‘National shame’: Black mothers in England twice as likely to be investigated by NHS over childbirth | Care Quality Commission (CQC)

Babies born to black mothers are almost twice as likely to be investigated for possible NHS safety failings, in a shocking disparity that has been branded a “national disgrace”.

More than 2,300 investigations were carried out by the maternity safety watchdog in England between 2020 and 2023 into cases including the tragic deaths of babies before, during and shortly after birth, as well as deaths of pregnant women or new mothers.

According to a study by the Guardian, for every 1,000 births among black women, 2.3 investigations were carried out, compared to 1.3 for white women.

The head of the Royal College of Midwives (RCM) said the problem was “purely down to institutional racism”. The Labour government has pledged to prioritise improving maternity care, including tackling stark racial disparities.

Maternity and Newborn Safety Investigations (MNSI), part of the Care Quality Commission (CQC), is a safety programme that investigates serious cases of maternal or newborn deaths, stillbirths and babies born with serious brain injuries across the NHS in England.

All NHS trusts are required to report certain patient safety incidents to MNSI for independent investigation. The watchdog is part of a national strategy to improve maternity safety.

Between 2020 and 2023, the MNSI conducted 2,334 investigations into maternity-related incidents that were referred to it. It examines cases where a baby dies during labour and before birth, where a baby is alive but dies in the first week of life, and where a baby is born with a potentially serious brain injury diagnosed in the first seven days of life. Cases where a mother dies during pregnancy or within 42 days of the end of her pregnancy are also examined.

Freedom of information requests and research by the Guardian show that black women are almost twice as likely to be subject to a maternity investigation as their white counterparts.

Black mothers are also three times more likely to be investigated for maternal death and just over twice as likely to be investigated for intrapartum stillbirth, when the baby dies after the onset of labor.

The higher rate of investigations reflects the increased likelihood among black women of experiencing maternal death, stillbirth and having babies born with severe brain injuries.

In the UK, black women are four times more likely to die during pregnancy or childbirth, and are also more likely to suffer some of the most serious complications of childbirth.

Bell Ribeiro-Addy, chair of the All-Party Parliamentary Group on Black Maternal Health Care, said the figures were shocking.

“It’s always shocking to hear figures like that, but these are figures we’ve been hearing regularly for a number of years and the previous government did absolutely nothing to address them,” she said.

“The idea that the colour of your skin at the time of birth can have such a significant, and potentially fatal, impact on your future is a national disgrace. I am pleased that the current Labour Government, in one of its manifesto commitments, [will] “We have set a goal to reduce maternal health disparities for Black women, and I hope to see the details of that goal soon.”

Gill Walton, RCM chief executive, said the problem was “purely down to institutional racism”.

“In the 21st century, a baby’s or a mother’s chances of survival should not be determined by the colour of their skin or where they were born,” she said. “But sadly, this is the case for too many families. It is not enough to express our shock and sadness: we must act. Everyone involved in the development and delivery of maternity services, from governments to midwives, must work together to address these disparities.”

“We know that the new Westminster government shares our ambition to get to a point where outcomes for pregnant women and their babies are no longer defined by their ethnicity or background. We have already written to the new Health Secretary to express our commitment to working with him on this issue as a matter of urgency. [The disparity] “This is purely due to institutional racism and there is much more to be done to address it.”

The RCM said it had made efforts to ensure the midwifery curriculum focused on caring for women from ethnic minorities and had launched a tool to enable midwives and other health professionals to assess the needs of pregnant women and provide the most appropriate package of care.

Sandy Lewis, director of MNSI’s maternity survey program, said the figures “confirm what we already know” about racial disparities in maternal care.

“These figures tell the same story, which is that black women and women from minority ethnic backgrounds have worse outcomes than white women, that’s what we know and that’s what our surveys clearly show,” she said. “I think what’s really clear to me is that this is an equitable outcome, so we need to make sure that care is individualised and supportive for women and people who are giving birth.”

“I think the most difficult question for all of us is to understand the ‘why’, and that is the area we need to explore much more deeply.”

Donna Ockenden, a maternity expert who led a landmark review of Shrewbury and Telford Hospitals NHS Trust, said: “We hear too often about the racial inequalities and disparities in healthcare delivery, particularly within maternity services in England.

“It is alarming to learn that black mothers are almost three times more likely to be investigated for maternal death and twice as likely to be investigated for stillbirth. This highlights the problem of inequality in the quality of perinatal care provided to families across England and must be addressed immediately.”

NHS England said: “It is unacceptable that black mothers and their babies experience disparities in care. While the NHS has improved maternity services over the last decade, we know there is still much to do to tackle inequalities and ensure all women and families receive quality care before, during and after pregnancy. All local health systems have published plans to support their local populations and we will work with government, royal colleges and others to implement these effectively.”