NHS must do more to track and evaluate race inequalities in maternal health, says report

Maternal policies developed by NHS bodies should target minority ethnic health inequalities and a national system for tracking progress should be established, a report1 has recommended. In theUK, blackwomenare four timesmore likely to die duringpregnancy or childbirth comparedwithwhite women, while women from Asian backgrounds face twice the risk of maternal mortality. Yet research from the NHS Race and Health Observatory, the University of Liverpool, and the University of Warwick found that few maternal policies developed by hospital trusts and other providers have a specific focus on tackling ethnic health inequalities across maternity care, while examples of good practice are often not shared across the system. The report calls for a central data repository to be set up to collect evidence and monitor improvements in reducing poor outcomes in maternal and neonatal healthcare for women from ethnic minorities. Daghni Rajasingam, consultant obstetrician and deputy chair of the NHS Race and Health Observatory’s maternal working group, said, “It is imperative that health teams, the NHS, integrated care boards, and all other providers of perinatal services take stock of this report and commit to effective action to tackle maternal health inequalities and more research as a priority. “There is an urgent need for programmes across England which are designed to tackle, track, and evaluate maternal inequalities.” The researchers examined past policies that were broadly designed to improve maternal and neonatal health. This included 19 interventions aimed at tackling ethnic inequalities that were published between 1981 and 2022. As a result of the limited number of published reports, the authors concluded that ad hoc examples of good practice may not have been published and, where available, are not being shared across the maternal and neonatal health system. Within the policies that were examined, interventions were found to be variable, broad, sporadic, not fully implemented, or designed for evaluation, creating a risk of duplication of multiple efforts across the country. The study team also found no evaluation of interventions which aim to tackle institutional or interpersonal racism, such as tackling ethnic stereotyping or supporting people with experience of discrimination in healthcare. Among other recommendations were better research and data recording, first trimester screening with early screening for preeclampsia, vitamin D supplementation, and support with postnatal depression for specific ethnic groups and specialist cultural liaison midwives to improve trust with pregnant women. Oluwaseun Esan, postdoctoral research associate at University of Liverpool and principal investigator of the study, said, “A specific policy on reducing ethnic health inequalities for black, Asian, and minority ethnic women is urgently required, as well as increased investment in research on interventions that tackle these inequalities in outcomes with health inequality impact assessments embedded from the development stage.”