Whilst the UK exceeds regarding its low maternal mortality ratio, there are still unfortunately disparities in maternal healthcare outcomes based on race (Women and Equalities Committee, 2023). White women have consistently experienced better outcomes compared to their Black and Asian counterparts. For Black women, their maternal mortality is four times higher compared to their White counterparts (Women and Equalities Committee, 2023). Asian women and women of mixed ethnicity experience a two times high mortality rate compared to White women (Women and Equalities Committee, 2023). One of the most surprising aspects of these figures, however, is that these disparities are not new - and instead have been documented for the past 20 years. It is only recently that the government has taken note of these figures and decided to do something to address them (Women and Equalities Committee, 2023).
These disparities are not just present in the UK, but exist in the United States, too (Hill et al, 2022). Black women are three times more likely to die associated with pregnancy that White women and American Indian and Alaska Native are two times more likely to die (Hill et al, 2022). These groups do not only suffer with regards to pregnancy-related mortality, but are also more likely to experience higher rates of pre-term births, lower birth weights, or “births for which they received late or no prenatal care compared to White women.” (Hill et al, 2023). Increased mortality rates also extend to Black women and American Indian and Alaska Native women’s children (Hill et al, 2023).
Increased maternal mortality rates are not only impacted by race or ethnicity, but also by their level of socioeconomic deprivation, with women living in the most deprived areas having the highest levels of maternal mortality (Women and Equalities Committee, 2023). Women in the most deprived areas are 2.5 times more likely to die as a result of a pregnancy-related complication than women from the least-deprived areas (Women and Equalities Committee, 2023). At least some of these causes of maternal death are preventable, with up to 38% being avoidable with improvements in care (Women and Equalities Committee, 2023).
So what can be done to address these disparities? This first step is the education of maternal healthcare providers, as “The maternity workforce must be properly equipped to understand and recognise the significant disparities that exist, and to use that knowledge to deliver personalised, effective and respectful care.” (Women and Equalities Committee, 2023).
One factor in differing maternal outcomes may be due to the timeliness of women accessing maternal care. One way to improve outcomes can be to ensure all women, especially those from groups which experience healthcare disparities, have quick access to maternal healthcare when they need it (Howell, 2019). Next, it is important to take steps in improve healthcare outcomes in general for women before focusing on pregnancy care. Ethnically minoritized women can have higher levels of chronic health conditions such as obesity and diabetes (Howell, 2019). These premorbid conditions can contribute to poorer pregnancy-related outcomes (Women and Equalities Committee, 2023).
Overall, overcoming the disparities in maternal healthcare outcomes associated with race requires a systemic overhaul including the education of healthcare professions and addressing systemic racism in our healthcare system. It seems we are all united in one opinion - skin tone should not be a determinant in healthcare outcomes, but it so often is. Frequent reviews and summation of figures across the UK and internationally will allow is to frequently review the rates of maternal death and make changes swiftly to counter these disparities.
References:
Hill, L., Artiga, S., Ranji, U. (2022) ‘Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them’, KFF, available at: https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/ (Accessed 28 January 2024)
Howell, E.A. (2019) ‘Reducing Disparities in Severe Maternal Morbidity and Mortality’, Clinical Obstetrics and Gynaecology, 61(2), pp. 387-399.
Women and Equalities Committee (2023) ‘Black Maternal Health’, UK Parliament, available at: https://publications.parliament.uk/pa/cm5803/cmselect/cmwomeq/94/report.html (Accessed 21 January 2024)
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