Maternal, newborn and infant health: priorities for improved outcomes

Gabrielle Mathews; Natasha Mutebi

Overview

The UK is underperforming compared with other countries in the Organisation for Economic Cooperation and Development (OECD) on infant and newborn mortality (rates of death). In 2022, the UK ranked 19 out of 22 comparable countries.[1][2] In 2023, England and Wales recorded 2,320 infant deaths, equating to 3.9 per 1,000 live births, alongside a neonatal mortality rate (under 28 days) of 3.0 per 1000 births.[3] In comparison, the average infant mortality rate across OECD countries is significantly lower, with countries like Iceland (1.3), Finland (1.7), and Japan (1.8) reporting lower rates. The United States reported a rate of 5.4, while Germany and France reported 3.1 and 3.5 respectively (2023).[4]

The maternal mortality rate for 2020 to 2022 rose to its highest level since 2003 to 2005. During 2020 to 2023, there were an estimated 9.8 deaths per 100,000 maternities (number of pregnancies resulting in live births or still births).[5] This is higher than countries including Norway, Iceland, and Australia, which each reported fewer than 3 deaths per 100,000 live births.[6]

There continue to be disparities in maternal health outcomes, with vulnerable populations including women from ethnic minority backgrounds and those living in the most deprived areas of England facing significantly higher risks.[7] Research highlights that these disparities reflect reported structural and systemic issues, including institutional bias and unequal access to safe and culturally sensitive care.[8] These issues were also highlighted in the 2023 House of Commons Women and Equalities Committee report on Black maternal health.

These outcomes are compounded by widening inequities in access to care and contribute to higher rates of pre-term birth, stillbirth, miscarriage, and complications.[9] In response to growing disparities, the former government established a Maternity Disparities Taskforce. Lord Darzi’s 2024 Independent investigation of the NHS highlighted complexities in pregnancy outcomes and discussed how related prevalent conditions, such as obesity and diabetes, can further increase risks of poor outcomes.

In July 2025, the government published a 10-year Health Plan for England. It contains an action to co-produce a new national maternity and neonatal action plan with bereaved families. Dr Penny Dash’s review of patient safety across the health and care landscape, published in July 2025, found that despite a decade of focus on maternity safety, progress has been inconsistent due to persistent variation in outcomes in maternal care and a need for stronger accountability mechanisms to ensure lasting improvement.

Challenges and opportunities

Disparities in outcomes

Ethnic and socioeconomic disparities in outcomes persist. Neonatal death rates are highest amongst Black and Asian infants, and Black women are up to four times more likely to die in childbirth compared to White women. [10][11][12] Black babies remain more than twice as likely to be stillborn compared to White babies, and neonatal death rates are highest among Asian and Black babies.[13]

In June 2025, the government launched a national maternity investigation aimed at driving improvement. The investigation will outline a series of measures to immediately improve care including an “anti-discrimination programme to tackle inequalities in care for Black, Asian and other underserved communities.”

Perinatal mental health

According to the Office for Health Improvement and Disparities (OHID), around a quarter of mothers (25.8%) experienced perinatal mental illness issues in 2019.[14] Approximately 600,000 women give birth in England every year. In 2023 to 2024, more than 57,000 new and expectant mothers received specialist support for mental health problems, an increase of a third from 2022 to 2023.[15] If these mental health issues are left untreated, it can have a long-lasting impact on the woman, child and wider family.[16]

Mental health conditions are a leading cause of late maternal death, as suicide and related conditions account for 34 to 40% of late deaths.[17] Late maternal death relates to death between 42 days and a year since birth. Academic studies estimate that perinatal mental health problems cost the UK £8.1 billion per year, with 72% of this cost attributed to the long-term impact on the child.[18]

Premature birth, still births, infant death and miscarriage

According to the MBRRACE-UK report, perinatal mortality (including stillbirths and neonatal deaths) in the UK was 4.84 per 1,000 total births in 2023.[19] Whilst this represents a 20% reduction in deaths since 2013, disparities exist.

Prematurity remains a leading driver of infant deaths and long-term disability outcomes.[20] The Saving Babies Lives 2024 Progress report found that 8% of babies in the UK are born preterm, 75% of these births result in neonatal death.[21]

Babies born preterm face increased risks of respiratory distress syndrome, cerebral palsy and developmental abnormalities.[22] These risks persist into later life with preterm birth associated with a greater risk of acquiring non-communicable diseases such as cardiovascular disease and diabetes.[23] Some researchers suggest that preterm birth should be considered a chronic disorder, warranting lifelong documentation in medical records at all ages.[24]

Babies born with rare diseases often face delayed diagnoses and fragmented care, which can exacerbate health outcomes. Data shows an increasingly recognised preventative strategy to reduce long-term harms is early identification through genomic screening and integrated neonatal care pathways. [25] The UK Government’s Genomics strategy (Genome UK: 2022 – 2025) and UK Rare disease framework for England, both highlight the need for early, equitable access to diagnostic tools and specialist support for affected families. The 10-Year Health Plan promises to create a new and accessible genomics population health service and universal newborn genomic testing.[26]

There also appear to be disparities in miscarriages with Black women having a 43% increased risk of miscarriage compared to white women.[27] Miscarriage can have substantial physical, emotional psychological and economic impacts, such as increased risk to infection, anxiety, depression and suicide. Estimates in 2021 showed that the short-term economic cost of miscarriage in the UK was £471 million per year.[28]

Researchers suggest that risk factors associated with miscarriage include age, smoking, stress, air pollution, night shifts and exposure to pesticides.[29] Researchers and advocacy groups have called for: more inclusive research; better data collection and screening instruments; culturally sensitive bereavement support; and improved care pathways for miscarriage and early pregnancy complications.[30][31]

Inconsistent access to maternity services

Antenatal and postnatal care access varies widely across geographical location and underserved communities. Inconsistent access can impact continuity and quality of care.[32] There are also other factors that contribute to barriers to access and disparities, such as availability of childcare, transport, translation services, housing and financial services, and immigration status. See more in Commons Library briefing Quality and safety of maternity care.

Workforce pressures

A shortage in maternity service staff and retention threatens the provision of one-to-one and community-based care, which researchers propose are key to reducing barriers, disparities and improving outcomes.[33]

In January 2024, the Institute of Health Visiting (IHV) reported a national shortage of approximately 5,000 health visitors in England, with 79% of health visitors indicating that their services lack the capacity to offer comprehensive support to all children with identified needs.[34]

Targeted interventions and community and integrated care

Stakeholders highlight the opportunity to improve outcomes in at-risk populations through local programmes, such as culturally appropriate tailored antenatal support and community midwifery.[35][36] Expansion of birthing centres, community-based services and integrated care hubs could potentially support better outcomes and patient experience. [37][38]

Stakeholders call for more co-designed training and solutions for pregnancy care, specifically with bereaved parents, women and frontline staff.[16][39][40][41]

With the implementation of the Health and Care Act 2022, Integrated Care Systems (ICSs) aim to deliver person-centred and coordinated care across settings including community and home environments. For example, a shift away from hospitals could be applied to low-risk pregnancies such as having community health workers and visiting midwives monitor maternal and foetal health indicators could allow early detection of complications (HS97).[42]

Technological innovations and digital intervention

Integrated digital records and remote monitoring tools could enhance continuity and early risk detection.[43] Additionally, researchers propose that upstream preventative strategies such as nutritional support, health education and early screenings, are needed for sustainable improvements in maternal outcomes.[44]

The national maternal investigation announced the implementation of a new digital system in maternity services by November 2025 to flag potential safety concerns in trusts and support rapid national action.[45]

Preventative care as a sustainable intervention

A life-course approach to reproductive health, using an integrated, community-based model as part of a whole-government prevention approach has been called for to improve disparities in outcomes.[46] For example, approximately 90% of women of reproductive age have at least one modifiable risk factor such as a family history of diabetes, that could negatively affect their pregnancy, highlighting the role preconception health could play in reducing pregnancy complications and poor outcomes.[47]

Key uncertainties and unknowns

How can we ensure equity in maternal and neonatal service quality and access?
Will continued declines in fertility alter planning and investment in maternal and neonatal services?
Which interventions most effectively mitigate disparity gaps in maternal and neonatal health?
What level of data supports accurate targeting and evaluation of maternal care?
How can workforce issues, especially regarding midwifery retention and training, be resolved?

Key questions for parliament

How can the government ensure it identifies and evaluates desirable impacts of the national maternity investigation?
What reinforces persistent ethnic and socioeconomic disparities in outcomes?
How can monitoring mechanisms ensure government initiatives such as the 2025 taskforce, produce measurable improvements?
What resources are required to ensure consistent, high-quality maternity services nationwide?
How can parliament support adoption of digital and integrated care innovations?
What policies are needed to embed preventive care into pre-conception and maternity pathways to ensure safe births?
How will demographic changes, including a falling fertility rate, impact service planning?
What mechanisms will ensure accountability on reducing inequalities and improving care quality?