How is ethnicity data collected in maternity?

By Hermione Jackson, Digital Midwife Project Advisor on 12 October 2020 Maternity Services Digital Maturity Equality and Diversity Race matters

There is mounting evidence about the health inequalities for people from black, Asian and minority ethnic (BAME) backgrounds. Data collection is the first step in understanding why these health inequalities exist. It is essential to accurately record ethnicity within the maternity record when it is known to support accurate analysis of that data.

Within maternity, the MBRRACE report (2019) highlighted that women from an Asian background are twice as likely to die during and shortly after childbirth; and that women from a black background are five times more likely to die. Capturing this vital data was only possible because ethnicity is recorded as part of the data collected for MBRRACE.

More recently, UKOSS data (BMJ 2020) highlighted that women from a BAME background were more likely to develop complications from COVID-19 which require hospital treatment. Again, this was because this data collection included ethnicity information.

In England, all maternity units are required to submit data to the Maternity Services Data Set (MSDS), which includes crucial details from a woman’s pregnancy and birth, as well as ethnicity. This rich data will allow for broader analysis around the pregnancy outcomes for women, including by ethnicity. There are similar data sets in Scotland, Wales and Northern Ireland.

The MSDS data is collected from each maternity unit’s electronic record (or maternity system). This data field may automatically populate from the hospital Patient Administration System (PAS) or be input manually by the midwife at the booking appointment.

This data is submitted monthly and published on the NHS Digital website. Recent analysis, however, suggested that there are still a significant number of submissions which include a higher than expected number of records where the ethnicity data is ‘not stated’, ‘unknown’ or missing. This may be due to process issues, interoperability issues or other insufficient documentation.

Healthcare systems in the UK use national data dictionaries to ensure that ethnicity data collected all adhere to the same standard and includes the same options. This standardisation of data allows for more straightforward analysis and comparison. The current data dictionary consists of the same ethnicity options as the last UK Census in 2011.

How do midwives record ethnicity in practice? In maternity records, we record ethnic information twice asking two different questions – firstly what ethnicity the woman identifies as? This is the ethnicity which will be submitted for MSDS. We also ask about all the ethnicities which make up her heritage; this information is important for the sickle cell and thalassemia screening test completed as part of the booking. How is ethnicity data collected and recorded within your organisation?