Continued impact of entrenched social inequalities clear in latest MBRRACE-UK report says RCM

on 11 November 2021 Midwifery Midwives RCOG - Royal College of Obstetricians and Gynaecologists RCOG Multi Disciplinary Working Multi-disciplinary care Safe high quality care Specialist Midwives Specialist Mental Health Midwives Safety Maternal Death Maternal Mental health BAME RCM

The Royal College of Midwives (RCM) has said ‘the continued impact of entrenched societal inequalities continues to show in these tragic results’ as it responds to the latest MBRRACE-UK Saving Lives, Improving Mothers’ Care report 2021.

This latest report focuses on 2017-19 where 191 women, from 2,173,810 women giving birth in the UK, died during or up to six weeks after the end of pregnancy from causes associated with their pregnancy.

Heart disease remains the leading cause of death, followed by epilepsy and stroke. Sepsis, and thrombosis and blood clots are the third and fourth most common causes of maternal death during or up to six weeks after the end of pregnancy. Maternal suicide remains the leading direct (pregnancy-related) cause of death over the first year after pregnancy. 

Responding, RCM’s Director for Professional Midwifery, Dr Mary Ross-Davie, said:

“Pregnancy and childbirth in the UK continue to be a safe experience for most women. However, we remain deeply concerned that mortality rates among Black women are four times higher than white women and twice as high if you are Asian or from another minority ethnic background. All those involved in commissioning and delivering maternity services must work together to address this unacceptable disparity.

“Also, it’s crucial that clinicians are aware of this increased risk and have a low threshold for assessment or admission of Black, Asian and minority ethnic women to ensure they receive the appropriate assessment and specialist care. Tragically, this report highlights maternal suicides, where improved care might have affected the outcome. High quality perinatal mental health services are essential to maternity care and every Trust or Board should have a specialist service that includes a specialist perinatal mental health midwife. The RCM has long called for specialist perinatal mental health provision in all Trusts and Health boards and this report highlights once more the urgent need to improve this provision. In many parts of the UK, these midwife roles do not exist or are very limited. This means many women who need additional support may not receive the right care.”

The RCM notes that, sadly, women living in the most deprived areas are twice as likely to die than those who live in the most affluent areas. This year’s report also shows a continued gap between the mortality rates for women from Black, Asian, or minority ethnicity backgrounds and those from white backgrounds.

The RCM says an improved focus on the implementation of recommendations in these reports is urgently needed as there was statistically a non-significant decrease in the overall maternal death rate in the UK between 2014-16 and this report (2017-19). 

Mary added:  

“This report is tragic, but there is much learning that can be taken from the report’s recommendations if we are to achieve a reduction in maternal deaths. Working with the Royal College of Obstetricians & Gynaecology and other partners, the RCM is committed to improving the safety and quality of maternity care. We know that continuity of carer significantly improves outcomes for all women from all backgrounds, particularly those in areas of high socio-economic disadvantage. However, the current shortage of midwives in England means the delivery of continuity of cares is a huge challenge. That’s why the RCM has called for more investment in recruiting and retaining staff so this can be implemented safely.”



To contact the RCM Media Office call 020 7312 3456, or email [email protected]

Notes to Editors

  • Read full MBRRACE-UK report here:
  • On specialist midwives: As part of the ongoing maternity safety strategy, the RCM is lobbying for action to address the inequalities in maternity by calling for more specialist midwives to care for women who have greater needs to improve health outcomes. Specialist midwifery roles include roles with a focus on perinatal mental health, smoking, obesity, teenage pregnancy, asylum-seeking and refugee women, traveller women, substance misuse, homelessness, and bereavement. The RCM is calling for more specialist caseload teams focussing on providing continuity of carer to BAME women to seek to address the growing health inequalities. In many parts of the UK, specialist midwife roles do not exist or are very limited. This means many women who need additional support may not receive the right care.




The Royal College of Midwives (RCM) is the only trade union and professional association dedicated to serving midwifery and the whole midwifery team. We provide workplace advice and support, professional and clinical guidance, and information, and learning opportunities with our broad range of events, conferences, and online resources.

For more information visit the RCM website