Maternal death rate in the UK

[ArabellaScott]

https://www.npeu.ox.ac.uk/news/2486-maternal-death-rates-in-the-uk-have-increased-to-levels-not-seen-for-almost-20-years

Alarming news about maternal death rates, the highest they've been for 20 years.

Death rates for Black women are three times as high as for white women. Asian women are twice as likely to die in childbirth or shortly afterwards as white women.

Thrombosis was the most common reason for death.

My opinion is that it's the impact of Covid, both direct and indirect.

MBRRACE should break down the data so we can see what specifically BAME women are dying of. My professional knowledge tells me that it's multifaceted and the answer isn't simple.

There is a higher prevalence of pre existing health conditions in women from BAME communities like hypertension, diabetes, obesity and cardiovascular disease. It's easy to dismiss this but obesity aside, these are conditions that can be really difficult to manage during pregnancy and birth and massively increase the risks to mum and babe.

Research tells us that Black and Asian women aren't listened to my professionals and sometimes their worries are dismissed. There are systematic inequalities and racism at play here.

Also language barriers, finding an interpreter is a bloody nightmare, there aren't enough of them and sometimes there aren't any available. Try doing a thorough assessment when you don't speak the same language. How can the woman give informed consent?

Other things to consider:
Socio-economic factors
Lack of understanding of how NHS services work... for example BAME women in a specific area of London were found to be more likely to book their pregnancies much later which can worsen outcomes.

Anecdotally the area I work is an area where lots of refugees are living at the moment, they aren't from here, they don't understand how services work, how to access care, what they need to do, who they go to, or how services work together.

Yes, higher death rates for black and Asian women. There are likely to be genetic factors as well as health factors, which I presume have been taken note of.

It's not necessarily genetic (though it probably is in part) - BAME women in this country are economically deprived, compared to the average population, and deprivation is a maternal mortality risk factor.

The reasons for the death rate are complex. It's not as simple as the NHS being shit at everything, as some PPs are suggesting, but, equally, the NHS has serious failings in maternity care. Postnatal care, in particular, is egregiously under-resourced. We spend billions less on healthcare than France and Germany, for example (our spend did increase for Covid but the baseline spend is low).

On top of that, we are bad at preventative and primary healthcare - we invest a far smaller percentage of our healthcare spend on those areas than most comparable countries. Women who are in poor health before they become pregnant are far more at risk.

Anecdotally the area I work is an area where lots of refugees are living at the moment, they aren't from here, they don't understand how services work, how to access care, what they need to do, who they go to, or how services work together.

Yes, I work in an urgent care centre and we regularly get migrant/refugee women attend who are in the 3rd trimester or even in labour, yet have had no antenatal care. However, that isn't a new thing, so it can't account for the recent rise in deaths.

@MissLucyEyelesbarrow I know, my post was aimed at @ZeldaFighter re the increased morbidity rates for black and Asian women.

In around 2018 it was 5x and it's now 3.7x I believe (I don't have the report infront of me this is from memory so excuse any errors).

Google fivexmore they're a fab organisation, successfully battling for change in mat services

Sorry to be that person, but I think you mean mortality rather than morbidity - morbidity means "illness".

The differential between black mortality and white mortality has dropped from five times to about 2.8 times, but this is largely down to an increase in the number of white women dying, rather than a drop in the number of black women dying.

You'll be accused of racism for daring to suggest there may be some genetic factors. That is the sort of woke racism described by John McWhorter- woke virtue signalling rather than addressing all the issues. Black women may meet some racism from staff but that isnt going to be the only cause of higher mortality.

Some of the genetic risk factors for black women could perhaps be compensated for by ensuring better access to ante natal care. That might mean holding clinics where people live or work.

Technology - google translate - might help when there are no interpreters available. It may not be perfect, it's better than no communication.

I haven't seen anyone suggest that racism from staff is the main problem (which is not to deny that it exists). Most PPs have highlighted differential access to services, for complex socioeconomic reasons.

If genetics were the main risk factor, you would expect consistent excess mortality amongst people of a particular ethnicity, wherever they lived. They would have the baseline mortality risk of the country they live in (obviously variable by country) plus a consistent additional risk caused by genetics. But that is not what we see. Women from ethnic minorities do have a higher mortality rate than white women in most (not all) majority white countries, but the level of excess risk is quite variable.

So genetics may well play a part, but it is probably not the main factor.

Sometimes the diagnostic routes rely on observations that are less effective for women with darker skin compared to caucasian women, which means early warning signs are missed.

You see it on NHS online a lot - eg recommending seeking help if someone pale or has blue lips. This is harder to spot on someone with darker skin than a caucasian person.

So research should be done to establish more universal warning signs, or if known already then training and publications (leaflets, NHS online) needs to be updated.

It's also little things like a lot of GD dietary advice mentions White British foods and diet and is often silent on other cuisines, particularly those of the ethnic groups more likely to develop GD.

Thanks for the input, everyone.

I found this recent report wrt Black maternal mortality.

https://lordslibrary.parliament.uk/maternal-mortality-rates-in-the-black-community/

'Published in April 2023, the House of Commons Women and Equalities Committee’s ‘Black maternal health’ report referred to several possible reasons for disparities in maternal mortality.[9] This included pre-existing health conditions, socio-economic factors including deprivation, and factors such as bias, microaggressions and racism. However, the committee noted that causes of disparities were multiple, complex and not fully understood. It warned that “fixating” on any one cause risked “oversimplifying” the problem.
The committee gave several recommendations to address the issue. It called on the government to set a definitive target and strategy to eliminate disparities in maternal health. It argued that existing government and NHS measures to address disparity in maternal deaths were “necessary but insufficient”. Additionally, the committee expressed concern that the government and NHS leadership had underestimated the extent to which racism played a role in these disparities.
The committee also criticised the government’s handling of the Maternity Disparities Taskforce, which “ha[d] not met for nine months” at the time of writing the report. It said the government should publish measures for gauging the taskforce’s success and update the committee on a six-monthly basis on the taskforce’s progress. Another challenge raised by the committee was “missing and inadequate data collection” on ethnicity. The committee called on the NHS to prioritise capturing ethnicity data and reducing delays in data delivery.'

@MissLucyEyelesbarrow I have seen it all being blamed on institutional racism and in particular staff not listening.

International comparisons are interesting - I understood we were similar to the US and Brazil - which are the countries with lower ratios, then perhaps we can find what they do better.

The dietary advice is something is interesting, that wouldnt be difficult or expensive to change. However some health authorities do seem to be trying - see https://www.mkuh.nhs.uk/patient-information-leaflet/gestational-diabetes-diet-sheet

I know there was higher COVID mortality for African Americans, and woke crew were blaming racism, but apparently it was linked to vitamin D deficiency.

Apparently many black skinned people in USA are vitamin D deficiency (with some having not low levels, but no level detected in their body). Vitamin D plays a big part in immunity and this was thought to be the reason.

I wonder if Vitamin D might play any part in birth? we would need to know the cause of death for these women.

aplogies for badly worded post. I need to go to bed!

Another thought on the generally increased maternal mortality rates -

I was always shocked by how incredibly unhealthy most of the women in the maternity ward waiting room were, whenever I was there. It seemed that most women would struggle to.move around, let alone birth a baby.

If you take the midwives out of the equation : a healthy mum is more likely to have a healthy birth. So all of these women literally require assistance to survive birth. If everyone is getting more unhealthy, it is likely that deaths are going to increase.

It does make me think that rather than everyone finger pointing to the authorities and saying how 'shocking' and 'disgusting' it is, it my might be worthwhile pointing out that birth is a physiological process that is dangerous if you are unhealthy. How long do we expect to trash our health and our bodies willy nilly, and expect other people to take care of us?

African Americans tend to be disadvantaged and in occupations where they are more exposed to covid, I doubt vitamin D deficiency would explain all, or even most, of the issues. Sixty percent of people with South Asian ancestry carry a gene (LZTFL1 ) that increases the risk of dying from covid compared to 15 percent of those with European ancestry but african americans dont have high levels of that gene. There is another gene APOL1 carried by many African Americans that does increase covid severity (and the risk of sepsis) and drugs are now being developed to target it.

Sometimes people are unable to take care of themselves because they dont have access to things that would help - there are places in this country where it's a very long trek to buy any fresh fruit and veg and if you are relying on food banks you'll be eating a lot from cans. We need ways to make healthy choices available to everyone.

Australia is regularly touted as a racist country. Its indigenous population suffers higher rates of death, morbidity, incarceration, child protection issues, poor nutrition, social disadvantage, overcrowding in houses, everything, you name it. Many of this population live hundreds to thousands of kilometres from access to good health care, fresh affordable food and so on.

Yet despite this, the MMR for this group of women is better than the MMR for women in the UK overall.

The high MMR for UK women is because the NHS is an absolute shit show. It’s the only explanation.

The maternal mortality rate for Aboriginal and Torres Island Australians pre-Covid was 17 per 100,000. We don't yet have the figures for rates during Covid.

The UK rate for the comparable period was 9 per 100,000.

We don't yet have the figures for rates during Covid.

Yes we do, it was in the link I provided earlier in the thread. For the comparable period to that in the OP, 2018-2020, the MMR for ATSI women was 9.4.

It was 17 over a 15 year period but improved to 9.4 for the last 3 years of that period. Whereas in the UK it got worse.

https://www.aihw.gov.au/reports/mothers-babies/maternal-deaths-in-australia-2018-2020/summary

Australia was hardly touched by COVID in 2020, compared to the U.K. There were fewer than 30,000 cases in the entire country in the whole year. The UK had double that number per day at peak times in 2020. It’s not a meaningful comparison.

It would be pretty surprising if a country that had >72 times as many deaths from COVID as Australia in 2020 had not also seen more deaths amongst pregnant and recently delivered women.

But that’s the point isn’t it. It was handled better overall (although those in Melbourne lockdowns might disagree), its impact was lessened and the health system was functioning better to cope. There was nothing intrinsically different to the virus itself. No pregnant women have died of Covid.

The meaningful comparison is that a functioning government and a functioning health system means women don’t die unnecessarily.

72 times as many deaths.

Only 2.6 times the population.

It’s a reflection on how incredibly dysfunctional the UK is overall. Pregnant and recently pregnant women aren’t dying unnecessarily because of racism, or genetics. It’s because the country is an absolute mess.

Make your mind up. You said that the maternal death rate has risen in the UK because the NHS is crap, and, as evidence, you compared us with Australia in 2020 (the only Covid year for which maternal death figures are available in both countries).

I pointed out that Australia hardly had any Covid in 2020, and now you're saying "that's the point".

Is it?

Upthread your point was that UK maternal mortality rose during Covid because the NHS is shit.

Presumably you do not blame the NHS for the UK's failure to lock down early in 2020?

So how has the high number of Covid cases in the UK in 2020 proved your point that the NHS is shit?

What you have actually done is pick a country - Australia - that (with the possible exception of NZ) was the least valid comparison with the UK for Covid. You then compared the two, ignoring the enormous difference in Covid prevalence. And you have used that as 'evidence' that the NHS is shit

And, then, when I pointed out the difference in Covid prevalence, you are unable to admit that this undermines your whole original point (UK > Australia maternal mortality during Covid = NHS is shit), so you are now pretending that this somehow supports your point, when in fact it completely undermines it.

UK mortality rate from Covid was in the middle of the pack in Europe.

UNlikely to be due to racism as that implies that all care was given to them was by staff who were not of the same ethnic group
Do you really believe that that is the only factor contributing while ignoring all the other factors such as life-style, hereditory factors, age.
To fix it- a better understanding of the individual circumstances of those who died and how to combat them.

Unless you are looking at age standardised death rates international comparisons are pretty much meaningless.

The interesting message from Australia is that their maternal death rate dropped. What, of anything, did they do differently?