Disparate outcomes: Can the UK Government's policy commitments successfully address the ethnic variation in maternal health?
In the face of persistent, concerning ethnic disparities in maternal outcomes in the UK, the Government has made bridging gaps in care a key focus in its evolving health policy proposals. Long-standing issues in health policy and organisation, and flagging action in the NHS, risk enduring disparate outcomes and demand further concrete policy action to match political rhetoric.
In his time in the London office, RPP UK’s intern Yashil Gopee explored the issues in ethnic maternal health and elaborated what needs to be done on the policy and public affairs level to help realise change.
The ethnic disparities in maternal outcomes in the UK
Women of minority ethnic backgrounds face many risks around childbirth. Black British women are 5 times more likely to die during pregnancy or within 6 weeks after birth than White women. Mixed ethnicity women are 3 times more at risk and Asian women twice at risk than White women. (MBRRACE-UK, 2021)
Ethnic minority women also face an increased risk of stillbirth (Mathews et al, 2022), pre-term birth and neonatal death. Despite (since 2007) falling infant mortality rates in all ethnic groups, rates remain higher among ethnic minority groups.
Government initiatives to tackle disparities
In 2022, the Department for Health and Social Care established a Maternity Disparities Taskforce to identify and address the disparities in maternity care experienced by ethnic minority women. The taskforce follows on from the founding of the Office for Health Improvement and Disparities (OHID), which focusses the now-defunct Public Health England’s population health remit to tackle inequality in treatment and health outcomes. The OHID will coordinate with the NHS and other health bodies to produce a timely and soon-to-be-published white paper on tackling ethnic disparities.
The NHS Long Term Plan – the 2019 strategy underpinning healthcare reforms due an imminent refresh – also makes provisions to tackle disparities, aiming to increase access to and availability of continuity of care throughout pregnancy, labour, and the postnatal period. The aim is to achieve 75% access by 2024, but significant obstacles remain.
Drivers of disparities – data, deprivation and discrimination
Disparities in maternal care outcomes are part of wider ethnic disparities in healthcare access and experience. Various public health bodies, research institutions and charities have attempted to map out these disparities. However, there are gaps in the data concerning minority groups and it is difficult to discern the intersections with socio-economic background and environment. Gauging an accurate representation of the issue has proved difficult and contributed to disparities being overlooked.
The “postcode lottery” of access to and quality of treatment reflects the fact that women living in more deprived areas often lack access to adequate pre- and post-natal services. Health authorities are often understaffed, under-equipped and over-stretched, resulting in more limited access. Ethnic minority groups are likely to live in these deprived areas.
Racism, overt and structural, is still faced by ethnic minority women. Discrimination has led to ethnic minority women facing less respectful treatment when discussing their concerns. For Black women in particular, it has been shown that there is a false conception of pain tolerance by medical practitioners. Black women are falsely seen to be able to better “weather” pain, which has in turn led to delayed or less effective treatment. This has led to low trust levels in the health care system.
Can the plans go far enough?
It is promising that the Government has established dedicated bodies to investigate and support policies that will tackle ethnic disparities in maternal outcomes. This is especially important for collection and analysis of data surrounding ethnic disparities. Addressing such issues may be hindered by the Government’s response to the Race Equality Commission’s report arguing systemic racism does not exist in the UK.
The dedicated bodies present an opportunity for targeted analysis of policy and NHS guidance that directly relate to the experiences of ethnic minority women. Various consultations and reviews have been carried out in the past with their recommendations failing to be adopted in full. A new review into biases in medical equipment must translate into concrete action.
These new bodies must ensure that their guidance and policies are targeted and implemented at the local, regional and national level. This would move away from the “one size fits all” approach that incumbered tangible action to be taken to tackle ethnic and other disparities. NHS Trusts should be encouraged to develop their own targeted practices based off a national framework.
Public affairs and new maternal health policy
The forthcoming refresh of the NHS Long Term Plan (LTP), and the enshrining of the Health and Care Bill in law, offers the opportunity to cement new political interest in ethnic maternal health into health policy. The Bill and the LTP leave much to local decision-makers, however; concerted thought and detailed financial and operational planning at a regional level is required to ensure that the government will actually come to the aid of minority ethnic women.
With this increasing regionalisation of healthcare policy, political advocacy too must focus on the regional level. Local health stakeholders – clinicians, NHS managers, and more – must be made aware of the prevailing national issues such as ethnic maternal health outcomes, and organisations must work with the new decision-makers in UK health policy to address practical issues in care.