An interim report commissioned by the UK government has found maternity services in England are failing “too many” families, with issues spanning the entire maternity journey, including instances of racial discrimination. The findings, published today by Baroness Amos, highlight systemic problems with staffing, accountability, and facilities.
The review, which has received evidence from over 8,000 people and involved meetings with more than 400 families, details a “patchy” and “inconsistent” level of care across NHS trusts. Whereas examples of safe and excellent care were observed, the report emphasizes the prevalence of “poor” and “lousy” experiences, with some trusts demonstrating improvements only after adverse events.
Racism and discrimination were identified as pervasive issues throughout the system. The report cites accounts of stereotypes being applied to expectant mothers based on their ethnicity. Asian women, for example, were described as being labelled as “princesses,” with the implication they were overly demanding or unable to cope with pain. Black women reported being perceived as having “tough skin” and a higher tolerance for pain, potentially impacting pain management decisions.
The findings reach amid growing concern over maternal mortality rates in England. Data from MBRRACE-UK, cited in the NHS England’s Maternal Care Bundle documentation, shows a 21% increase in maternal mortality since 2009-2011, although this figure includes deaths related to COVID-19. Excluding COVID-19 related deaths, the increase is 7%. The data also reveals significant disparities in outcomes, with Black women dying at more than twice the rate of white women, and women in the most deprived areas dying at almost twice the rate of those in the least deprived areas.
The Maternal Care Bundle, launched by NHS England, aims to address these issues by setting best practice standards across five areas of clinical care. However, the interim report suggests that implementation of these standards remains inconsistent. MBRRACE-UK assessors found that improvements in care could have potentially made a difference for 45% of the women who died between 2021 and 2023.
Health Secretary Wes Streeting has pledged to act on the final recommendations of Baroness Amos’s review, which are due to be published in June. The Department of Health has not yet responded to specific criticisms outlined in the interim report. The NHS England has launched a Maternity and Neonatal Equalities dashboard to improve transparency and achieve equality in services for vulnerable groups, but the effectiveness of this initiative remains to be seen.
A 2022-2024 Care Quality Commission inspection found that nearly half of 131 maternity services in England required improvement or were deemed inadequate, further illustrating the scale of the challenges facing the sector.
