Ethnic, Economic Inequalities 'Responsible For Substantial Proportion' Of Still And Premature Births

A quarter of stillbirths and a fifth of premature births across England have been linked to poverty, race, weight and smoking and could be avoided, a new study suggests.

The study found that 24% of stillbirths, 19% of live premature births and 31% of live births of smaller babies were attributed to socio-economic inequality and would not have occurred if all women had the same risks.

A review in The Lancet of more than one million births found South Asian and black women living in the most deprived parts of the country experience the largest inequalities during pregnancy.

Experts behind the review suggest that while factors such as high body mass index and smoking could be contributing to the risks, "socioeconomic and ethnic inequalities were responsible for a substantial proportion of stillbirths, preterm births, and births with FGR (foetal growth restriction) in England".

Half of stillbirths and three-quarters of births where the baby is smaller than expected in South Asian women living in the most deprived fifth of neighbourhoods would be potentially avoidable if these women had the same risks as white women living in the most affluent fifth, the study said.

Similarly, about two-thirds of still births and nearly half of those involving small babies in black women from the most deprived neighbourhoods were potentially avoidable if they had the same risks as white women in richer areas.

An estimated 60,000 babies are born prematurely (before 37 weeks) in the UK every year.

The NHS has set a target of halving stillbirth and neonatal death rates, and reducing levels of premature birth, by 25% by 2025.

In 2019, around one in 255 births resulted in a stillbirth in England and Wales, alongside around one in 302 in Scotland.

In the new study, a team from the National Maternity and Perinatal Audit analysed the birth records of almost 1.2 million women.

The experts found that 24% of stillbirths, 19% of live premature births and 31% of live births of smaller babies were attributed to socio-economic inequality and would not have occurred if all women had the same risks as those in the least deprived group.

But when experts adjusted for ethnicity, mothers smoking and BMI, these statistics were cut (to 12%, 12%, and 16%, respectively), which the authors suggested means these factors may explain a considerable part of the socio-economic inequalities in pregnancy outcomes.

Co-lead author Dr Jennifer Jardine, from the Royal College of Obstetrics and Gynaecologists, said:

"The stark reality is that across England, women's socioeconomic and ethnic background are still strongly related to their likelihood of experiencing serious adverse outcomes for their baby.

"I think that people will be shocked to see that these inequalities are still responsible for a substantial proportion of adverse pregnancy outcomes in England.

"Over the past few decades, efforts to close the gap in birth outcomes focusing primarily on improving maternity care and targeting individual behaviours have not been successful."

She added:

"While we must continue to encourage healthy behaviours during pregnancy, we also need public health professionals and politicians to strengthen efforts to address the lifelong, cumulative impact of racism and social and economic inequalities on the health of women, families, and communities."

Co-lead author Professor Jan van der Meulen, from the London School of Hygiene & Tropical Medicine, added:

"Women from deprived neighbourhoods and black and minority ethnic groups may be at a disadvantage because of their environment, for example, because of pollution, poor housing, social isolation, limited access to maternity and health care, insecure employment, poor working conditions, and stressful life events."

In total, 1,155,981 women with a singleton birth were included in the study - 77% were white, 12% South Asian, 5% black, 2% mixed race/ethnicity, and 4% other race/ethnicity.