Poverty in UK could increase death rates during or after pregnancy, warns WHO
Britain is falling behind European countries for mortality among mothers, and suicide is the leading cause of postpartum death
The cost of living crisis could exacerbate Britain’s already woeful rates of women dying during and after pregnancy, the World Health Organization has warned, with health inequalities becoming starker as more expectant mothers are plunged into poverty.
The UK is falling behind most comparable European countries, as 9.6 mothers die within six weeks of childbirth for every 100,000 babies, with suicide becoming the leading cause of death.
Dr Natasha Azzopardi-Muscat, a WHO director and medical doctor specialising in maternal health, said there was a “visible association” between the likelihood of a woman dying in the weeks before and after childbirth and high levels of deprivation.
She said the WHO was “very concerned” the situation in the UK could be worsened by the cost of living crisis.
“Clearly it’s not just that everyone is experiencing the same levels of maternal mortality but there are disparities and we see that those living in the most deprived areas continue to have the highest maternal mortality rates, so I think that is a very strong and key message,” she said.
“It’s not only [about] focusing on maternal care itself and ensuring you have a sufficient and competent workforce [to give] quality of care – this is all very important – but there seems to be something about the underlying risk factors that a woman has before becoming pregnant, and her wider socioeconomic and perhaps ethnic background, which are also impacting the outcomes.”
Azzopardi-Muscat added that “other countries with similar levels of economic development are faring better in terms of their maternal mortality”, noting that there is “room for improvement” in the UK, with the WHO set to publish data shedding further light on this in early 2023.
She blamed the rising rate on poor health among pregnant women, including high levels of diabetes and obesity, and “inadequate” use of antenatal care services, which are failing to reach women from black, Asian and minority ethnic backgrounds and those living in deprived areas.
She added that the UK must invest more in antenatal and perinatal mental health support during a “very delicate and fragile period in a woman’s life” to bring down the “very, very alarming” suicide rate for new mothers.
The intervention comes after the UK’s Care Quality Commission warned of a “concerning decline” in women’s experiences with maternity services due to a shortage of frontline staff. The health watchdog said it had noticed a “deterioration” over the last five years in the ratings women gave their care, with many reporting feeling they did not always get the help they needed during labour and birth and feeling they were not listened to when they raised concerns.
In November, the MBRRACE Saving Lives, Improving Mothers’ Care report revealed that 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, while suicides accounted for 18% of all deaths.
A recent international analysis also showed the UK was an outlier in terms of maternal health, with mothers in the UK three times more likely to die around the time of pregnancy compared with those in Norway.
Prof Marian Knight, the University of Oxford academic who led the MBRRACE study, said the problem was that the UK was “designing our systems for white middle-class women, but we need to be designing our systems so that they work for everybody”.
She added: “The very clear pattern, which has been getting worse over the last few years, is that many of the women who die have multiple disadvantages. The inequalities for people in the least affluent areas compared to most affluent is increasing.”
Experts warned that cost of living pressures could make things worse.
“We’re seeing really clearly that the external landscape weighs very heavily on mental health and the cost of living directly can have a massive impact,” said Laura Seebohm, the chief executive of Maternal Mental Health Alliance (MMHA).
A recent poll of 500 mothers commissioned by the charity found that 72% of those who had given birth in the past three months reported that cost of living concerns had negatively affected their mental health in pregnancy compared with just 30% of those who had a baby 18-24 months ago.
Besides causing general anxiety, cost of living concerns can directly affect women’s ability to travel to appointments and to access help. “There is a real fear of judgment if the health visitor comes and the heating isn’t on due to fuel poverty,” she said. “So you isolate from the support that is out there.”
Jess Heron, the chief executive of Action on Postpartum Psychosis, said she was concerned about the recent increase in bereaved family members contacting the charity following the death by suicide of a relative after postpartum psychosis, which she said was a “stark contrast to a decade-long trend of reduced maternal deaths relating to postpartum psychosis”.
The charity is campaigning for more mother and baby units across the UK to make access to specialist care more equitable. “Where mental health services are stretched and there is no access to a mother and baby unit, mothers may be separated from their baby, and the care and support they receive isn’t appropriate for their postpartum needs – both physical and mental,” she said.
Azzopardi-Muscat said that while ministers should improve the quality of care and NHS staffing, a “very strong and key message” emerging from the reports was that they must first tackle the underlying structural disadvantages that were resulting in poorer women being more likely to die within six weeks of childbirth, in particular by providing “very good services in the most deprived areas where needs tend to be greater”, and which were “culturally appropriate” to reach all ethnic groups.
She said that since maternal health was often considered a “warning signal” for the wider health system, it could mean the UK soon saw an increase in deaths in early childhood and shortened life expectancy.
Responding to a question on whether high maternal mortality showed the devastating impact of poverty and social disadvantage on maternal health, Azzopardi-Muscat said the WHO was pressuring countries to develop their economies in ways that prioritise “building equity and wellbeing as a principle”.
She said: “We strongly emphasise the need for universal health coverage – not only on the statute book but also in practice. That means that care is available to those who need it in a timely manner.”
A government spokesperson said: “The NHS is investing an additional £127m in maternity services in the next year to increase the maternity workforce – on top of £95m already invested to recruit an additional 1,200 midwives and 100 consultant obstetricians.
“We are expanding access to mental health support for those who’ve recently given birth, with 33 new maternal mental health services available across England by March 2024 and a requirement for GPs to offer a postnatal health check for new mothers.”
In the UK and Ireland, Samaritans can be contacted on 116 123, or email [email protected] or [email protected]. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org.