In high-income countries like Denmark and the Netherlands, pregnancy is comparatively safe. But maternal deaths still happen and in places like the UK they are growing. Understanding why it is important, not only for the family a woman leaves behind, but also for the services that cared for her and for society in general. Maternal deaths have long been considered an indicator of the quality of the health system where they occur.
Most women who die in high-income countries do not die from pregnancy complications, such as bleeding, but from medical or mental health conditions that worsen with pregnancy. a new study comparing eight European countries found that heart disease, blood clots, and suicide are the leading causes of maternal death.
Crucially, these women don’t just die during pregnancy or childbirth. Most die after the end of the pregnancy. A recent UK study of women who died during or up to a year after the end of their pregnancy found that only 14% of women, one in seven, died while still pregnant.
Heart disease is the leading cause of maternal death in the UK but arguably it need not be. The simple fact of pregnancy leads to inequitable care.
Most women who die of heart disease during or after pregnancy in the UK are at increased risk due to older age, obesity or smoking and do not know they have heart problems before they become pregnant. Investigations into their deaths have repeatedly shown that women who approach their doctor about symptoms related to heart disease are dismissed or their symptoms attributed to pregnancy.
Even if their heart disease was diagnosed, these women did not receive the same quality care as people who are not pregnant; treatments were stopped or started too late, simply because the women were pregnant or breastfeeding.
So why are the rates higher in the UK? Deaths from heart disease, along with other conditions such as epilepsy, mental health problems or asthma, largely explain the difference in maternal mortality rates between the UK and countries like Norway. While there is no single answer as to why these deaths are higher, the characteristics of the UK population are part of the explanation.
Also, Maternal age at delivery continues to increase in the United Kingdom. Women aged 40 and over are three times more likely to die during or up to six weeks after pregnancy than women aged 20 to 24.
fixing the problem
Tackling the UK’s higher maternal mortality rate requires action beyond maternity services. Health before and after pregnancy, and the care pregnant women receive in other parts of the hospital or community, are essential and services must communicate with each other.
Mental health is an important example. Post-pregnancy is the time when mental health care and support is critical, but maternity care ends just four weeks into pregnancy. Mental health services to support women during and immediately after pregnancy are growingBut they often don’t serve women with more than one existing health problem, such as those with mental illness and substance use.
While the higher rates in the UK can be partly explained by the way the health service is organized and different population characteristics, overall UK maternal death figures mask other disparities. Some groups of women have disproportionately low results. Black women are almost four times more likely to die and Asian women are twice as likely to die, compared to white women.
And the women who live in the 20% of the most disadvantaged areas are more than twice as likely to die compared to those who live in more prosperous 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 diagnosis of mental health, substance use, or domestic abuse.
Disparities based on race or ethnicity are not unique to the UK: similar patterns are seen in France, Holland Y the United States. They reinforce the effect that society in general has on maternal deaths.
Recent UK research on racial injustice in maternity care found that many pregnant women from minority ethnic groups felt insecure, ignored, and incredulous, and requested individualized care that respected their rights.
Basic obstacles to accessing safe care were identified, such as the lack of interpretation services. No similar research has yet focused on caring for women from disadvantaged groups, but research has identified similar themes of impotence in her attempts to navigate the complex maternity system.
While the UK has an open access healthcare system, access is not equitable. Unfortunately, there is no silver bullet for reducing maternal deaths, but a good place to start will be to listen to women from these various vulnerable groups.