Despite a steady decline in birth rates across the United Kingdom, concerns are mounting over maternal health, as recent findings underscore persistent—and in some cases deepening—inequalities affecting women during and after pregnancy.

A large-scale review of maternal deaths between 2014 and 2022, led by MBRRACE-UK and published in BMJ Medicine, shed critical light on the intersection of social vulnerability and maternal outcomes. Researchers examined 1,451 cases of maternal death and found that nearly 30% involved women whose children were under the supervision of social care services before or after birth—a statistic described by the study’s authors as both striking and troubling.

“These figures point to a complex interplay of deprivation, mental health, and systemic barriers to effective care,” the study noted.

The profile of those most at risk is telling. Women under the age of 20 were found to be 85% more likely to die than those in their twenties, while those living in the most deprived neighborhoods faced more than double the risk compared to women in the least deprived areas. Although women from a range of ethnic backgrounds were represented, White women comprised three-quarters of the maternal deaths in the subset involving social care—a distribution that mirrors the demographic composition of the UK but invites deeper analysis into the structural factors at play.

Critically, the timing and causes of many deaths also reflect systemic gaps. According to the report, a significant portion of maternal deaths occurred not during or immediately after childbirth, but in the extended postpartum period—between six weeks and one year after delivery. In this late phase, psychiatric causes emerged as a leading contributing factor, with deaths frequently linked to suicide, accidental overdose, or domestic violence.

“There were missed opportunities at multiple levels of care,” the authors stated. “In particular, failures to recognize escalating mental health risks and disruptions in the continuity of care were recurring themes.”

While the decline in neonatal mortality—from 8.1 deaths per 1,000 births in 2010 to 6.8 in 2022—suggests improvements in some aspects of early-life care, maternal outcomes haven’t mirrored that progress. Instead, the picture appears more fragmented, particularly when factoring in risk elements linked to advanced maternal age and longstanding health disparities.

Women giving birth in their forties face distinct challenges, with research indicating sharply higher risks of stillbirth and other complications. A 2023 review on advanced maternal age reported that mothers aged 40 or older have a 1.75 times greater likelihood of experiencing stillbirth compared to younger mothers, as well as an increased probability of fetal growth restriction. Long-term outcomes are also an issue: the probability of a child losing their mother before reaching adulthood rises significantly with maternal age.

Compounding these factors are persistent racial and socioeconomic disparities in health outcomes. Government data published in recent years point to striking inequalities in infant mortality, with rates among Black families roughly twice those recorded among White families in England. Underlying these statistics are broader concerns about healthcare access: fewer general practitioners in underserved areas, longer waiting times, and systemic under-provisioning in communities with high needs.

Recognizing the urgency of these patterns, the MBRRACE-UK report calls for sweeping reforms across the maternity care system. Among the key proposals are the implementation of trauma-informed care pathways, better integration between social and medical services, and more consistent training for health professionals in identifying and managing social risk factors.

As Dr. Marian Knight, one of the lead authors of the review, remarked during the study’s publication, “We need to stop seeing these cases in isolation. They are not just the result of individual circumstances, but the consequence of how services are—or are not—designed to support women with complex lives.”

The findings point to a widening gap between improved outcomes for newborns and the persistent vulnerabilities facing mothers, particularly in the months following childbirth. While the overall number of births continues to decline, the proportion of women facing multilayered barriers to care appears to be rising, suggesting that maternal health requires renewed focus—not just during delivery, but across an extended continuum of support.