Sands & Tommy's Joint Policy Unit responds to new report on stillbirth and neonatal deaths

Today MBRRACE-UK published their report looking at deaths of babies before, during, or up to 28 days after birth.

While it shows a continued decline in stillbirths and neonatal deaths up to 2020, sadly we know that more recent data from the Office of National Statistics (ONS) indicates an increase in stillbirth rates in England and Wales for 2021. Data from the National Records of Scotland also shows that rates of neonatal death increased in Scotland in 2021.  

The MBRRACE report showed that 8/1000 babies of Black African and Black Caribbean heritage living in the most deprived areas were stillborn – more than double the lowest stillbirth rate for White babies in the least deprived areas. 

Babies of Black African, Black Caribbean, Pakistani and Bangladeshi ethnicity are nearly twice as likely to be from deprived areas as babies from other ethnicities and are much more affected by the higher rates of stillbirth and neonatal death associated with deprivation.

The highest neonatal death rates were for babies of Pakistani and Black African ethnicity from the most deprived areas, at over 3 per 1000 live births.

This year’s report also found an increase in both stillbirth and neonatal death rates for twins over the period 2016 - 2020. 

Variation in the number of deaths between different maternity units across the country remains too high, even when data is adjusted to take into account local levels of deprivation and babies' ethnicity.

Kath Abrahams, Tommy’s Chief Executive says: 

Each year MBRRACE data gives us a clear look at whether perinatal mortality in the UK is rising or falling. What matters now is how this data is used and what changes because of it, nationally and locally. 

We’re deeply concerned about the persistent, unacceptable, inequality in access to care and in outcomes for families shown in the latest MBRRACE and ONS reports. The Government must invest in the people and the research needed to help reduce the number of stillbirths and neonatal deaths and ensure that all women and pregnant people and their babies are receiving best-practice care during and after pregnancy. No mother or baby should be at a higher risk of death because of their postcode, ethnicity, or income.

MBRRACE data is UK-wide and covers deaths up to 2020. It’s based on notifications from health professionals and while it is one year behind ONS data, it provides a more detailed breakdown, which can be used by individual maternity units to evaluate and improve services. 

Prioritising a strong and healthy maternity workforce

Through the Sands and Tommy’s Joint Policy Unit, we’re working to make sure saving babies' lives and reducing inequalities is a national policy priority. 

Recent reports have consistently highlighted how a better-supported workforce is vital to supporting improvements in maternity and neonatal care.  

But workforce numbers are going in the wrong direction. The overall number of midwives working in the NHS in England has fallen over recent years and there has also been a particularly sharp rise in sickness absence for midwives. While there are huge pressures across the NHS, the decline in the number of midwives is particularly stark has come at a time when numbers of other staff working in other areas of care have increased. 

Robert Wilson, Head of the Sands and Tommy’s Joint Policy Unit says: 

Much more concerted action is required if we are going to achieve ambitions to reduce the number of babies that die before or shortly after birth, tackle unacceptable inequalities, and ensure everybody can benefit from best-practice care throughout pregnancy and the neonatal period.

In 2021 the Health and Social Care Committee recommended the budget for maternity services in England be increased by £200-350million per year. While some recent welcome commitments have been made, we are still far short of the amount needed to fund a safe maternity workforce.

If the Government is serious about achieving its ambitions to save more babies lives and reduce inequalities it must commit to the workforce and funding required to achieve this.

The Sands and Tommy’s Joint Policy Unit was set up with the aim of securing policy change to reduce rates of miscarriage, stillbirth, pre-term birth and neonatal death. We are continuing to monitor a range of public data sets and research findings to track progress in the UK, pulling together evidence to identify the key changes needed to save babies lives, reduce inequalities and improve outcomes.

Clea Harmer, Sands Chief Executive, says:

The MBRRACE report annually gives us detailed data to understand where we need to target improvements to save babies’ lives. More must be done to address the stark inequalities in perinatal mortality rates relating to ethnicity and level of deprivation. It is also truly shocking to see the increase in twin deaths and the widening gap between twin and singleton deaths. Beneath the positive headline figures of an overall reduction in perinatal mortality rates, this report highlights just how much more there is to be done.

At Tommy’s we are committed to funding research to find the answers that can prevent babies’ deaths, reduce inequality, and improve support for mothers facing the highest risks. 

Our Manchester Stillbirth Research Centre team are working tirelessly to understand the causes of stillbirth, so we can find ways to identify who is most at risk and develop treatments that will give them the best possible chance of bringing home a happy, healthy baby.

Meanwhile, the Tommy’s National Centre for Maternity Improvement has developed the Tommy’s App – currently being trialled in 4 NHS trusts – to help ensure every woman and pregnant person receives the right care at the right time and ultimately, save more babies’ lives.