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Study shows inequalities in health outcomes for Black and minority ethnic women and their babies

Part-funded by Wellbeing of Women and NIHR, researchers analysed data from more than two million pregnancies in high- and upper-middle-income countries


Babies born to Black mothers in rich countries are more likely to be stillborn or die in the first four weeks of life than those born to white women, according to a study part funded by Wellbeing of Women and the National Institute for Health and Care Research (NIHR).

In the largest analysis ever undertaken, researchers studied data on more than 2.2 million pregnancies across 20 countries, including the UK, US, Canada, and other countries in Europe and around the world such as Brazil, Australia and New Zealand

Significantly worse survival and health impacts were found for babies born to women from Black and minority ethnic groups across high and upper-middle-income countries.

The research has been published in the Lancet journal.

Jeremy Barratt, Head of Research for Wellbeing of Women, said: “This large and comprehensive study adds further evidence that women who are Black or from minority ethnic communities and their babies experience worse outcomes during pregnancy and shortly after birth compared with white women. It is completely unacceptable that babies born to Black and minority ethnic women are at greater risk of health complications and death in the first few weeks of life, even in rich developed countries.

“More research is desperately needed to identify why these disparities exist so that these inequalities can be addressed once and for all. We must ensure all pregnant woman and their babies receive only the best care, regardless of race and ethnicity.”

Inequalities in perinatal outcomes

The study found that babies born to Black women were twice as likely to be stillborn or die within 28 days of being born compared to white women. Black mothers also experienced worse outcomes including preterm birth and small-for-gestation-age babies leading to increased risk of health complications.

Hispanic mothers experienced worse neonatal mortality with three times as many babies dying in the first four weeks after birth compared to white women across the countries considered for the study. Mothers from South and East Asia had significantly higher rates of preterm birth and small-for-gestation-age babies.

Professor Shakila Thangaratinam from the University of Birmingham and lead author of the study said: “Our analysis shows that babies of mothers from underserved and underrepresented racial and ethnic groups being more likely to die or face serious complications is a global phenomenon. Simply put, it’s not good enough that women who aren’t white are more likely to either lose their baby either during pregnancy or in the first weeks of life, or experience complications that can have a significant impact on their quality of life.

“Race and ethnic disparities in perinatal care is not located to one specific country or region, which means that there is a systemic issue across richer countries that needs to be addressed as an international community. Taken together with strong evidence that ethnic minority mothers themselves are at increased risk of death or major health complications during pregnancy, this paper further supports the need to urgently understand how healthcare systems are struggling to provide the right care for underserved families.”

The next step

While the analysis of 51 papers demonstrates the scale of inequalities between groups, the research group point out a lack of data identifying the scale of the risks faced by women from racial and minority ethnic backgrounds.

Dr John Allotey, Lecturer in Epidemiology and Women’s Health at the University of Birmingham and Wellbeing of Women researcher, said: “We urgently need to answer the question about why these systematic disparities exist around the world. We do already know that there are barriers that disproportionately affect women from racial and ethnic minority backgrounds, and part of addressing this tragic perinatal outcome gap is having better data on underserved populations.

“More data will enable clinicians to plan better interventions to serve minority mothers, and also provide better accountability to close the gap.”

Researchers in the team are based in the University of Birmingham, Birmingham Children’s Hospital, Ramon y Cajal Hospital Madrid, and St George’s University London.

Read about the research project we are funding.

For information and support on stillbirth, please visit NHS UK, Sands UK and Tommy's.