MBRRACE Perinatal Death Report Shows More Needs To Be Done To Help Women From Ethnic Minority And Socially Deprived Communities

MBRRACE-UK has today published a report focussing on the deaths of babies after 22 weeks’ gestation, including stillbirths and neonatal deaths, for the period between 1 January and 31 December 2020. 

It has collated and analysed national surveillance data in order to set out trends and to identify where improvements are needed in health care for mothers and babies.

Rates of baby death from 24 weeks of pregnancy

MBRRACE-UK found that since 2013 there has been a year-on-year reduction in both the total number of stillbirths and the total number of neonatal deaths. This trend has continued in 2020 with 2,292 reported stillbirths compared to 2,399 reported stillbirths in 2019.

Although the overall trends are encouraging, the report found that stillbirth and neonatal death rates have increased for twins. Between 2016 and 2020 there was a 19% increase in the twin stillbirth rate and a 16% increase in the twin neonatal death rate. Compared to singleton pregnancies, the risk of baby death in twins is over twice as high. The report recommends that this data is further investigated in order to understand the reasons for increasing mortality rates in twin pregnancies.

The effect of ethnicity and deprivation on rates of baby death

The report has highlighted concerning findings regarding the effect of ethnicity and deprivation on rates of baby death. 

The report explored stillbirth rates and neonatal mortality rates by ethnicity and found wide disparities across different ethnic groups. Stillbirth and neonatal death rates were lowest for babies of white ethnicity (3.43 stillbirths per 1,000 total births and 1.63 neonatal deaths per 1,000 live births). These figures present a stark contrast to those for babies of Pakistani and Black African ethnicity from the most deprived areas, for whom stillbirth rates were over 6 per 1,000 total births and neonatal mortality rates over 3 per 1,000 live births.

Stillbirth and neonatal death rates increased with socio-economic deprivation across all ethnic groups. Data for 2016 to 2020 showed an increase in mortality with increasing deprivation, with stillbirth and neonatal deaths almost twice as likely in the most deprived areas compared to the least deprived areas.

The report found that deprivation had an even more significant impact on the stillbirth and neonatal mortality rates for babies of different ethnicities. The report found that, when compared with other ethnicities, babies of Black African, Black Caribbean, Pakistani and Bangladeshi ethnicity are nearly twice as likely to be from deprived areas and so are disproportionately experiencing the effects of increasing deprivation.

Strategy to tackle disparities in maternity care  

The MBRRACE-UK report highlights the compound effect of multiple disadvantage and calls for strategies to tackle disparities in maternity care. It recommends that policy makers, UK public health services service planners and commissioners at local and national level take various actions, including:

• A multi-agency targeted approach affecting people living in areas of high socio-economic deprivations across all points of the reproductive, pregnancy and neonatal healthcare pathway
  
  
• Identifying the specific needs of Black and Asian populations and ensure that these are addressed as part of their reproductive and pregnancy healthcare provision.
  
  
• Developing UK-wide harmonised indicators to identify high risk groups, including ethnicity and deprivation measures, to facilitate direct population comparisons
  
  
• Developing focused initiatives to reduce stillbirths and neonatal deaths among those at the highest risk, informed by the multidimensional effects of ethnicity, deprivation and age

Conclusion

The trends identified in this year’s MBRRACE-UK report provide further evidence that not every mother and baby in the UK has an equal chance of a positive and safe outcome. 

Inequalities continue to be rooted in a mother’s ethnicity and wider social circumstances. The national picture remains highly concerning and, as recommended by MBRRACE-UK, more needs to be done at a local and national level to improve the maternity care for mothers in these higher risk groups.

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