The findings suggest that current national programmes to make pregnancy safer, which focus on individual women's risk and behaviour and their antenatal care, will not be enough to improve outcomes for babies born in England. The authors say that to reduce disparities in birth outcomes at a national level, politicians, public health professionals, and healthcare providers must work together to address racism and discrimination and improve women's social circumstances, social support, and health throughout their lives.
Dr Jennifer Jardine, co-lead author and spokesperson for the Royal College of Obstetricians and Gynaecologists, said:
"The stark reality is that across England, women's socioeconomic and ethnic background are still strongly related to their likelihood of experiencing serious adverse outcomes for their baby. I think that people will be shocked to see that these inequalities are still responsible for a substantial proportion of adverse pregnancy outcomes in England.
"Over the past few decades, efforts to close the gap in birth outcomes focusing primarily on improving maternity care and targeting individual behaviours have not been successful. Birth outcomes don't only represent a woman's health during pregnancy but also reflect her health and wellbeing across her entire life. While we must continue to encourage healthy behaviours during pregnancy, we also need public health professionals and politicians to strengthen efforts to address the lifelong, cumulative impact of racism and social and economic inequalities on the health of women, families, and communities."
Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said:
“The findings of this study are alarming but sadly they come as no surprise. They provide more evidence that poverty, racism and discrimination can affect women throughout their lives and ultimately lead to devastating incidences of pregnancy complications and baby loss.
“The fact this study attributes 24 percent of stillbirths to socioeconomic inequality and 12 percent to ethnic inequality demands the strongest possible action from across government to address the wider factors that influence the health of women and their babies.
“These disparities are something we as healthcare leaders also have a duty to address and we are committed to providing innovative clinical solutions. All women should have equal access to high-quality antenatal care and support, regardless of their background, but the current pregnancy risk assessment is more than 50 years old. As a result, some women receive unnecessary care and others, too little too late, widening rather than reducing health inequalities.
“Our new Tommy’s clinical decision tool – currently being introduced in four early adopter maternity units across England – puts research and digital innovation into practice, using clinically validated algorithms, taking all relevant risk factors into account and producing a more accurate and personalised assessment of a woman’s chance of developing pregnancy complications that can lead to adverse outcomes.
“We hope the UK government and NHS will provide further investment to roll out this evidence based technology to all pregnant women in the UK to help reduce these stark inequalities.
“The RCOG’s Race Equality Taskforce was set up to prioritise women and their babies, and to tackle the inequalities and systemic racism that continues to exist in our healthcare system. We are committed to working together with policy makers and healthcare providers to address discrimination, bias and poor behaviours by improving training for doctors and ensuring we are attracting a diverse and anti-racist workforce.”
Dr Christine Ekechi, consultant obstetrician and gynaecologist and Co-Chair of the Race Equality Taskforce at the Royal College of Obstetricians and Gynaecologists, said:
“We already know that Black women are four times more likely to die in childbirth compared with white women, and this research shows that the largest maternal inequalities exist for the most deprived South Asian and Black women – which is heart breaking. These women are being let down by a healthcare system that is supposed to protect them.
“Reducing the occurrence of potentially avoidable adverse pregnancy outcomes needs to be a national priority, with maternity services and healthcare professionals working with policy makers and the government to urgently address these inequalities. It is not enough to target interventions at the individual if we do not acknowledge and address the social circumstances which significantly influences the health outcomes for themselves and their families. What happens in a woman’s life and home plays as significant a role in her pregnancy, as does occur when she interacts with the health system. We must do better at recognising this fact.
“All women should feel listened to, both within and outside the healthcare system, and we must continue to push for significant progress in improving maternal and obstetric care for those most at risk of adverse outcomes.”
For media enquiries please contact the RCOG press office on +44 (0)7740 175342 or email firstname.lastname@example.org
Notes to editors
- Read the full Lancet paper: Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study
- The Tommy’s National Centre for Maternity Improvement is an alliance of the Royal College of Obstetricians & Gynaecologists (RCOG), the Royal College of Midwives (RCM) and Tommy's. Together we have developed an online clinical decision support tool: an app, shared between healthcare professionals and women, to help ensure every woman receives the right care at the right time and ultimately, save more babies’ lives. Find out more about the app.
- The RCOG’s Race Equality Taskforce advises the College on issues related to race equality, with a particular focus on addressing the disparity in health outcomes experienced by Black, Asian and minority ethnic girls and women in the UK, and tackling the impact of bias and racism on the careers and development of doctors working in obstetrics and gynaecology.