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Uneven maternity care provision in the UK with ‘gaps’ that risk women’s lives

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A major report into maternity services pre-pandemic has showed the chances of dying during or after pregnancy, while low, vary greatly depending on the prosperity of the area in which women live, and their race and age – highlighting gaps in care which must be filled.

Sharon Banga, a medical negligence specialist solicitor in Shoosmiths’ Birmingham office, said the report should be compulsory reading for maternity staff, service providers and policymakers to maintain standards for all women.

The MBRRACE-UK - Saving Lives, Improving Mothers’ Care 2021 found that during 2017-19, 191 women died during or up to six weeks after the end of pregnancy, from causes associated with their pregnancy.

This works out as 8.8 women per 100,000 which is not statistically significantly different compared with 2010-12. However, it concludes that outcomes for women are not equal, with gaps in mortality rates between women from deprived and affluent areas, women of different ages and women from different ethnic groups.

Women from Black ethnic groups were four times more likely to die, and women from Asian ethnic backgrounds almost twice as likely to die than White women.

Women living in the most deprived areas are twice as likely to die than those who live in the most affluent areas, and for women over the age of 45, fewer than a third of them received care in line with guidance.

Assessors judged that in 37% of cases improvements in care may have made a difference to the outcome.

The report also examines in detail the care of 495 women who died during, or up to one year after, pregnancy in the same period. The report includes detailed chapters on mental health and multiple adversity, cancer in pregnancy and thromboembolism, or blood clots.

Sharon remarks that, while it is positive that these key issues are being addressed, these findings need to be closely monitored moving forward, because there are still worrying gaps in care:

“One of the things that came out in the study was that people who are at higher risk of complications are being put into situations where they're not receiving the enhanced care that they are entitled to. If you are specifically higher risk, there should be a plan in place, and I am concerned that for many women there is not, leading to either higher rates of injury or death. A plan might include consultant care, for example, for someone who's got low thyroid function and there will also be other circumstances where additional midwifery appointments are warranted. It's important to ensure this all takes place in the interest of maternity safety.”

The authors of the study make it clear that it was conducted before the pandemic, and that they predict these inequalities to be worsened by the impact of COVID-19. The imperative to address the systemic issues of cultural and structural biases affecting women’s care based on their pregnancy, they say, is more fundamental than ever to the prevention of maternal death and disease.

Sharon concludes:

“The pandemic has been a worrying time for women accessing maternity services, and the predictions in this report correspond with what we are hearing from our clients in terms of concerns regarding maternity care provided which can sometimes lead to serious maternal injuries or sadly, even fatalities.”

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Disclaimer

This information is for educational purposes only and does not constitute legal advice. It is recommended that specific professional advice is sought before acting on any of the information given. © Shoosmiths LLP 2021

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