Health inequalities mean babies are still not born equal

In Heart of Birmingham primary care trust, there are approximately 82 ENDs every year, equating to 0.9 per cent of all live births.

Among Europeans, the END rate is only 0.2 per cent. But, worryingly, among Indian women it is 0.5 per cent, for Pakistani and Bangladeshi women it is 1.0 per cent and for Black Caribbean and Black African women it is 1.8 per cent.

In Heart of Birmingham the largest cause of END is congenital anomaly. This accounts for 36 per cent of all ENDs and 45 per cent of ENDs in babies born to women from Pakistani and Bangladeshi communities, where there is a tradition of consanguinity (marriages between close relatives, usually first or second cousins), encouraged by a belief that marrying within the family strengthens that family.

This data raises sensitive questions. What should the NHS do about cultural practices that affect health? Should it intervene directly or engage community leaders to address the issue?

The PCT estimates programmes to cut congenital abnormalities could, at best, prevent 11 END deaths each year, whereas programmes to cut deaths due to other causes could prevent 21 deaths. Even for Pakistani and Bangladeshi communities, the PCT estimates that programmes aimed at cutting END due to causes other than congenital anomaly would prevent 10 deaths, whereas those aimed at congenital anomaly would prevent nine.

If we examine data for stillbirths (where the baby dies before delivery) in Birmingham, the greatest cause of death is fetal growth restriction. Effective interventions include stopping smoking, cutting teenage pregnancy, and improving maternal nutrition and access to services.

This raises two questions: why do some women access maternity services late or intermittently? Qualitative research for the Birmingham Health and Wellbeing Partnership by Dr Foster Intelligence has identified previously unconsidered factors, such as asylum-seekers living on vouchers being unable to pay for transport; and embarrassment about discussing pregnancy and birth with health professionals who may not understand specific issues of some ethnic groups, such as female genital mutilation.

The data clearly shows considerable inequality in stillbirth and END - and suggests tailored solutions are needed for at-risk groups.