Renewed focus on maternal healthcare highlights disparities and need for legislative solutions

Zahrah Haider, IBA Content EditorMonday 2 October 2023

Over the summer, the UK government published its response to a report from the Women and Equalities Select Committee (the ‘Committee’) on Black maternal health, recognising discrepancies in maternal care quality based on ethnicity. The Committee’s report, Black maternal health, was published in April and outlined the ‘glaring and persistent disparities in outcomes for women depending on their ethnicity’. Caroline Nokes MP, the Committee Chair, said there was a fear that ‘the Government and NHS have not fully grasped that racism has played a key part in the complex reasons underlying the disparities’.

According to a 2022 report from MBRRACE-UK – a national audit programme to collect information on maternal deaths – between 2018–2020, Black women were 3.7 times more likely to die than white women during childbirth, during pregnancy and during the end of, or up to a year after, pregnancy.

The government’s response describes how it has been working ‘in collaboration with the membership [of the Maternity Disparities Taskforce, established in 2022] to produce pre-pregnancy guidance targeted for ethnic minority women and those living in the most deprived areas’. Commenting on the response, Nokes welcomed the government’s commitment to ending maternal health disparities and its promises on maternity staff training, but suggested ‘its response stops short of the significant action we need to end these appalling disparities in maternal deaths’.

‘Our inquiry clearly found that without further funding, it will not be possible to implement measures such as continuity of care and to combat inequalities, due to considerable staffing shortages across maternity services,’ added Nokes. Despite agreeing to some of the Committee’s recommendations, the government has rejected the recommendation to increase the annual budget for maternity services. It didn’t respond to Global Insight’s request for comment.

There should be legislation to allocate funding for further research on improving [maternal] health outcomes

Anne Walsh
Vice-Chair, IBA Healthcare and Life Sciences Law Committee

In May, former US Olympic sprinter Tori Bowie passed away from childbirth complications – she was eight months pregnant and in active labour when she died. The cause of death was ruled to be natural causes, although the autopsy revealed that Bowie possibly suffered complications linked to childbirth, such as respiratory distress and eclampsia. Like preeclampsia, eclampsia is a pregnancy-related disorder related to high blood pressure. According to the US National Institutes of Health, Black women are more at risk of developing preeclampsia. A Centers for Disease Control and Prevention report published in 2021 found that the maternal mortality rate for Black women was 2.6 times the rate for white and Hispanic women. Although cases of preeclampsia and eclampsia are well-documented, there are no definitive causes. The statistics ask the question, however, of what more can be done to protect mothers – especially those from minority backgrounds – before, during and after childbirth.

In the US, several federal initiatives seek to address issues relating to maternal health and wellbeing. The Black Maternal Health Momnibus Act (the ‘Momnibus’) – reintroduced to the House of Representatives in May by US Senator Cory Booker and US Representatives Lauren Underwood and Alma Adams – aims to ‘end preventable maternal mortality, severe maternal morbidity, and maternal health disparities in the United States’. Led by the Black Maternal Health Caucus, the Momnibus highlights, among other things, the need to address the effects of the climate crisis on maternal health; promote maternal vaccinations; increase funding for community-based organisations; and improve data collection processes to better understand the causes of the US maternal health crisis.

Anne Walsh is the Vice-Chair of the IBA Healthcare and Life Sciences Law Committee and a director at Hyman, Phelps & McNamara in Washington, DC. She says there should be ‘legislation to allocate funding for further research on improving [maternal] health outcomes’, especially for those from ethnic minority backgrounds. ‘Two of the critical – and tangibly fixable – causes are distance to healthcare providers and access to insurance coverage’, she says. And because ‘women still have lower financial access than men, that disparity impacts the affordability and accessibility of healthcare for women in the US’.

Although legislative packages such as the Momnibus recognise all the drivers of maternal mortality, there’s still a considerable amount of work needed to eliminate racial and ethnic disparities. As Senator Booker said in a statement, ‘the United States has the highest maternal mortality rate of industrialized nations, and the rate is only rising’.

With affordability and accessibility to healthcare being an ongoing issue, many jurisdictions are introducing free initiatives to promote maternal wellbeing. Beth Michoma, an Advocate of the High Court of Kenya, says the programmes her country has put in place ‘have greatly contributed to a drop in maternal [and] child mortality’. These include M-Mama, which offers free transport and emergency referral systems for pregnant women to healthcare facilities, and the Linda Mama programme, which provides free maternal healthcare, including post-delivery care. Despite the ‘inalienable right for every person’ to high quality healthcare ‘as enshrined in Article 43 of Kenya’s Constitution’, there are still multiple barriers, in addition to a lack of funding. Michoma cites understaffed healthcare facilities, an inadequate infrastructure and a lack of awareness of healthcare issues – especially in rural areas – that all have a bearing on maternal and newborn wellbeing.

Although the maternal mortality rates in the US aren’t as high as countries such as Kenya – and Pakistan – Sahar Iqbal, Membership Officer of the IBA Communications Law Committee and a partner at Akhund Forbes in Karachi, says ‘while specific challenges may differ, [those countries experience] disparities in healthcare outcomes, particularly among minority populations’. She says that, in Pakistan, ‘the disparity is observed between urban and rural communities, while in the US, it is primarily based on racial factors’.

Despite facing challenges, Pakistan ‘has taken several measures to reduce maternal mortality rates to under 70 per 100,000 women by 2030’, in accordance with UN Sustainable Development Goal 3. One significant achievement is the increase in antenatal care and delivery care coverage, with the number of skilled antenatal care providers rising from 26 per cent in 1991 to 91 per cent in 2019. Moreover, the percentage of deliveries taking place in healthcare facilities has significantly increased from 14 per cent to 71 per cent, Iqbal adds.

It’s promising that there are ongoing inquiries into maternal health and increasing calls to policymakers to implement provisions for more funding, awareness and community interventions, for vulnerable and minority women in particular. However, there’s still a long way to go to ensure maternal health and wellbeing becomes a top priority for any government, regardless of its economic status.

Image credit: Prostock-studio/AdobeStock.com

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