Any official report that starts with a dodgy statement makes me want to have a good hard look at the rest of it.
The House of Commons’ Women and Equalities Committee have reported on Black Maternal Health Disparities.
The Committee make the point; the UK is one of the best and safest places to have a baby.
Really?
According to the seminal Better Births Report, from the Cumberlege Review, we spend £560 million each year on compensating families for negligence during maternity care.
The top three places to give birth are Poland, Estonia and Japan.
We are 18th in OECD comparisons. Rank 9th on the number of midwives per 1,000 births. Nowhere in the running for maternity and paternity packages.
The new Commons’ report looking at ethnic disparity in maternal deaths says;
‘…the reasons are not fully understood… there were many possible reasons…
…including;
• pre-existing conditions
• co-morbidities;
• socio-economic factors including deprivation;
• factors impacting on the care that women received, including ignorance, bias, micro-aggressions and racism…
The report continues; 60% of women who died in 2018–20 during, or up to six weeks after the end of pregnancy, had pre-existing medical problems…
… Black women and Asian women are over-represented in that group.
If we know all that, why can’t midwives, obstetricians, GPs, health visitors, social care and everyone else, be mindful and act accordingly?
If the conditions are beyond the scope of maternity services… change the scope of maternity services!
The Office for National Statistics tells us; a higher proportion of babies from Black, Asian and ‘Any Other’ ethnic groups were born in the most deprived areas, compared with the White ethnic group.
The 2010 Marmot Review points to the overlap in poverty and ethnicity. We know this stuff.
Cumberlege points out;
‘… the data we have is often of poor quality, paper based when it should be electronic and in some aspects of care, there is no data at all.’
Baroness Cumberlege was right then and she’s right now. The Commons report mentions data 73 times.
They say:
• ethnicity data has regularly appeared in the confidential enquiry reports from at least 2000 onwards;
• Black African women were almost seven times as likely to die than White women;
• [there is] a data and information gap on the needs, experiences and outcomes of minority ethnic women;
• in August 2022, an English maternal morbidity outcome indicator was under development, it’s still not finished… why?
HMG told the Committee;
‘… the social determinants of health are beyond the control of health services…’
That’s right but does it mean there is nothing the NHS can do, or should do?
Which brings us to the unspoken question.
Are Black and Asian women discriminated against in child birth on the grounds of race?
The Muslim Women’s Network say yes; and add, ‘…they’re likely to receive poorer standards of care’.
The Committee say yes; ‘… implicit or explicit racism played a role in women’s access to treatment and the care they received….’
Five X More say yes; ‘over 42% of women … reported feeling discriminated against during their maternity care, with one of the most common reasons being their race.’
Is it worth pointing out three things;
• The overall proportion of registered nurses, midwives and nursing associates from Black, Asian and minority ethnic backgrounds is now 26%… 7% higher than in 2018.
Is this important?
• The Maternity Disparities Taskforce has not met for nine months.
Is this important?
• The Ockenden report says HMG should commit to increasing the annual budget for maternity services to £200–350 million from the next financial year.
This is important.
The Committee’s report highlights a very ugly part of healthcare but admits there is a paucity of data, repeats most of what we know and really adds nothing.
It’s a shelf-sitter.
There is a problem but I’m not sure we know exactly what it is.
That is bad.
There is a problem and I’m far from sure we now how to fix it
That is worse.
There’s been a problem for a long time and we’ve let is slide.
That is unforgivable.
Frankly, the report is a bit of a boorach but it gets one thing right;
‘A fully staffed, properly funded maternity services workforce is fundamental to delivering safe, personalised care to pregnant women and new mothers, and a prerequisite to rolling out any measures to combat inequalities.’
There you are… the answer in black and white.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
