Atlas Of Birth

For women and their families in the UK, pregnancy and childbirth should be a positive experience. However this is too often not the case. Maternal health care in the UK is in a state of emergency. Recent reviews and inquiries (1) have highlighted serious concerns about the safety and quality of services.

This 'Atlas of Birth' for the UK sets out to map where the problems lie and to suggest solutions and examples of best practice. It is based on data gathered by a team of researchers across a number of institutions from publically- available sources and illustrated by the words of women – those receiving care and those delivering care – who speak from experience.

The challenges are urgent and many, but this Atlas of Birth shows that poor quality of care and poor health outcomes are not inevitable. They are almost always linked to inequalities – which can and must be tackled. When we map the differences in women's experiences, we show that inequalities are linked to ethnicity and to poverty – and to where women live.

It's wrong that risks are not equally experienced. Probably the starkest statistic that summarises these inequities is that black women are nearly four times as likely to die in childbirth than white women (2). It is a further sad fact that newborn deaths and stillbirths are also linked to ethnicity and poverty.

Underpinning all this is lack of human resources, particularly midwives. But we can see differences even between Health Trusts in recruitment and retention of staff, while even when we do have high quality, safe and personalised care, including essential mental health services, people do not have equal access to them.

All women and their families in the UK, have a right to safe and respectful care during pregnancy and childbirth – as do all women wherever they live in the world. These rights are set out in the Universal Rights of Women and Newborns – The Charter for Respectful Maternal and Newborn Care (whiteribbonalliance.org).

The Charter provides a measurable standard of care which governments (including the UK government) have promised – and often failed – to deliver. It spells out clearly how health systems must ensure the health, safety and dignity of both women and newborns, taking care that this most fundamental dyad of human life be fully protected. It is based on widely accepted human rights instruments including the Convention on the Rights of the Child, the European Convention on Human Rights and Biomedicine, among other legally binding agreements.

Right 5 declares that everyone has the right to equality, freedom from discrimination and equitable care. It says that no one is allowed to discriminate against you or your newborn because of something they think or do not like about either one of you. Equality requires that pregnant women have the same protections under the law as they would when they are not pregnant, including the right to make decisions about what happens to their bodies.

This Atlas of Birth sets out to provide the high quality, accessible data which is essential if we are to inform effective responses to inequalities. However the data we need to do this is not always readily available; it is often fragmented, provided by a disparate group of institutions and not disaggregated in the way that we need in order to measure and monitor inequalities.

We aim to change this, and so this online Atlas of Birth provides a platform for bringing together and presenting existing high-quality data on inequalities – and advocating for more and better data so that we can discuss underlying causes and possible responses.

At the heart of our work is a call for clear, reliable, centralised and accessible data on inequalities that can be used for developing policy and services that meet the needs of all women, all babies, whoever they are, wherever they live. Because as the saying goes - if you are not counted, you don’t count.

This website is still very much a work in progress, and we hope to develop it further in collaboration with service users and civil society groups. If you have any comments or ideas please contact Sarah Neal (s.neal@soton.ac.uk).

Dr Sarah Neal, University of Southampton

Brigid McConville, White Ribbon Alliance

Gill Moncrieff, University of Stirling

Lucy Stone, Swansea University

Professor Zoe Matthews, University of Southampton

Dr Jason Sadler, University of Southampton

Professor Soo Downe, University of Central Lancashire (UCLan)

Note: this document uses the terms 'woman' or 'mother' throughout. These should be taken to include people who do not identify as women but are pregnant or have given birth.

Introduction

Reference links