Pregnancy outcomes in Black, Asian and minority ethnic women | Nursing Times

Introduction

Race and ethnicity have been associated with poor pregnancy outcomes in many countries. In the UK, the rate of stillbirth among Black and Asian mothers is higher than the rate for White women (Fig 1); Black and Asian newborn babies are also more likely to die than White babies (Draper et al, 2022).

Most studies examine trends for individual countries; this article discusses Sheikh et al’s (2022) large database study of more than two million pregnancies, which explored how race and ethnicity are linked to pregnancy outcomes in wealthy countries. It identified that babies born to Black women worldwide had poorer outcomes (such as baby death and stillbirth) than those born to White women. This was true even after controlling for the following among mothers:

• Older age;
• A lower level of education, which is an indicator of poorer economic and social status.

Racial disparities in some outcomes were found in all regions. Black women consistently had worse outcomes than White women across the globe. Compared with White women, South Asian women had an increased risk of early birth and having a baby with a low birthweight. Hispanic women were more likely to experience baby death than White women.

The researchers call for a global, joined-up approach to tackling disparities, as well as for the routine collection of data on race and ethnicity. More research is needed to understand why outcomes are far worse for women from ethnic minorities than they are for White women. Breaking down barriers to care for minority ethnic women, particularly those who are Black, could help. The NHS is rolling out additional support for pregnant women who are Black, Asian or from an ethnic minority (NHS England, 2020).

The issue

Outcomes in pregnancy are worse for people from underserved and ethnic minority communities than for White people. Inequalities are particularly stark in wealthier countries, where the quality of healthcare is high and infant mortality rates are low.

In England and Wales, the rate of baby death and stillbirth generally declined between 2007 and 2019 among all ethnicities. However, the rate has remained highest in the Black ethnic group and second highest in the Asian ethnic group (Office for National Statistics, 2021).

Previous studies on the effect of race on pregnancy outcomes have focused on specific races or countries, rather than on all races globally. The study discussed in this article explored how race and ethnicity are linked with pregnancy outcomes (including stillbirths and baby deaths) in wealthier countries.

What’s new?

This study used data from the International Prediction of Pregnancy Complications Network. The analysis included 2,198,655 singleton pregnancies in 20 countries classified as high income and upper-middle income in 2024 by the World Bank (no date). Data came from 51 studies; 42 were observational and nine were randomised controlled trials. The studies varied in how they defined race; nevertheless, they consistently identified a link between race and poor pregnancy outcomes.

The studies compared pregnancy outcomes in at least two races or ethnicities. The main outcomes were:

• Baby death (≤28 days after birth);
• Stillbirth (≥20 weeks’ pregnancy).

Secondary outcomes were:

• Pre-term birth (<37 weeks’ gestation);
• Babies with a low birthweight (<tenth centile).

Previous research has linked worse pregnancy outcomes with mothers’ older age, higher weight, previous births and lower level of education. Where possible, the researchers controlled for these factors to be able to focus on the effect of race and ethnicity.

The researchers identified that Black women were twice as likely to experience stillbirth and baby death than White women, and were at a higher risk of having an early birth and a baby with a low birthweight. Compared with White women, South Asian women had an increased risk of early birth and of having a baby with low birthweight. In the US, Hispanic women (those who were of Spanish-speaking or Latin American heritage) were three times more likely to experience a baby death than White women.

The effects of race and ethnicity on pre-term birth and babies with an unexpectedly low birthweight were the same across the regions assessed.

Why is this important?

The researchers believe this study is the first to assess the effects of race and ethnicity on pregnancy outcomes in high-income and upper-middle-income countries. Racial disparities in pregnancy outcomes were consistent across all geographical regions. The researchers call for global joined-up action to fix the problem; tackling barriers to care relating to race and ethnicity across women’s lifespans could help, particularly for Black women.

The link between worse pregnancy outcomes and race and ethnicity persisted even after educational attainment was controlled for – this suggests that poverty, alone, does not explain the association.

Women from ethnic minority groups are known to have poorer access to antenatal care in many countries; research has shown that clinicians are more likely to ignore the concerns of women from minority groups (Alhusen et al, 2016). These problems are made worse by racial discrimination in society, as well as lower health literacy in some groups (Alhusen et al, 2016). Poor outcomes for mothers and babies have been linked to structural racism in countries where public policies and institutional practices reinforce racial inequality (Aspen Institute, 2016).

What’s next?

Routine collection of data on race, ethnicity and maternal education would help to monitor this issue. Studies that ask women about their experiences could also explore potential solutions to racial inequalities in pregnancy care.

Training for midwifery and medical students could help them to identify racial biases in healthcare and help them to improve their communication with women from diverse backgrounds.

Further research could also explore why more Black and South Asian babies develop complications or die, and whether clinical processes contribute.