London School of Hygiene & Tropical Medicine

Maternal health, defined by the World Health Organization as “the health of women during pregnancy, childbirth and the postnatal period” has, in recent years, increasingly been the subject of media attention. Continued high maternal death rates globally, inequalities in healthcare and a number of policy changes have brought the issue to the forefront.

Public attention to the topic in the United Kingdom has also increased in recent years, partly due to the publication of the Birth Trauma Inquiry by the All Party Parliamentary Group (APPG) on Birth Trauma, which aimed to investigate birth trauma and develop policy recommendations to reduce the rate of birth trauma. The inquiry compiled ‘harrowing’ stories of birth trauma experienced by mothers in the United Kingdom and called upon the government to publish a national maternity improvement strategy, which would be led by a newly appointed Maternity Commissioner.

The Birth Trauma Inquiry made headlines upon its publication, having gathered evidence from over 1,300 personal and 92 professional submissions (from charities, organisations, and healthcare staff), as well as conducting 7 oral evidence sessions. The findings of the Birth Trauma Inquiry provide evidence that there are several areas of the United Kingdom’s maternal healthcare that are failing to provide optimal care. This is despite the fact that the UK’s maternity policy has been focused on compassionate care since 2016, and a national maternity and neonatal transformation plan was initiated in 2023.

The inquiry set out recommendations for the improvement of maternal healthcare in the United Kingdom through a national maternity improvement strategy. These recommendations include expanding access to mental health services, improving continuity and digitisation of maternal care, ensuring informed consent through better education and addressing disparities in care for ethnic minorities, covering areas such as birth injuries, support for marginalised groups and international best practices.

As full scale government response to the inquiry report, which was published over a year ago, is awaited, researchers in the maternal health field are in a position to generate supporting new evidence to help guide policy aimed at improving maternal health in the UK.

The MARCH Centre at the London School of Hygiene & Tropical Medicine (LSHTM) has centred birth (births that are wanted and pregnancies that are safe) as one of its three core themes since it was established in 2011. The MARCH Centre conducts research into topics such as obstetric complications, maternal mortality, prevention and treatment of infectious and chronic diseases during pregnancy, as well as research on stillbirth, and newborn deaths and illness.

Some of the recent research from the MARCH Centre focuses on and addresses the topics raised in the Birth Trauma Inquiry report, such as inequities faced by marginalised groups, reproductive health and maternity disparities.

One such piece of research is a recent report from LSHTM and the Missing Billion Initiative, which looked at disparities in maternity care for disabled women in the United Kingdom. The report showed that disabled women in the UK experience worse maternity care and neonatal outcomes than non-disabled women. While disabled women in the UK constitute 20% of women of reproductive age, the inequalities they face as regards maternal and neonatal outcomes are stark.

Key findings of the report showed that, among disabled mothers, there were higher odds of stillbirth or neonatal mortality, higher odds of caesarean birth, lower odds of breastfeeding, and higher odds of longer postnatal hospital stays. Despite these findings, Professor Hannah Kuper, co-author, Director of the International Centre for Evidence in Disability at LSHTM and co-founder of the Missing Billion Initiative, emphasised that there is a “paucity of data” on the topic, and that there is “almost no policy guidance addressing this inequity”.

Another piece of MARCH Centre research is the recent analysis of the Women’s Reproductive Health Survey, undertaken by researchers at LSHTM. The analysis found that, in England, “almost three-quarters of those surveyed reported recent experience of at least one reproductive health issue”, as explained by Melissa Palmer, Assistant Professor at LSHTM and lead author on the study.

Key findings from the analysis also included that among those in their 30s, over 10% reported experience of pregnancy loss or infertility within the last year, a third reported having a reproductive condition, such as endometriosis, Polycystic Ovary Syndrome, or different cancers, and that women from minority ethnic groups, particularly black women, were more likely to report reproductive conditions, menstrual issues and pregnancy-related adverse experiences. Most importantly, this study was the first of its kind to examine such a broad range of experiences relating to reproductive health in a single group, establishing a new evidence base for the state of reproductive health in the UK.

The results of these studies are in line with the findings of the Birth Trauma Inquiry, indicating that there is urgent action needed to address the disparities in maternal care and reproductive health outcomes that women are experiencing across the country.

Last year, following a MARCH-led application, LSHTM was selected as one of nine lead institutions to join the National Institute for Health and Care Research (NIHR) Challenge Maternity Disparities Consortium, which aims to tackle maternity disparities in the UK. LSHTM will lead the Research Excellence for Reframing & Accelerating Maternity Equality (REFRAME) collaboration, leading “innovative and transformative research that will drive improved understanding of and response to the underpinning causes of maternity inequalities in the UK”, as Aduragbemi Banke-Thomas, MARCH Centre Co-Director and Associate Professor, explained following the announcement.

High-quality research by the MARCH Centre and LSHTM provides the foundation to “inform cross-sectional policy changes in the UK”, as highlighted by Ipek Gurol-Urganci, Associate Professor at LSHTM. With this as a continuous goal of the MARCH Centre and its researchers, the evidence base to inform policy makers through inquiries, like the Birth Trauma Inquiry, can be expanded and consolidated. In turn, this evidence can motivate policymakers to make important changes that will improve maternal and neonatal health outcomes. This continuous conversation between research and policy is vital, helping to address existing disparities, inequalities and traumatic experiences in maternal care in the United Kingdom. This is one of many ways the MARCH Centre is committed to its core theme, Birth (Births that are wanted and pregnancies that are safe) in the UK - and as the Birth Trauma Inquiry, along with MARCH Centre research, has shown, there is still a long way to go.