As part of the extensive and ongoing review of maternity and neonatal care by Baroness Amos, an interim report has been released which highlights that too many families are being failed by maternity services. To date, she and her team have met with over 400 family members and heard from over 8,000 people through the public call for evidence.

Baroness Amos commented that ‘nothing prepared me for the scale of unacceptable care that women and families have received, and continue to receive, the tragic consequences for their babies, and the impact on their mental, physical and emotional wellbeing’. She concludes that the system at present is simply not working for women, babies and families or for staff.

She has been blunt in saying that she simply does not understand why change has been so slow but that her investigations have affirmed for her that change is not only possible but also that it is necessary and urgent. In a recent interview with BBC Breakfast, Baroness Amos commented that, although any change is welcomed, progress is patchy and inconsistent and that “What I have heard from families it is so traumatic and distressing. I have seen Trusts that have changed their practices as a result of what has happened in those trusts. It is a very mixed picture. It is not consistent.”

A specific issue that she raised in her interim report was in respect of the impact of racism upon maternity and neonatal care. She acknowledges that the investigation is not carried out in a vacuum and that there are wider societal issues at play which are influencing attitudes but is frank that there is no place for racism and discrimination in the NHS.

The opening words of the NHS constitution make it clear that the NHS is for all, belonging to the people and benefiting everyone equally. Baroness Amos found that this is not being achieved as would be hoped, being specifically concerned that the persistent inequality in the maternity and neonatal system places women from black and Asian backgrounds at higher risks of adverse outcomes.

Although the cornerstone of the NHS is to provide the highest standards of excellence and professionalism and for the patient to be at the heart of everything that the NHS does, she noted systemic issues surrounding race, with racism and discrimination exhibited by staff towards women and families, between staff and by women and families towards staff.

Not only is racism and discrimination unable to be reconciled with the core principles of the NHS, it has a practical and devastating impact in that inequalities extend to babies’ outcomes. Babies of Black ethnicity are more than twice as likely to be stillborn and are at an increased risk of preterm birth and neonatal admission at term when compared with white babies. Neonatal mortality rates are also higher for Black and Asian babies compared with white babies.

She has carried out specific investigations with black and Asian women and their families, engaging with these communities to ensure that their concerns were heard and acknowledged. She noted that specific issues raised were:

• the importance of improving ways to reach and work with women and families who may be fearful of engaging with the system, who are unsure how to or for whom there are language or cultural barriers
• the lack of trust in the maternity system
• the benefits of using faith leaders or community organisations trusted by families and that support families to feel safe
• the importance of improving communication between families and healthcare professionals to provide more culturally sensitive care, especially when communicating risk
• concerns around how systemic racism and stereotyping can impact on treatment and care
• the importance of research and innovation funding for identifying solutions that tackle inequalities

The interim report notes the damaging effect of stereotypes being perpetuated in maternity and neonatal services, such as accounts of Asian women being stereotyped as ‘princesses’, with the implication that they are overly demanding or unable to cope with pain and of black women being deemed as having “tough skin” and “able to tolerate pain.”

The report further noted the concerns of Muslim families that their religious beliefs could influence their care; families expressed that they felt that they could not raise concerns due to fear that discriminatory attributes may result in poor treatment for their child. Within the report, reference is made to cruel or insensitive comments that have been made to families from the maternity staff and a belief that the system is ‘not for them’, eroding confidence and trust in maternity services.

Baroness Amos’ investigation remains ongoing and as part of this, she considers it crucial to explore the extent to which racism and discrimination is present, tolerated or actively addressed in the NHS and how systems respond when racist and discriminatory behaviours, policies and practices are uncovered.

Baroness Amos acknowledged that health inequality is not faced solely on the grounds of race or ethnicity but also due to disability, socioeconomic status, neurodiversity and gender identity. Her point is that, irrespective of why health inequality is faced, she is

striving to bring about positive change and stop the pattern of seldom heard from communities facing such inequalities.

She is clear that maternity services need to focus on reducing practical barriers and building trust and confidence. This includes outreach delivered in partnership with voluntary and community organisations, so that those facing health inequality have access to information and support to help them with navigating services.

There will be no quick and easy fix to maternity and neonatal care, due to the need for widespread overhaul of practices. Indeed, Baroness Amos acknowledges that it was 10 years ago that a vision for safe, kind, family-friendly maternity services for all women and families in England was set out and in spite of this, women and their children are continuing to be harmed through no fault of their own.

We wholeheartedly support the systemic change pursued by Baroness Amos but our priority is and always will be the women and children who are at the heart of maternity and neonatal services, irrespective of race or ethnicity. We are here to support and to advocate for these victims and get them the answers and justice that they deserve. Should you or a loved one have suffered harm related to maternity or neonatal care which you think may have been avoided, please contact our experienced team to discuss how we can help.