Maternity baby deaths much higher in northern England than in the South

A new paper in the Journal of Public Health, published by Oxford University Press, indicates that maternity services in the North of England most consistently report higher-than-average rates of perinatal mortality, including stillbirths, compared to those in the South.

The year 2025 marked the end of a decade-long UK government national maternity safety initiative, which aimed to halve the rate of stillbirths, neonatal and maternal deaths and brain injuries occurring during or soon after birth. While this was not achieved, a 36% reduction in perinatal mortality was significant, and policymakers have recommended using data to better understand and reduce the variation between clinical outcomes in different locations.

Responding to this, researchers here aimed to identify maternity services most consistently reporting both higher-than-average and lower-than-average rates of extended perinatal mortality (including stillbirths and neonatal deaths) throughout the government’s 10-year initiative. They conducted a retrospective study of perinatal mortality surveillance reports published by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audit and Confidential Enquiries collaboration) between 2015 and 2024, to compare mortality rates for births occurring between 2013 and 2022 at 121 maternity services in England.

The researchers identified ten organizations most consistently reporting higher-than-average deaths of babies and 15 reporting lower-than-average deaths. They also identified a total of 20 (16.5%) organizations with higher-than-average deaths in 80% of reports and/or the past five years and 22 (18.2%) with lower-than-average deaths.

The maternity services most consistently reporting lower-than-average deaths included Portsmouth Hospitals University NHS Trust, Royal Free London NHS Foundation Trust, and University College London Hospitals NHS Foundation. Those most consistently reporting higher-than-average deaths included Sandwell and West Birmingham Hospitals NHS Trust, Liverpool Women’s NHS Foundation Trust, and The Leeds Teaching Hospitals NHS Trust.

All ten organizations with the highest comparable 10-year mortality rates were in the Midlands and North of England, and all fifteen organizations with the lowest mortality rates were in the South of England. These findings suggest that babies in the Midlands and North of England are more likely to die before, during, or shortly after birth than those in the South. This adds to longstanding findings on mortality inequalities in England’s North and South regions, including recent reports from the UK government (2019) and The Northern Health Science Alliance and N8 Research Partnership (2021).

The first MBRRACE-UK publication of data to highlight higher-than-average and lower-than-average deaths at individual organizations coincided with the government’s 2015 safety initiative, and for eight years, its reports instructed ‘red flag’ maternity services to conduct a review or investigation to identify factors that might be responsible for their comparatively higher rates. However, this study’s authors found no evidence of local action, or any follow-up by MBRRACE-UK, NHS England, the Care Quality Commission, the Royal College of Obstetricians and Gynaecologists, or the Royal College of Midwives.

In 2023, MBRRACE-UK redirected its instructions for review towards governments, royal colleges, and commissioners. The authors suggest that with no specific responsibility for individual organizations to review, investigate, or report any action taken, this may be missing a highly valuable opportunity for improvement and shared learning.

“Investigations into avoidable maternity deaths and injuries in England have focused on learning lessons by establishing where problems lie,” said the paper’s lead author, Pauline McDonagh Hull. “This study highlights opportunities for recognizing and learning from maternity services with comparably good or markedly improved outcomes – what are they doing differently? Furthermore, the UK has some of the best maternity data in the world, and if steps were taken to ensure all organizations submit complete data to MBRRACE-UK and NHS England Digital, it would further support research and analysis to better understand and improve both perinatal and maternal outcomes.”

The paper, “Lessons to be learned: a retrospective study of MBRRACE-UK perinatal mortality surveillance (2015–2024) to identify maternity services most consistently reporting higher- and lower-than-average deaths,” is available (at midnight EST on January 15^th) at https://doi.org/10.1093/pubmed/fdaf145.

Direct correspondence to: 
Pauline McDonagh Hull
Department of Community Health Sciences
Cumming School of Medicine, University of Calgary
CWPH Building, 3280 Hospital Drive NW
Calgary, AB T2N 4Z6, CANADA
pauline.hull@ucalgary.ca

To request a copy of the study, please contact:
Daniel Luzer 
daniel.luzer@oup.com