Health

Thousands of adverse birth outcomes in England down to ‘alarming’ inequality

Thousands of babies in England are being born prematurely, smaller than expected or stillborn because of “alarming” and “devastating” socioeconomic and racial inequality across the country, a landmark study has suggested.

Both are known risk factors for poor pregnancy outcomes. However, until now, little has been known about the scale of their “heartbreaking” impact on women and babies.

Now research involving more than 1m births suggests socioeconomic inequalities account for a quarter of all stillbirths, a fifth of preterm births, and a third of cases of foetal growth restriction (FGR), a condition in which babies are smaller than expected for their gestational age.

At the same time, one in 10 stillbirths and almost one in five FGR cases are due to racial inequalities, the study suggests. The findings, which have prompted calls for urgent action, were published in the medical journal the Lancet.

Dr Jennifer Jardine of the Royal College of Obstetrics and Gynaecologists (RCOG), one of the study’s co-lead authors, said: “I think that people will be shocked. 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.”

The review, which was conducted by a team from the National Maternity and Perinatal Audit, analysed 1,155,981 birth records between April 2015 and March 2017 in NHS hospitals in England.

The analysis estimates that 24% of stillbirths, 19% of preterm births, and 31% of FGR cases were attributed to socioeconomic inequality and would not have occurred if all women had the same risk of adverse pregnancy outcomes as women in the least-deprived group.

Adjusting for ethnicity, maternal smoking and body mass index (BMI) substantially reduced these inequalities. That suggests that these characteristics can explain a considerable part of the socioeconomic inequalities in pregnancy outcomes.

Pregnancy complications disproportionately affected Black and minority-ethnic women: 12% of all stillbirths, 1% of preterm births, and 17% of FGR cases were attributed to ethnic inequality.

Prof Jan van der Meulen of the London School of Hygiene & Tropical Medicine, another co-lead author, told the Guardian the disparities were unacceptable but said there were no quick fixes that could immediately solve the problem.

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

However, the study findings suggest that current national programmes to make pregnancy safer, which focus on an individual woman’s risk and behaviour and their antenatal care, will not be enough to improve outcomes for babies born in England.

To reduce disparities in birth outcomes at a national level, Van der Meulen said, politicians, public health professionals and healthcare providers must work together to tackle racism and discrimination and improve women’s social circumstances, social support and health throughout their lives.

“National targets to make pregnancy safer will only be achieved if there is a concerted effort by midwives, obstetricians, public health professionals and politicians to tackle the broader socioeconomic and ethnic inequalities,” he said.

The largest increases in excess risk of complications among the most socioeconomically disadvantaged Black and south Asian and women.

Half of stillbirths (53.5%) and seven in 10 FGR cases (71.7%) among south Asian women living in the most deprived fifth of neighbourhoods in England could be avoidable if they had the same risks as white women in the most affluent fifth, the study suggests.

This was similarly the case for nearly two-thirds of stillbirths (63.7%) and half of FGR cases (55%) among Black women from the most deprived neighbourhoods.

“There are many possible reasons for these disparities,” said Van der Meulen. “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.”

Dr Edward Morris, the president of the RCOG, said the findings of the study were alarming, adding: “They provide more evidence that poverty, racism and discrimination can affect women throughout their lives and ultimately lead to devastating incidences of pregnancy complications and baby loss.”

Dr Christine Ekechi, a consultant obstetrician and gynaecologist and co-chair of RCOG’s race equality taskforce, said the disparities were heartbreaking.

“These women are being let down by a healthcare system that is supposed to protect them. Reducing the occurrence of potentially avoidable adverse pregnancy outcomes needs to be a national priority,” she said.

Health

Akwa Ibom records five monkeypox cases

The Akwa Ibom State Government has raised the alarm over the increasing cases of monkeypox in the state, with five confirmed cases recorded so far.

The government has urged residents to be vigilant as the disease spreads across local government areas.

During an update on Friday, September 6, the state government revealed that out of 30 samples collected for diagnosis, five tested positive. The initial four confirmed cases included three males and one female, aged 2, 4, 12, and 41.

Samuel Etuk, the official in charge of disease surveillance and notification at the state Ministry of Health, confirmed the fifth case and noted that contact tracing efforts are underway while the affected individuals are in isolation.

Etuk provided details at a Media Review Meeting organized by Breakthrough Action Nigeria (BA-N) in collaboration with the State Tuberculosis and Leprosy Control Programme (STBLCP).

He emphasized the importance of community involvement in monitoring the disease, with 10 informants engaged in each of the state’s 368 political wards to report cases to health authorities.

Etuk explained that Mpox can be transmitted from animals to humans (a zoonotic process), as well as through direct or indirect human contact. Transmission can occur through contact with urine, blood, faeces, skin lesions, and oral secretions.

Symptoms of Mpox typically appear after an incubation period of 5 to 21 days and include fever, headaches, swollen lymph nodes, back pain, rashes, and muscle pain. The rashes often start on the face and spread to other parts of the body.

To prevent further spread, residents are advised to avoid contact with sick animals or humans, maintain proper hygiene, and report any suspected cases to health authorities or the Nigeria Centre for Disease Control (NCDC).

Etuk reminded the public that the World Health Organisation (WHO) had declared Mpox a global public health emergency of international concern in August 2024, signaling the need for heightened awareness and preventive measures.

Health

FG to establish blood collection centres in 774 LGAs

The Federal Government has announced plans to establish Blood Collection Centres in all 774 local government areas, including the FCT, to ensure availability of blood during medical emergencies and transfusions.

Abdullahi Haruna, Head, Media and Publicity, National Blood Service Agency (NBSA), made this known in a statement on Saturday in Abuja.

The statement quoted Prof. Saleh Yuguda, the Director-General, NBSA, as reiterating government’s commitment towards addressing blood shortages in the country as the initiative would save lives.

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“We are working tirelessly to ensure that blood needs are adequately addressed, and this initiative is a significant step towards achieving that goal.

“NBSA has partnered with the Nigerian Security and Civil Defence Corps (NSCDC) to establish a formidable blood bank at the Corp’s medical facility.

“This collaboration aims to mitigate blood shortages during medical emergencies and provide critical support to sister security agencies,” he said.

He explained that to kickstart the blood collection project, the FCT will host strategic blood collection facilities in easily accessible locations.

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“This move is expected to increase blood donation rates and ensure a steady supply of blood for medical purposes.

“The establishment of blood collection centers across Nigeria is a testament to the government’s commitment to improving the country’s healthcare system.

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“As the project rolls out, Nigerians should expect improved access to blood transfusions and better health outcomes,” he said.

The statement also disclosed that the Deputy Commandant Emeka Okeke of the NSCDC said: “this initiative will play a vital role in addressing blood shortages and saving lives.”

Health

WHO sets targets to end Mpox outbreaks in Africa

The World Health Organisation, WHO, has set a target of halting mpox outbreaks in Africa within the next six months.

This announcement came as the first vaccine shipments are expected to arrive in the Democratic Republic of Congo, DRC, in the coming days.

Africa, particularly the DRC, with over 18,000 suspected cases and 629 deaths, has received only a fraction of the vaccines to combat the virus.

At a press briefing on Monday, September 2, WHO Director-General, Dr Tedros Adhanom Ghebreyesus expressed confidence in ending the outbreaks, citing strong government leadership and collaborative partnerships.

In August, WHO declared mpox outbreaks a global emergency to spur a more robust international response even though a new strain of mpox known as clade1b, has been identified in many countries, including Burundi, Cameroon, Rwanda, and Kenya.

The potentially more contagious variant of the virus was detected in Congo in May, prompting heightened concerns among health officials.

WHO estimates that approximately 230,000 vaccines could soon be sent to Congo and other affected countries. The WHO is also implementing educational campaigns to inform people in outbreak areas about preventing the spread of the disease.

Africa’s Centers for Disease Control and Prevention has said it aims to receive 380,000 vaccine doses from donors, including the US and the EU, which falls short of the quantity required to eradicate the outbreaks.