Five year study reveals “unacceptable” inequalities in stillbirth rates between Black, Asian and White babies

• Researchers say around 1,800 stillbirths could have been prevented between 2014 and 2019 if ethnic inequalities did not exist - a 12% reduction in the number of stillbirths
• Enquiry underway into the quality of care provision for Black and Asian mothers whose babies are stillborn or die shortly after birth

New research published today in the BMJ Open by the University of Leicester has highlighted “unacceptable” significant and persistent inequalities in stillbirth rates between Black, Asian and White babies.

Using data from the MBRRACE-UK national perinatal mortality surveillance programme, the study found that although overall stillbirth rates have fallen by a fifth between 2014 and 2019, for every 1,000 births there were over seven stillbirths in babies of Black ethnicity and around six stillbirths in babies of Pakistani and Bangladeshi ethnicity. This compares with around five stillbirths for babies of Indian ethnicity, and three stillbirths for every 1000 births in babies of White ethnicity.

Stillbirths in the babies of Pakistani, Bangladeshi and Black African mothers were more likely to be caused by congenital anomalies, compared with babies of Indian, Black Caribbean and White mothers. Higher proportions of stillbirths were linked to complications with the placenta for the babies of Black mothers.

Ruth Matthews, lead author and researcher at the University of Leicester, said: “While these results show the number of stillbirths in the UK continue to fall, there remain unacceptable ethnic inequalities in stillbirth rates, with babies of Black, Pakistani and Bangladeshi ethnicities at much higher risk of being stillborn than babies of White ethnicities.

“We estimated that around 1,800 stillbirths could have been prevented between 2014 and 2019 if stillbirth rates in all ethnic groups were the same as rates in babies of White ethnicity, a 12% reduction in the number of stillbirths.

“To achieve Government targets of up to a 50% reduction in stillbirth rates across the UK by 2025, more needs to be done to address the impact of ethnic and socioeconomic inequalities for these babies.”

In this national surveillance programme of perinatal mortality, the cause of the baby’s death was not known for a high number of stillbirths - this was more common for babies of Bangladeshi, Indian and other Asian ethnicities. 

Ruth Matthews continues: “It is vital that all parents are offered a post-mortem to provide the opportunity to understand the reason for their loss, and help plan future pregnancies. 

“It is important to address the concerns of parents who are less likely to consent to a post-mortem.”

A confidential enquiry into the quality of care provision for Black mothers whose babies are stillborn or die shortly after birth is currently underway and is being extended to include Asian mothers.

Professor Elizabeth Draper, MBRRACE-UK perinatal lead at the University of Leicester said: “Alongside the surveillance data, this enquiry will enable us to identify specific issues for Black and Asian mothers and their babies for the targeting of interventions to reduce stillbirths and baby deaths. 

“We will also develop recommendations to improve the quality of care provision for these groups of women across the UK.”

Commenting on the report findings, Professor Jacqueline Dunkley-Bent, Chief Midwife at NHS England and report co-author, said: “Overall, England remains a safe place to be pregnant, give birth and raise healthy children, however this study shows that inequalities remain for babies of black, Pakistani and Bangladeshi ethnicities. That is why NHS England's national equity and equality guidance is a significant step in ensuring that the right maternity care is provided at scale and with an intensity that is equal to the level of disadvantage.”

‘Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study’ is available in BMJ Open.