MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) published a new report at the end of 2020, which explores the risk of mortality amongst women of different ethnicities during pregnancy or childbirth. Titled ‘Saving Lives, Improving Mothers’ Care,’ it found that black women are four times more likely to die than white women, while Asian women suffer twice the risk white women do. The data was collected pre-Covid 19, which means that the results are a greater cause for concern, with the pandemic tearing away more eagerly at the livelihoods of ethnic minorities. And, although the figures made for even tougher reading last year – when black women were calculated to be five times more likely to die – experts warn that the new report is not a sign of progress.
The lead author of the MBRRACE-UK report, Professor Marian Knight, stressed the continued importance of this issue, and explained why the statistical changes don’t count for much: “The drop to a fourfold difference should not be a reason to lessen our efforts. The rate of deaths among white women has gone up by a tiny amount and the rate of black women has come down a little but neither of these are statistically significant changes because the overall rates are low.”
President of the Faculty of Public Health, Professor Maggie Ray, framed the “multiple and complex problems that affect women who die in pregnancy,” categorizing them as “social, physical and mental.” She went on to explain that “Women who live in more deprived areas continue to be at greater risk of dying during or after pregnancy, and many of the complex factors underlying this increased risk need action much more widely than in maternity services, and beyond the health sector, and often long before pregnancy.” It is getting to the crux of these factors, then, which make a difference in everyday life, that could help tackle the inequalities in mortality rates affecting soon-to-be mothers.
Luckily, the report looks into what these factors might be. More than half of women who die are overweight or obese, while cardiac disease, mostly acquired, takes more lives than any other condition during or after pregnancy. In light of these findings, it is hard to look past the fact that those living in deprived areas have less access to high-quality, nutritious food. And that they are too occupied with putting food on the table, or providing other basic necessities, to make looking after their health a priority. Perhaps these stresses constitute some of the reasons for why maternal suicide is still the leading cause of death between six weeks and a year after the end of pregnancy.
One of the report’s most fascinating details is its discovery about the rise in maternal deaths from SUDEP, short for ‘sudden unexpected death in epilepsy.’ Perhaps even more fascinating, and concerning, however, is its conclusion that mere access to accommodation with a shower can reduce the risk of SUDEP. That this solution was even included in the report indicates the disparity in living conditions between different ethnicities across the UK. This is exactly the kind of inequality that needs to be addressed if progress is to be made in this area. So, while Professor Maggie Ray might be right in saying “pre-pregnancy medication adjustment” and “culturally appropriate lifestyle advice” offer hope for improvement, this only skims the surface of what is really needed to bring about change.
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