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. 2021 Dec 13:43:101237.
doi: 10.1016/j.eclinm.2021.101237. eCollection 2022 Jan.

A national cohort study and confidential enquiry to investigate ethnic disparities in maternal mortality

Marian Knight  1 , Kathryn Bunch  1 , Nicola Vousden  1 , Anita Banerjee  2 , Philippa Cox  3 , Fiona Cross-Sudworth  4 , Mandish K Dhanjal  5 , Jenny Douglas  6 , Joanna Girling  7 , Sara Kenyon  4 , Rohit Kotnis  8 , Roshni Patel  7 , Judy Shakespeare  1   9 , Derek Tuffnell  10 , Meg Wilkinson  11 , Jennifer J Kurinczuk  1 ; MBRRACE-UK
Affiliations

A national cohort study and confidential enquiry to investigate ethnic disparities in maternal mortality

Marian Knight et al. EClinicalMedicine. .

Abstract

Background: Ethnic disparities in maternal mortality were first documented in the UK in the early 2000s but are known to be widening. This project aimed to describe the women who died in the UK during or up to a year after the end of pregnancy, to compare the quality of care received by women from different aggregated ethnic groups, and to identify any structural or cultural biases or discrimination affecting their care.

Methods: National surveillance data was used to identify all 1894 women who died during or up to a year after the end of pregnancy between 2009 and 18 in the UK. Their characteristics and causes of death were described. A Confidential Enquiry was undertaken to describe the quality of care women received. The care of a stratified random sample of 54 women who died during or up to a year after the end of pregnancy between 2009 and 18, (18 from the aggregated group of Black women, 19 from the Asian aggregated group and 17 from the White aggregated group) was re-examined specifically to describe any structural or cultural biases or discrimination identified.

Findings: There were no major differences causes of death between women from different aggregated ethnic groups, with cardiovascular disease the leading cause of death in all groups. Multiple areas of bias were identified in the care women received, including lack of nuanced care (notable amongst women from Black aggregated ethnic groups who died), microaggressions (most prominent in the care of women from Asian aggregated ethnic groups who died) and clinical, social and cultural complexity (evident across all ethnic groups).

Interpretation: This confidential enquiry suggests that multiple structural and other biases exist in UK maternity care. Further research on the role of microaggressions is warranted.

Funding: This research is funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217-21,202. MK is an NIHR Senior Investigator. SK is part funded and FCS fully funded by the National Institute for Health Research (NIHR) Applied Research Centre (ARC) West Midlands. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Keywords: Confidential Enquiry; Ethnic disparity; Maternal Mortality.

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Conflict of interest statement

All authors have completed the ICMJE disclosure form and declare: Marian Knight, Sara Kenyon and Jennifer Kurinczuk received grants from the NIHR PRP in relation to the submitted work. Mandish K. Dhanjal reports she is co-chair of the North West London Local Maternity System (LMS), and for the LMS, chair of the 'Reducing inequalities in maternity' subgroup. Kathryn Bunch, Nicola Vousden, Anita Banerjee, Philippa Cox, Fiona Cross-Sudworth, Jenny Douglas, Joanna Girling, Rohit Kotnis, Roshni R. Patel, Judy Shakespeare, Derek Tuffnell and Meg Wilkinson have no financial relationships with any organisations that might have an interest in the submitted work in the previous three years. No authors have other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Figure 1
Potential biases identified in the care of women from different aggregated ethnic groups (n = 54 women; 18 Black, 19 Asian and 17 White).
See this image and copyright information in PMC

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