UK and Ireland see sharp rise in maternal deaths

The number of women dying during pregnancy or shortly after has risen sharply in the UK and Ireland, with increases steepest in the most deprived areas, a report has found.

In 2018-2020, 229 women in the UK and Ireland died during or up to six weeks after pregnancy from pregnancy specific causes or conditions made worse by pregnancy, found the ninth annual report from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE-UK).1 This is a 24% increase compared with 2017-2019 and a 19% increase if covid deaths were excluded.

A further 289 women died between six weeks and one year after pregnancy during the same period, in line with previous years.

The data show a widening gap in outcomes for women who live in the most deprived areas compared with those who live elsewhere, and a rise in maternal suicide deaths.

Marian Knight, professor of maternal and child population health at Oxford Population Health, who led the study, said, “Many women who died had multiple disadvantages and health and social problems. It is critical that health professionals and service providers recognise and respond to the individual needs of all women during and after their pregnancies, and that sufficient resources are available to enable appropriate care across all services.

“Urgent action needs to be taken across the maternity system in its widest sense to ensure that this worrying increase in maternal deaths is reversed.”

Between 2018 and 2020, the maternal death rate during or within 42 days of the end of pregnancy in the UK was 10.90 of 100 000 maternities (95% confidence interval 9.53 to 12.40), compared with 8.79 of 100 000 (95% CI 7.58 to 10.12) in 2017-19 (rate ratio 1.24, 95% CI 1.02 to 1.51, P=0.028).

Over the same period, women living in the most deprived areas were more than twice as likely to die as women in the least deprived areas of the country (17.96 of 100 000, 95% CI 14.24 to 22.35 compared with 7.12 of 100 000, 95% CI 4.22 to 11.25).

Maternal suicide was the leading direct cause of death between six weeks and one year after the end of pregnancy, accounting for 18% of the women who died.

In 2020, women were three times more likely to die by suicide during or up to six weeks after the end of pregnancy compared with 2017-2019. Ten women died out of 674 377 giving birth in 2020 (1.48 of 100 000) (RR 3.22, 95% CI 1.20 to 8.63, P=0.012) compared with 10 out of 2 173 810 in 2017-19 (0.46 of 100 000).

Inequalities linked to ethnicity remain stark, with a threefold difference in maternal mortality among women from black ethnic backgrounds (33.99 of 100 000, 95% CI 22.21 to 49.80) and an almost twofold difference among women from Asian ethnic backgrounds (16.12 of 100 000, 95% CI 10.88 to 23.01) compared with white women (9.23 of 100 000, 95% CI 7.70 to 10.97), although these have narrowed slightly since the previous report.

Ranee Thakar, president elect of the Royal College of Obstetricians and Gynaecologists, said, “The results of today’s report are worrying, especially the increase in maternal deaths and the increasing impact mental ill health has on mortality.

“It is also clear from the report that disparities in society have a clear impact on the likelihood of mortality. We continue to call on the UK government to commit to a time specific target to reduce maternal inequities.”