The number of women dying in pregnancy or shortly after giving birth in the UK has risen sharply, with evidence of widening health inequalities, a major report has found.
The report, MBRRACE Saving Lives, Improving Mothers’ Care, found that 229 women died during pregnancy or up to six weeks after in 2018-20, a 19% increase on previous years once Covid deaths were excluded. It also detailed the care of 289 women who had died up to a year after pregnancy in the same period.
Women living in the most deprived areas were more than twice as likely to die as those in the most affluent parts of the UK, the report found, a disparity that has significantly increased.
Prof Marian Knight, of the University of Oxford, who led the study, described the picture as “bleak”. “Maternal mortality has got significantly worse,” she said. “The really very clear pattern, which has been getting worse over the last few years, is that many of the women who die have multiple disadvantages.
“Maternal mortality rates are a barometer of health systems,” she added. “This, for me, is a barometer of our health system in its widest sense.”
Ethnicity linked disparities remain stark, but have narrowed slightly since the previous report. “The disparity between black women and white women has not got worse, despite all of the pandemic challenges,” said Knight. “That has to be regarded positively, but the maternal mortality of black women is still 3.7 times that of white women.”
In previous annual reviews, cardiac events have been the leading cause of maternal deaths in the UK, but the latest data found mental illness was now on an equal footing.
The leading direct cause of death was suicide, which had tripled since 2017-19 among pregnant women or within six weeks of their pregnancy ending, accounting for 18% of maternal deaths in total.
The government has a stated ambition to halve maternal mortality in England between 2010 and 2025, but it has increased by 8% since 2010-12, the latest figures show. The report found that many of the women did not have a formal mental health diagnosis, but they were facing multiple adversities, including a history of childhood trauma or domestic abuse.
“We need to recognise where we’re not providing the services for these groups of women,” said Knight. “We are designing our systems for the white middle-class woman. We have to design our systems so that they work for everybody.”
The Royal College of Midwives said the increase in maternal deaths was “a tragic indication of a lack of government investment in maternity services”.
“Any rise in maternal deaths, however small, is deeply worrying and we are moving backward not forward,” Gill Walton, the chief executive of the RCM, said. “Governments must focus efforts on the crucial areas where women are being let down and not getting the care they deserve and should expect. We have overstretched midwives and maternity services that have been trying to do too much, with too little, for far too long. This should be a time of great joy for women and families, but tragically for some, it is a time of heartbreak.”
Naomi Delap, the director of the charity Birth Companions, said the reasons behind the rising figures needed urgent investigation. “This maternal deaths report is a damning indictment of the government’s failure to focus on the social determinants of health, and to invest in mental health support and wraparound services for women living in the most challenging circumstances,” she said.