Why is the UK mired in a maternity and neonatal deaths scandal?

Two new inquiries have found that substandard care in at least two hospital trusts contributed to a rise in maternal and neonatal deaths in England, UK.

An inquiry into maternity care in Nottingham found that more than ۵۰۰ mothers and babies either came to harm or died due to poor care.

The report released last week, which was led by childbirth expert and midwife Donna Ockenden, found that in Queen’s Medical Centre and Nottingham City Hospital, “multiple” women had experienced “bullying” and poor or “cruel” care as understaffing issues persisted.

Moreover, it found that ۴۴۴ women and ۷۶ newborn babies suffered “potentially avoidable” outcomes due to poor care over ۱۳ years at Nottingham University Hospitals Trust (NUH).

A similar review, the Amos report, named after Baroness Valerie Amos, into the British healthcare system’s maternity services also found similar outcomes: women and babies being failed as hospitals ignored patient needs.

According to research published in January by Oxford University, the UK maternal mortality rate for ۲۰۲۲-۲۰۲۴ was ۱۲.۸ deaths per ۱۰۰,۰۰۰ maternities.

That was ۲۰ percent higher than ۲۰۰۹-۲۰۱۱, “meaning the UK government has missed its ambition to halve maternal mortality”, the Oxford report concluded.

Here’s what we know about the maternity scandal in British hospitals.

What did the inquiries into UK maternal and neonatal deaths reveal?

The Ockenden report, which undertook a three-year inquiry into the deaths of ۲۷ mothers in the Nottingham area between ۲۰۰۶ and ۲۰۲۴, found “failures in care that may have or substantially impacted on the outcome in six deaths”.

In one particularly shocking case, the inquiry found that a baby who died early in gestation was “inadvertently disposed of as clinical waste by laboratory staff after her post-mortem examination”, causing huge distress to her parents.

Overall, the report found failures in the following key areas:

• Listening to women and families and acting promptly on concerns.
• Continuity of care, particularly for those with additional social or medical complexities.
• Robust clinical governance to ensure timely information-sharing across organisations.
• Prompt access to imaging for women with concerning neurological symptoms.

The inquiry also found that deaths of newborns would most likely have been prevented if they had been handled with proper care in hospitals. It highlighted a “bullying and toxic culture” which persisted at NUH, as well as senior managers failing to act when repeatedly warned about specific problems. Mothers in labour were routinely turned away from the two maternity units and told to return home – often when they should not have been – the inquiry noted.

It found that both maternity units were short-staffed and not equipped to manage the number of births and complex cases they had.

Ockenden also found that “when complaints were made, the trust’s instinct was to cover up rather than investigate failings”.

It was noted that several clinicians refused to respond to questions from the inquiry.

The Nottingham Maternity Families group, which represents ۶۰۰ harmed and bereaved families, said that was “appalling” and called for the sacking of senior managers who declined to give evidence. The group called on the government to launch a statutory public inquiry into maternity failings across England as a whole.

Following publication of the Ockenden report, Kath Abrahams, chief executive of the baby loss charity, Tommy’s, said: “This is a truly harrowing report. It is utterly inexcusable that pregnant women seeking help at Nottingham University Hospitals NHS Trust were in some cases treated so poorly – sometimes with devastating consequences – and that healthcare professionals and families who did as much as they could to flag the risks were ignored.

Both the Ockenden and Amos reports found similar reasons for the rise in deaths in the UK, all of which pointed to failings within the NHS and in maternal and clinical care.

Amos’s review also points to racism and discrimination as being “embedded throughout the system”.

According to the report, women and families who were interviewed said they received unfair or unequal treatment, were subjected to stereotypes, racial slurs, Islamophobia and antisemitism.

Staff at the hospital also shared similar sentiments about being subjected to racism while performing their jobs.

Have similar issues been uncovered at other hospitals in the UK?

Yes. In the northern city of Leeds, an independent inquiry was launched following a BBC investigation last year which revealed that at least ۵۶ baby deaths and two maternal deaths between ۲۰۱۹ and ۲۰۲۴ might have been preventable at Leeds Teaching Hospitals.

At the same time, the Care Quality Commission rated Leeds Teaching Hospitals as “inadequate” and found that the hospitals had low staffing levels and concerns about infection control.

In March, Ockenden was appointed to oversee another review into the Leeds Teaching Hospitals that is expected to cover hypoxic injuries and maternal deaths from ۲۰۱۱ to ۲۰۲۵.

What measures has the government announced?

On Tuesday, Health Secretary James Murray called the Amos review a “watershed moment”.

“We will dismantle toxic dynamics, boost staff morale and support better teamwork between midwives, doctors and other clinicians,” he told members of parliament.

“We need not only the right policies, procedures and processes to be put in place but also a fundamental reset in the culture of a service that too often puts the desire to protect itself above the duty to protect women and babies,” he added.

Murray also said that a new maternity and neonatal commissioner, who has yet to be appointed, would be appointed in a bid to transform childbirth services. This will be a statutory role and the commissioner will be accountable to parliament.

The commissioner will co-chair a National Maternity and Neonatal Taskforce alongside the Secretary of State for Health and Social Care, “giving them direct influence over policy, safety protocols, and NHS resource allocation”, the government said.

The health secretary also announced additional funds of ۴۱ million pounds ($۵۴.۷۵m) to improve safety at maternity and neonatal facilities and will create ۱,۰۰۰ temporary midwifery posts and to publish new national standards for emergency maternity care.

What other factors are causing an increase in maternal and neonatal deaths in the UK?

According to MBRRACE (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK), in ۲۰۲۲-۲۰۲۴, ۲۵۲ women died from “direct or indirect causes during or soon after pregnancy among ۱,۹۶۹,۳۲۱ maternities”.

“Blood clots continued to be the leading cause of maternal death in the UK during pregnancy or up to six weeks after the end of pregnancy. Heart disease was the second most common cause of death, followed by mental health-related causes (suicide and substance use),” it found.

At the same time, class background and race also played a part in the mortality rate, with research finding that the rate of deaths among black women in ۲۰۲۲- ۲۰۲۴ was “nearly three times higher than that of white women”.

“Women living in the most deprived areas continued to have a maternal mortality rate nearly twice that of women living in the least deprived areas.”

Are insurance-based healthcare systems better than national health services?

Despite the NHS’s failings, the United States, which is unusual among western nations with an insurance-based healthcare system, has a higher rate of maternal and neonatal deaths, predominantly due to unequal access to healthcare, experts say.

According to one study by Johns Hopkins University, for example, Black patients on the government-subsidised insurance plan, Medicare, were admitted to lower-quality hospitals, despite living close to better facilities.

Due to the US system of insurance-based healthcare, many people have declared bankruptcy as the result of medical costs, with the Consumer Financial Protection Bureau reporting in ۲۰۲۴ that about ۱۰۰ million US citizens owed more than $۲۲۰bn in medical debt.

The Commonwealth Fund also reported that the US ranked last among ۱۶ high-income countries when it comes to deaths that could potentially have been prevented with timely health care.

It added that, at the end of the decade, “the preventable mortality rate in the US was almost twice that in France”, which had the lowest rate – ۵۵ per ۱۰۰,۰۰۰ and operates a national healthcare system.

According to the Centres for Disease Control, in ۲۰۲۴, ۶۴۹ women died of maternal causes in the US compared with ۶۶۹ the year earlier.