Why UK maternal deaths are rising

In high-income countries like Denmark and the Netherlands, pregnancy is relatively safe. But maternal deaths are still happening and in places like the UK they are on the rise. Understanding why is important, not only for the family a woman leaves behind, but also for the services that provided her care and for society in general. Maternal deaths have long been considered an indicator of the quality of the health system in which they occur.

Most women who die in high-income countries do not die from pregnancy-related complications, such as bleeding, but from medical or mental health problems made worse by pregnancy. A new study comparing eight European countries has found heart disease, blood clots and suicide to be the leading causes of maternal death.

Above all, these women do not die only during pregnancy or childbirth. Most die after the pregnancy ends. A recent UK study of women who died during or up to a year after pregnancy ended found that just 14% of women – one in seven – died while still pregnant.

Heart disease is the leading cause of maternal death in the UK, but arguably doesn’t need to be. The mere fact of being pregnant leads to inequitable care.

Most women who die of heart disease during or after pregnancy in the UK are at greater risk due to advanced age, obesity or smoking and are unaware they have heart problems until to get pregnant. Inquests into their deaths have repeatedly shown that women who consult their doctors about symptoms related to heart disease are dismissed or their symptoms are attributed to pregnancy.

Even if their heart disease was diagnosed, these women did not receive the same quality of care as people who were not pregnant; treatments were suspended or started too late, simply because the women were pregnant or breastfeeding.

So why are rates higher in the UK? Deaths from heart disease, as well as other conditions such as epilepsy, mental health problems or asthma, largely explain the difference in maternal death rates between the UK and countries like Norway. Although there is no single answer to why these deaths are higher, the characteristics of the British population are part of the explanation.

Mental health issues during and after pregnancy are often not adequately addressed.

More than half of women giving birth in the UK are now overweight or obese, compared to 40% in Norway. Being obese doubles your risk of dying during or up to six weeks after pregnancy ends.

In addition, the maternal age at childbirth continues to rise in the UK. Women aged 40 or older are three times more likely to die during or up to six weeks after pregnancy than women aged 20 to 24.

Solve the problem

Tackling the UK’s higher maternal mortality rate requires action beyond maternity services. Pre-pregnancy and post-pregnancy health, as well as the care that pregnant women receive in other parts of the hospital or community, are all essential and services need to communicate with each other.

Mental health is an important example. After pregnancy is when mental health care and support is essential, but maternity care does not end until four weeks after pregnancy. Mental health services to support women during and immediately after pregnancy are increasing, but they often fail to address women with more than one existing health condition, such as those with both mental illness and substance abuse.

While the higher rates in the UK may be partly explained by the way the health service is organized and the different characteristics of the population, the overall maternal mortality figures in the UK mask other disparities. Some groups of women perform disproportionately poorly. Black women are almost four times more likely to die and Asian women twice as likely to die, compared to white women.

And women living in the poorest 20% of areas are more than twice as likely to die as those living in wealthier areas. Eleven per cent of women who died during or up to a year after pregnancy in the UK in 2018-20 had serious and multiple disadvantages, including a mental health diagnosis, substance use or domestic violence.

Disparities based on race or ethnicity are not unique to the UK – similar patterns are seen in France, the Netherlands and the US. They reinforce the effect that society at large has on maternal deaths.

A recent UK survey of racial injustice in maternity care found that many pregnant women from minority ethnic groups felt unsafe, ignored and disbelieved, and called for individualized, rights-respecting care.

Fundamental barriers to accessing safe care, such as the lack of interpretation services, were identified. No similar survey has yet focused on the care of women from disadvantaged groups, but research has identified similar themes of helplessness in their attempts to navigate the complex system of motherhood.

Although the UK has an open healthcare system, access is not equitable. Unfortunately, there is no silver bullet to reducing maternal deaths, but a good starting point will be to listen to women from these various vulnerable groups.

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