accountability, women will continue to be failed, and black women, who already bear the brunt of the disparities, will continue to be disproportionately harmed. That is why I ask the Minister to commit to reviewing these issues urgently, to meet me and my colleagues from the Liberal Democrat health team to discuss a more effective plan to improve maternity safety, and to set out a clear path to address the deep disparities in black maternal health. Alongside that, the Liberal Democrats are calling for a cross-Government strategy, led by the Department of Health and Social Care, with annual progress reports on reducing miscarriage and stillbirth rates among ethnic minorities. We also call for increased funding for public health initiatives, with a portion earmarked to allow communities facing the worst health inequalities to co-produce solutions tailored to their specific needs. We propose the establishment of a health creation unit in the Cabinet Office to lead work across Government to improve health and tackle inequalities. Black women have waited too long for their concerns to be heard, for the system to change and for justice to be done. We owe it to them and to every woman, family and baby in this country to get maternity services right. No woman should fear for her life or her child’s life because of the colour of her skin or the postcode that she lives in. We have to do better.

14:59:00

It is a pleasure to serve under your chairmanship, Ms Furniss. I, too, congratulate the hon. Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) on securing this important debate today. As she said in her opening speech, the UK enjoys some of the best outcomes in the world when it comes to maternity health, but there is always more work to be done to improve our outcomes further. I hope we can all agree that equal access to the best care, for all across our society, should always be our target. That should be based on excellence across the board as standard. We are considering Black Maternal Health Awareness Week, which is part of National Minority Health Month, and I welcome the opportunity to discuss this topic and exchange views with colleagues from across the House. Colleagues will know that as a clinician myself, I am always guided by data when assessing current healthcare practices and new policy proposals. A 2023 report by the maternal, newborn and infant clinical outcome review programme found that in the period from 2019 to 2021, 241 UK women died during pregnancy or up to six weeks after the end of pregnancy. That equates to a rate of 11.7 women per 100,000 giving birth. Each of those cases represents a tragedy for the woman and baby involved and their family and loved ones, and we must do all we can to prevent them. The data does, as has been mentioned, also show that women from black backgrounds face a mortality rate much higher than the average; it is equal to 37.2 per 100,000. Women from Asian backgrounds also face a higher rate, at 17.6 per 100,000. Clearly, those figures present a pretty stark picture, but we must exercise care in the interventions that we make, and balance our desire to solve the problem with ensuring that we do that in a way that resolves the problem without risking creating others. At the outset, it is crucial to ask what the Government are doing to understand the specific causes of these outcome disparities, because if we understand the causes, we will be better able to manage and treat them. The Kirkup and Ockenden reports have already been mentioned. What are the Government doing to ensure that those recommendations are fully implemented, and to develop a strategy to ensure that all women have the opportunity for a safe pregnancy and birth? What kinds of data held by the NHS and the Department of Health and Social Care might cast light on other demographic, economic or geographical patterns that contribute to these numbers, which we may be able to help to resolve? We know that the most significant factor in predicting death during the maternity period is a pre-existing medical condition, and we know that disparities exist in the incidence of some pre-existing conditions that are relevant between some ethnic groups in the wider population. For example, a 2018 research paper in the American Journal of Kidney Diseases found that rates of heart disease were 20% higher among the black community than those from white backgrounds, and rates of stroke were a remarkable 40% higher. Do the Government know how the rates of pre-existing conditions among ethnic groups are influencing the figures on maternal health, and how are they going to work to reduce the risks of such conditions among these groups to try to improve the care not just during maternity, but during the whole of black ladies’ or ethnic minority ladies’ lives? Maternal mortality itself arises from a number of conditions and causes. In the period from 2019 to 2021, for example, 14% of maternal deaths were attributed to cardiac disease, 14% to blood clots, 10% to sepsis and 9% to epilepsy or stroke. What are the Government doing to understand the prevalence of those conditions among ethnic groups, how the conditions can be prevented, how they can be identified in black women—indeed, in all women—how they can be better treated to save lives, how they can be better managed to save lives, and what research can be done to ensure that they are, if possible, prevented? Socioeconomic deprivation has also been mentioned, and it is important to consider the impact of deprivation. In the period from 2019 to 2021, 12% of women who died during pregnancy or in the year afterwards were at severe and multiple disadvantage. That included, in particular, women who had suffered mental health conditions or domestic abuse, or had a history of substance abuse. How do the Government understand these factors and their influence on mortality rates, and what are they doing to help to resolve those issues? Closer to home, in February 2022 the NHS Race and Health Observatory published “Ethnic Inequalities in Healthcare: A Rapid Evidence Review”. The authors of that report noted: “Tackling poorer care and outcomes among ethnic minority women and babies continues to be a focus within the…NHS England and NHS Improvement Maternity Transformation Programme Equity Strategy, which includes pledges to improve equity for mothers and babies and race equality for staff.” The Government’s abolition of NHS England risks placing that ongoing programme of work, like many others, in jeopardy. Will the Minister tell us the current status of the maternity transformation programme and the implementation of the equity strategy under the NHSE and DHSC reorganisation? How is that work being prioritised, given the many other demands on the Department’s time and resources—not least from the reorganisation—that might previously have been spent on improving care? The previous Government improved the number of midwives per baby and made progress towards the national maternity safety ambition of halving the 2010 rate of stillbirths, neonatal maternal deaths and brain injuries in newborn babies. When will the Government set out their ambition for the next decade? The Labour Government promised more than 1,000 new midwives in their manifesto last year. Will the Minister update us on how many of those 1,000 midwives are now working for the NHS? The Minister for Care recently stated that the 41 maternal mental health services are now live and will be active in every integrated care system by the end of 2025-26. How will the Government ensure that access to those services can continue when ICSs face such high cuts in funding? Colleagues have mentioned the possible influence of systemic racism or unconscious bias in maternal outcomes. The NHS has an employed population of 1 million, and it is likely that some bad apples will be found within that overwhelmingly brilliant staff cohort, but I dispute that the NHS overall is a racist organisation. I work in the NHS—I should declare that interest—and I have not seen evidence of structural racism. The Royal College of Obstetricians and Gynaecologists reported that, as of 2024, 45% of obstetric and gynaeco-logical doctors identify as of a black, Asian or minority ethnic background, and 26% of births were to women of black or other minority ethnic backgrounds. Figures for midwives are harder to assert, because they are collated with nursing staff, but the proportion among nurses is 22%.

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

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

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

That is not what I said.

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

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

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

I think we have both made our positions clear. I accept that some people will have received poor care and that the people who delivered that poor care need to be hauled over the coals. They need to be called out for what they have done and we must ensure that such care does not happen again. But I do not accept that the NHS is a racist organisation. Another issue is language barriers. It is well recognised that it is difficult for people who have a language barrier to access health services. Can the Minister tell us what the Government are doing to help with that? In recent years in my medical career I have seen improvements in the delivery of language services, but when I was a more junior doctor an appointment needed to be booked in advance and an interpreter had to attend in person. Sometimes they were available and sometimes they were not. Sometimes other members of staff or family members would be used to interpret, which is a poor standard of care, relatively speaking.

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

I did the junior part of my medical career in Nottinghamshire. I am describing what happened in the junior part of my career, which is about 20 years ago now. My experience 20 years ago was that it was very difficult to get interpreters, and that the people used to interpret were not proper interpreters and not the appropriate people. That should not be happening. The service is still not perfect, but over time we have seen translation services improve. Many hospitals have instituted new iPad systems where one can choose a country of origin or the language that the person speaks, and a dial-up system of interpreters working from home is used to provide an interpreting system. That is much better—it is more available to the patient than the services we had in the past, which required someone in person—but it is still not perfect. We still see areas across the country where those services and that interpretation are unavailable to people. How will the Minister ensure that women who have difficulties with the English language are able to access interpreters when they need them—not just for appointments, but for out-of-hours emergencies? That is when interpreters are most difficult to obtain, particularly for languages spoken by fewer people in the United Kingdom. I want to ask about the Government’s plans. The previous Government instituted a three-year plan, which comes to an end next year. When will the Government produce the plan? They talked about their 10-year NHS plan, which they said they would produce in the spring. I believe we are in the spring now—if we look outside, it is a beautiful day; the flowers are out and the lambs have been born. Where is the plan that the Government promised? What targets are they going to set, and when, to improve maternity care for all women, and specifically for black women?

15:14:00

It is a pleasure to serve under your chairmanship, Ms Furniss. Before I begin, I thank my hon. Friend the Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) for securing this important debate during Black Maternal Health Awareness Week. It is so important that we raise awareness of the disproportionate challenges faced by black mothers during pregnancy and after childbirth; debates in weeks such as this are critical to that. I want to pay tribute to the charities that do so much vital work in this space: the Motherhood Group, Five X More, Black Mums Upfront, which is part of Bliss, and Ebony Bonds, to name just a few. I am taking this debate on behalf of the Minister for women’s health and patient safety, Baroness Merron. I also want to thank all hon. Members for their contributions to this debate. I will seek to pick up and answer all their queries, but if they feel I have not done so by the end of the debate, I ask them to please get in touch and I can ensure we respond. I want to thank the charity Sands for shining a spotlight on some of the most heartbreaking cases of baby loss in the UK, and for giving a voice to so many black and Asian women who have gone through the nightmare of losing a child. One such case was Amber Lincoln from Woolwich in south-east London. She was miscategorised as low risk when she was pregnant, and nearly died from undetected complications after her delivery. A series of individual and systemic failings led to cancellations and delays, and her twins, Anaya and Mael, were born and died at 22 weeks in November 2022, before she could access the care she needed. Amber said: “If the NHS just listened to me. And just put my appointment through when I was constantly asking. If they had the notes there properly I wouldn't have been treated that way.” She said the fact she was mixed race led midwives to focus on diabetes and high blood pressure rather than other high-risk indicators. I wish I could stand here and say that Amber was an isolated case, but her story will sound familiar to black women up and down the country, and it shows in the figures. The latest data from MBRRACE-UK shows maternal mortality rates for women from black ethnic backgrounds are more than double those for white women. Black women and their babies are also at higher risk of stillbirth, neonatal death and miscarriage. That should shame us in modern Britain. Tackling inequalities and racism in maternity services is an absolute priority for this Government. Our manifesto committed to setting an explicit target to close the black and Asian maternal mortality gaps. That commitment has not wavered—we are working hard not only to set a target but to set the actions that will help deliver it. It is crucial we set the right targets and ensure the system is supported to achieve them, which is why the Government are currently considering the action needed that would drive change on the ground, ensuring that targets set are evidence-based, and women and baby-centred. Our ambition is not just to improve maternal outcomes; we want to improve black women’s experiences of maternity care too. We know that too often black women are not listened to and experience racism and bias. That is completely unacceptable. Importantly, our ambition must also extend beyond maternity services, so that we can tackle wider health inequalities, including the determinants of ill health. I know that health inequalities do not start at the door of maternity services, and nor do they end when women go home. Here is what we are doing and where we need to go further. We are aware of calls for a national inquiry into maternity care, which we will carefully consider. There have been a number of reviews, inquiries and wider research in recent years that have provided a shared and clear sense of the issues in maternity and neonatal care. The most important priority must remain for us to target resources and efforts to address the existing issues identified and avoid any further delays. The focus must be to address inequalities and the action taken to do so for women and babies. NHS England is now in the final year of delivering its three-year plan to improve maternity and neonatal services. Central to the plan is the objective to reduce inequalities for all in maternity access, experience and outcomes, and taking steps to tackle and address inequalities for black women. To achieve this objective, all local areas now have in place and are implementing their equity and equality action plans. Those plans detail local interventions tailored to population needs, in order to tackle inequalities for women and babies from ethnic minorities and those living in the most deprived areas. There have been some great examples of local best practice within those plans, ranging from targeted pre-conception health support to tailored support to ensure equitable access to care, and bespoke communications for pregnant asylum seekers and refugees. As part of the three-year delivery plan, all local areas are working to implement version three of the Saving Babies’ Lives care bundle, which provides maternity units with guidance and interventions to reduce and tackle the inequalities in stillbirths, neonatal deaths, brain injuries and pre-term births. Those local and national interventions are essential steps to improving equity and equality in maternity care. In parallel, however, it is vital that we continue to work to foster a culture of safety, compassion, honesty and one that is actively anti-racist, which must be led by outstanding leadership. I am pleased that all 150 maternity and neonatal units in England have signed up to the perinatal culture and leadership programme. For clarity, and I think particularly for the shadow Minister, we recognise that racism and unconscious bias need to be tackled, that they are unacceptable and must be tackled in the NHS.

Will the Minister give way on that point?

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

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

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

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

I think that we have to do everything possible to make sure that all the systems in the NHS are as equitable as possible. We have set clear expectations for escalation and accountability through the three-year plan, and all 150 maternity and neonatal units in England have signed up to the perinatal culture and leadership programme. We are supporting staff to hold up their hands when things go wrong through the Freedom to Speak Up initiative. Our approach to tackling inequalities in maternity and neonatal care must be underpinned by evidence, research and—critically—working with women and their families. As my hon. Friend the Member for Sherwood Forest (Michelle Welsh) pointed out, it is crucial that women’s voices, including black women’s voices, are heard. My hon. Friend the Member for Clapham and Brixton Hill mentioned funding for research. The National Institute for Health and Care Research has launched a £500 million funding call that challenges researchers and policymakers to come up with new ways of tackling maternity inequalities and poor pregnancy outcomes. The NIHR has also invited applications for funding of up to £500,000 for a research project to understand how biases in medical devices used during the pregnancy and neonatal period might be contributing to inequalities for women and babies. NHSE is working closely with the NHS Race and Health Observatory on the outputs of the learning and action network programme, which aims to address inequalities for women and babies from black, Asian and other ethnic minority backgrounds. Local maternity and neonatal voices partnerships bring together the voices and experiences of women and families to improve maternity and neonatal care. More than a quarter of the partnership leads are from ethnic minority groups. Women’s voices must continue to be at the heart of our improvements to care. I will be frank with colleagues: although the measures I have set out are important, I do not believe they will be enough to meet the scale of our ambitions. The Government are committed to ensuring that all women and babies, regardless of their ethnicity, background or location, receive the high-quality, equitable care they deserve. Many of these initiatives began under the previous Government, and although there has been some progress across maternity and neonatal care—for example, good progress has been made in reducing the number of stillbirths and neonatal deaths—we have much further to go to improve care and tackle inequalities. Looking forward, we are clear that we want to see high-impact actions to tackle inequalities and racism in maternity services. Baroness Merron and the Secretary of State are working closely across the sector to identify the right actions and interventions to deliver the required change. The shadow Minister asked about data collection. Data on women’s ethnic background is routinely collected by services at multiple points throughout maternity care. The data is used to disaggregate reporting of adverse outcomes, such as maternal mortality, by ethnicity. Differences by ethnicity are also reported as part of the Care Quality Commission’s annual survey, which asks a sample of pregnant women and new mothers about their experiences of NHS maternity services. NHS trusts are incentivised to collect this information through the maternity incentive scheme, which is a financial incentive programme that is designed to enhance maternity safety in NHS trusts. Safety action 2 of the maternity incentive scheme incentivises trusts to submit digital information, including ethnicity data, to the maternity services dataset. Some of our processes will take time to implement, but we need to understand the immediate actions that can begin to deliver change here and now. I therefore reiterate our commitment to setting an explicit target to close the black and Asian maternal mortality gap. We must get this right. Targets must be evidence based, and that is why it is so important that the data is collected, as I have said, that our targets are women and baby-centred and, crucially, that the system is supported to meet the targets that are set. To this end, NHS England has undertaken a review of the evidence base and conducted extensive stakeholder engagement to identify the key drivers of inequalities for black and Asian women and babies—again ensuring that black women’s voices are heard.

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

We are working at pace, ensuring that what we do is right and that it is achievable. The shadow Minister will be aware that the Government are developing a 10-year plan for health, and women’s health, including maternity health, will be at the centre of it. We want to ensure that whatever we put in place dovetails with all the other interventions and actions that the Government are putting forward. The areas identified for intervention so far include the improper management of existing conditions, racism and discrimination, and access to care. We are clear that we want to see innovative and high-impact ideas that will shift the dial. We want to make sure not just that we are coming up with some sort of plan, but that it can be delivered and will be impactful. Let me assure my hon. Friend the Member for Clapham and Brixton Hill that this issue keeps us up at night. I know that she will continue to hold us to account. I began my speech by referencing Amber’s story. She asked how she could put her trust in a system that let her down so badly, and I completely understand why she felt that way. It is our duty to make sure that women like Amber can trust the system with something as precious as their children, and to prevent what should be one of the most joyful days in their lives from becoming a tragedy.

15:30:00

I thank all Members present in this afternoon’s debate for their thoughtful and balanced contributions. It is not very often in the House that we are generally in agreement, so I am heartened to be joined by Members from different political backgrounds calling for us to improve the state of maternity care. I was grateful for the intervention from my hon. Friend the Member for Manchester Rusholme (Afzal Khan), who talked about the lack of spaces where black women feel supported and the importance of increasing those for all women in maternity care. My hon. Friend the Member for Croydon East (Natasha Irons) pointed out the need for a national target and framework to challenge these issues. My hon. Friend the Member for Sherwood Forest (Michelle Welsh), the chair of the APPG on maternity, gave a fantastic speech on the significant concerns about the quality and safety of maternity services in the Nottingham University Hospitals Trust. She made very important points on tackling the underlying issues of culture within the NHS. I was also pleased to hear the Liberal Democrat spokesperson, the hon. Member for Chichester (Jess Brown-Fuller), rightly pointing out that this disparity is a national scandal. We are at risk of normalising these issues, and it is so important that we continue to challenge them. Although I do not agree with the shadow Minister on much, she made a very good point about language services. I thank the Minister for her response and for detailing the steps that the Government are taking to tackle this. I know that the Government have committed to setting a target to end racial disparities in maternity care, and I was pleased to see it as a manifesto commitment, but at times, it can feel as though the issue is being kicked into the long grass, as the target has not yet been set. We are looking forward to that, and there are several campaigns watching the debate this afternoon that will have rejoiced when they heard that the Government have committed to setting a target. Like me, however, they continue to wait in eager anticipation to hear what it is. I hope the Minister will take that on board, and that we will not wait too much longer for the target to be announced. Should there be a national inquiry into maternity services, we would hope that black maternal health would be considered as a clear element of the problem, with stand-alone recommendations on what should be done to tackle the disparities. That would be extremely important. I also thank the Minister for acknowledging the need for anti-racism training, that systemic racism exists, and that there are various things that we must do to tackle it. One of the worst things that can happen to women in this situation is being gaslit into thinking that their experiences did not happen. Women not being listened to purely because of what they look like, where they are from and their ethnic origin, is causing so many problems and even leading to deaths. We must acknowledge them and, instead of burying our heads in the sand, tackle issues of racism and discrimination in our health service. Finally, I thank all the campaigners listening to the debate today again for their hard work and tireless campaigning. Many of the women in the campaign are involved because of their own experience in maternity care or that of a loved one. Many who have dedicated their time to campaigning on the issue do so because they do not want anybody else to go through what they did. It can be exhausting to re-live past traumas and continue to push the cause, but it is through their hard work that we are having the debate today and that we have a Government willing to address the issues. In my opening remarks, I mentioned the worrying findings from the recent MBRRACE-UK report, which revealed that the overall maternal death rate is increasing. That is outrageous. That should be alarming to all of us and should spur us into action. I say this each time we have this debate: improving the state of maternity care for black and ethnic minority women and babies will improve the overall quality of maternity care for all mothers and babies. I hope we can agree that that is certainly worth doing. Question put and agreed to. Resolved, That this House has considered Black Maternal Health Week 2025.

15:35:00