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This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.

An analysis of more than 2 million pregnancies found that babies born to Black women worldwide had poorer outcomes (such as baby death and stillbirth) than White women. This was true even after controlling for older age and a lower level of education among mothers (an indicator of poorer economic and social status).

Race and ethnicity have been associated with poor pregnancy outcomes in many countries. In the UK, the rate of baby deaths and stillbirth among Black and Asian mothers is higher than for White women. Most studies examine trends for individual countries. This large database study explored how race and ethnicity is linked to pregnancy outcomes in wealthy countries.

Black women consistently had worse outcomes than White women across the globe. Hispanic women were three times more likely to experience baby death compared with White women. South Asian women had an increased risk of early birth and having a baby with an unexpectedly low weight (small for the length of pregnancy) compared with White women. Racial disparities in some outcomes were found in all regions.

The researchers call for a global, joined-up approach to tackling disparities. Breaking down barriers to care for ethnic minorities, particularly Black women, could help. More research is needed to understand why outcomes are for worse for ethnic minorities. The researchers recommend routine collection of data on race and ethnicity.

More information on support for minority ethnic mothers is available on the NHS website.

The issue: worse pregnancy outcomes among ethnic minorities

Outcomes in pregnancy are worse for people from ethnic minority and underserved communities than White people. Inequalities are particularly stark in wealthier countries (high- and upper-middle-income countries according to the World Bank), where the quality of healthcare is high and infant mortality rates are low.

In England and Wales, the rate of baby death and stillbirth generally declined between 2007 and 2019 among all ethnicities. However, the rate remained highest in the Black ethnic group and second highest in the Asian ethnic group.

Previous studies on the effect of race on pregnancy outcomes have focused on specific races or countries, rather than all races globally. This study explored how race and ethnicity are linked with pregnancy outcomes (including stillbirths and baby deaths) in high- and upper-middle-income countries.

What’s new?

This study was based on an international database (International Prediction of Pregnancy Complications Network). The analysis included more than 2 million pregnancies involving one baby (not twins, for example) in 20 high- and upper-middle-income countries (such as Greece). Data came from 51 studies (42 observational: 9 randomised controlled trials).

The studies compared pregnancy outcomes in at least two races or ethnicities. The main outcomes were baby death (up to 28 days after birth) and stillbirth (at 20 weeks’ pregnancy, or later). Secondary outcomes were early (preterm) birth and low birthweight babies.

Previous research has linked mothers’ older age, higher weight, previous births, and a lower level of education with worse pregnancy outcomes. The researchers controlled for these factors where possible, to focus on the effect of race and ethnicity.

The researchers found:

  • Black women were twice as likely to experience stillbirth and baby death than White women, and were at a higher risk of having an early birth and a baby with low birthweight
  • Hispanic women (women in the USA of Spanish-speaking or Latin American heritage) were 3 times more likely to experience a baby death than White women
  • South Asian women had an increased risk of early birth and having a baby with low birthweight compared with White women.

The effects of race and ethnicity on preterm birth and babies with an unexpectedly low birthweight were the same across the regions assessed.

Why is this important?

The researchers believe this study is the first to assess the effect of race and ethnicity on pregnancy outcomes in high- and upper-middle-income countries. Racial disparities in pregnancy outcomes were consistent across all geographical regions. The researchers call for global joined-up action to fix the problem. Tackling barriers to care relating to race and ethnicity across women’s lifespans could help, they say, particularly for Black women.

The link between race and ethnicity, and worse pregnancy outcomes, persisted even after educational attainment (a measure of economic and social status) was controlled for. This suggests that poverty alone does not explain the association.

Women from ethnic minority groups are known to have poorer access to pregnancy (antenatal) care in many countries; research has shown that clinicians are more likely to ignore the concerns of women from minority groups. These problems are made worse by racial discrimination in society, and lower health literacy in some groups. Poor outcomes for mothers and babies have been linked to structural racism in countries where public policies and institutional practices reinforce racial inequality.

This analysis included studies from the International Prediction of Pregnancy Complications Network database only. The studies varied in how they defined race. Nevertheless, they consistently found a link between race and poor pregnancy outcomes.

What’s next?

Routine collection of data on race, ethnicity, and maternal education would help monitor this issue. Studies that ask women about their experiences could also explore potential solutions to racial inequalities in pregnancy care.

Training for midwifery and medical students could help them identify racial biases in healthcare, and help them improve their communication with women from different backgrounds.

Further research could explore why more Black and South Asian babies develop complications or die, and whether clinical processes contribute.

You may be interested to read

This summary is based on: Sheikh J, and others. Effects of race and ethnicity on perinatal outcomes in high-income and upper-middle-income countries: an individual participant data meta-analysis of 2 198 655 pregnancies. The Lancet 2022; 400: 2049 – 62.

A podcast about the study in The Guardian.

An article about the study in the Chronicle of Higher Education.

A Birthrights report about racial disparities in pregnancy outcomes in the UK.

An summary of mother and baby deaths across the UK from 2018 – 2020 from MBRRACE.

Funding: This study used data from the IPPIC IPD Network database, which was set up using funding from the NIHR Health and Technology Assessment Programme.

Conflicts of Interest: The study authors declare no conflicts of interest.

Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.

NIHR Evidence is covered by the creative commons, CC-BY licence. Written content may be freely reproduced provided that suitable acknowledgement is made. Note, this license excludes comments made by third parties, audiovisual content, and linked content on other websites.

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