Abrishami D. The need for cultural competency in health care. Radiologic Technology. 2018; 89:(5)441-448

Adebayo A, Liu M, Cheah W. Sociocultural understanding of miscarriages, stillbirths, and infant loss: a study of Nigerian women. Journal of Intercultural Communication Research. 2019; 48:(2)91-111

Aquino MR, Edge D, Smith DM. Pregnancy as an ideal time for interven/on to address the complex needs of black and minority ethnic women: views of British midwives. Midwifery. 2015; 31:(3)373-379

Acachie IT, Mwini-Nyaledzigbor P, Affram C, Adjei DN. Mothers' experiences of stillbirth: a study in the Accra Metropolis (socio-cultural implications). Advances in Multidisciplinary and Interdisciplinary Research Journal. 2016; 2:(2)223-230

Boughtwood D, Shanley C, Adams J, Santalucia Y, Kyriazopoulos H, Rowland J, Pond D. The role of the bilingual/bicultural worker in dementia education, support and care. Dementia. 2013; 12:(1)7-21

Campinha-Bacote A, Campinha-Bacote J. Extending a model of cultural competence in healthcare delivery to the field of health care law. Journal of Nursing Law. 2009; 13:(2)36-44

Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006–2008. BJOG. 2011; 118:(1)1-203

Chilvers R. What does better births look like for you?. Midwives. 2015; 18:(1)

Chinouya MJ, Madziva C. Late booking amongst African women in a London borough, England: implications for health promotion. Health Promotion International. 2017; 34:(1)123-132

Dean SV, Imam AM, Lassi ZS, Bhuca ZA. Importance of intervening in the pre-conception period to impact pregnancy outcomes. Maternal and child nutrition: the first 1 000 days. 2013; 74:63-73

de Bernis L, Kinney MV, Stones W, ten Hoope-Bender P, Vivio D, Hopkins Leisher S, Bhutta ZA, Gülmezoglu M, Mathai M, Belizán JM, Franco L, McDougall L, Zeitlin J, Malata A. Stillbirths: ending preventable deaths by 2030. Lancet. 2016; 387:(10019)703-716

Department of Health. National service framework: children, young people and maternity services. 2004. (accessed 10 September 2019)

National service framework for children young people and maternity services standard 11: maternity services preconception care. 2007a;

Maternity matters: choice, access and continuity of care in a safe service. 2007b;

Department of Health. Tackling health inequalities in infant and maternal health outcomes: report of the infant mortality na/onal support team. 2010a. (accessed 16 April 2020)

Department of Health. Midwifery 2020: delivering expectations. 2010b. (accessed 16 April 2020)

Draper ES, Gallimore ID, Kurinczuk JJ, Smith PW, Boby T, Smith LK, Manktelow BN. MBRRACE-UK perinatal mortality surveil-lance report: UK perinatal deaths for births from January to December 2017: summary report.Leicester: department of health sciences, University of Leicester; 2019

Dunkley-Bent J. Better births: a platform for innovation and transformation. British Journal of Midwifery. 2016; 24:(5)

Esegbona-Adeigbe S. Cultural qualities and antenatal care for black African women: a literature review. British Journal of Midwifery. 2018; 26:(8)532-539

Flenady V, Wojcieszek AM, Middleton P, Ellwood David, Erwich JJ, Coory M, Khong YT, Silver RM, Smith GCS, Boyle FM, Lawn JE, Blencowe H, Hopkins Leisher S, Gross MM, Horey D, Farrales L, Bloomfield F, McCowan L, Brown SJ, Joseph KS, Zeitlin J, Reinebrant HE, Ravaldi C, Vannacci A, Cassidy J, Cassidy P, Farquhar C, Wallace E, Siassakos D, Heazell AEP, Storey C, Sadler L, Petersen S, Frøen JF, Goldenberg RL. Stillbirths: recall to action in high income countries. Lancet. 2016; 387:(10019)691-702

Frøen JF, Friberg IK, Lawn JE, Bhutta ZA, Pattinson RC, Allanson ER, Flenady V, McClure EM, Franco L, Goldenberg RL, Kinney MV, Hopkins Leisher S, Pitt C, Islam M, Khera A, Dhaliwal L, Aggarwal N, Raina N, Temmerman M. Stillbirths: progress and unfinished business. Lancet. 2016; 387:(10018)574-586

Garcia R, Ali N, Papadopoulos C, Randhawa G. Specific antenatal interven/ons for Black, Asian and Minority Ethnic (BAME) pregnant women at high risk of poor birth outcomes in the United Kingdom: a scoping review. BMC Pregnancy and Childbirth. 2015; 15:(1)

Goldenberg RL, McClure EM, Bhutta ZA, Belizán JM, Reddy UM, Rubens CE, Mabeya H, Flenady V, Darmstadt GL. Stillbirths: the vision for 2020. Lancet. 2011; 377:(9779)1798-1805

Gopichandran V, Subramaniam S, Kalsingh MJ. Psycho-social impact of stillbirths on women and their families in Tamil Nadu, India – a qualitative study. BMC Pregnancy and Childbirth. 2018; 109:(18)1471-2393

Heazell AE. Stillbirth – a challenge for the 21st century. BMC Pregnancy and Childbirth. 2016; 16:(1)

Hollowell J, Oakley L, Vigurs C, Barnec-Page E, Kavanagh J, Oliver S. Increasing the early initiation of antenatal care by black and minority ethnic women in the United Kingdom: a systematic review and mixed methods synthesis of women's views and the literature on intervention effectiveness.: University of Oxford: National Perinatal Epidemiology Unit; 2012

Homer CSE, Leap N, Edwards N, Sandall J. Midwifery continuity of care in an area of high socio-economic disadvantage in London: a retrospective analysis of Albany Midwifery Practice outcomes using routine data (1997–2009). Midwifery. 2017; 48:1-10

Homer CS, ten Hoope-Bender P. Supporting women, families, and care providers after stillbirths. Lancet. 2016; 387:(10018)516-517

Hussein N, Kai J, Qureshi N. The effects of preconception interven/ons on improving reproductive health and pregnancy outcomes in primary care: a systematic review. European Journal of General Practice. 2016; 22:(1)42-52

Jones E, Lacof SR, Coast E. Interventions to provide culturally-appropriate maternity care services: factors affecting implementation. BMC Pregnancy and Childbirth. 2017; 17:(1)

Kerber KJ, de Graft-Johnson JE, Bhuca ZA, Okong P, Starrs A, Lawn JE. Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet. 2007; 370:(9595)1358-1369

Ker CR. A comprehensive update on stillbirth prevention: from preconception to postpartum, individuals to public health administrations. Current Obstetrics and Gynaecology Reports. 2018; 7:(4)172-178

Kiguli J, Munabi IG, Ssegujja E, Nabaliisa J, Kabonesa C, Kiguli S, Josaphat B. Stillbirths in sub-Saharan Africa: unspoken grief. Lancet. 2016; 387:(10018)e16-e18

Kingdon C, Roberts D, Turner M A, Storey C, Crossland N, Finlayson K W, Downe S. Inequalities and stillbirth in the UK: a meta-narrative review. BMJ Open. 2019; 9:(9)

Saving lives, improving mothers' care-surveillance of maternal deaths in the UK 2011–13 and lessons learned to inform maternity care from the UK and Ireland confiden/al enquiries into maternal deaths and morbidity 2009–13. MBRRACE-UK. 2015;

Saving lives, improving mothers' care - surveillance of maternal deaths in the UK 2012-14 and lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2012-14. In: Knight M, Tuffnell D, Kenyon S, Shakespeare J, Gray R, Kurinczuk JJ (eds). Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2016

Lassi ZS, Haider BA, Bhuca ZA. Community-based intervention packages for reducing maternal morbidity and mortality and improving neonatal outcomes. Journal of Development Effectiveness. 2012; 10:(11)151-187

Lassi ZS, Dean SV, Mallick D, Bhutta ZA. Preconception care: delivery strategies and packages for care. Reproductive health. 2014; 11:(3)

Lee SK, Sulaiman-Hill CR, Thompson C. Overcoming language barriers in community-based research with refugee and migrant populations: options for using bilingual workers. BMC International Health and Human Rights. 2014; 14:(1)

Lewis G. The confidential enquiry into maternal and child health (CEMACH). Saving mothers' lives: reviewing maternal deaths to make motherhood safer - 2003-2005.London: CEMACH; 2007

Mazza D, Chapman A, Michie S. Barriers to the implementation of preconception care guidelines as perceived by general practitioners: a qualitative study. BMC Health Services Research. 2013; 13:(1)

McBride J, Block A, Russo A. An integrated healthcare service for asylum seekers and refugees in the south-eastern region of Melbourne: Monash Health Refugee Health and Wellbeing. Australian Journal of Primary Health. 2017; 23:(4)323-328

Muglu J, Rather H, Arroyo-Manzano D, Bhattacharya S, Balchin I, Khalil A, Thilaganathan B, Khan KS, Zamora J, Thangaratinam S. Risks of stillbirth and neonatal death with advancing gestation at term: a systematic review and meta-analysis of cohort studies of 15 million pregnancies. PLOS Medicine. 2019; 16:(7)

Murphy S, Cacciatore J. The psychological, social, and economic impact of stillbirth on families. Seminars in Fetal and Neonatal Medicine. 2017; 22:(3)129-134

Saving babies' lives: a care bundle for reducing stillbirth.London: NHS England; 2016a

Better births, Improving outcomes of maternity services in England: a five year forward plan.: NHS England; 2016b

Saving babies' lives version two: a care bundle for reducing perinatal mortality.: NHS England; 2019

National Institute for Health and Care Excellence. Antenatal care for uncomplicated pregnancies. 2008. (accessed 10 September 2019)

National Institute for Health and Care Excellence. Pregnancy and complex social factors: a model for service provision for pregnant women with social complex factors. 2010. (accessed 10 September 2019)

Origlia P, Jevic C, Sayn-Wicgenstein FZ, Cignacco E. Experiences of antenatal care among women who are socioeconomically deprived in high-income industrialized countries: an integrative review. Journal of Midwifery and Women's Health. 2017; 62:(5)589-598

Rasanathan K, Damji N, Atsbeha T, Drisse MN, Davis A, Dora C, Karam A, Kuruvilla S, Mahon J, Neira M, Montesinos EV. Ensuring multisectoral action on the determinants of reproductive, maternal, newborn, child, and adolescent health in the post-2015 era. 2015; 351

Rasanathan K, Bennec S, Atkins V, Beschel R, Carrasquilla G, Charles J, Dasgupta R, Emerson K, Glandon D, Kanchanachitra C, Kingsley P, Matheson D, Murithi Mbabu R, Mwansambo C, Myers M, Paul J, Radebe T, Smith J, Solar O, Soucat A, Ssennyonjo A, Wismar M, Zaidi S. Governing multisectoral action for health in low- and middle-income countries. PLOS Med. 2017; 14:(4)

Rayment-Jones H, Harris J, Harden A, Khan Z, Sandall J. How do women with social risk factors experience United Kingdom maternity care? A realist synthesis. Birth. 2019; 46:(3)461-474

Riggs E, Muyeen S, Brown S Cultural safety and belonging for refugee background women ascending group pregnancy care: an Australian qualitative study. Birth. 2017; 44:(2)145-152

Standards for maternity care-maternity audit indicators.: RCOG; 2008

Multisectoral approach for promoting public health. 2017.

Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews. 2016; (4)

Shengelia L. The crucial needs of sexual and reproductive healthcare: sharing experience of observing evidence-based practices in Edinburgh, the UK. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2016; 1:(206)

Shingshetty L, Mirza M, Rather H, Muglu J. Antenatal care pattern amongst women with perinatal mortality: 2 year experience in Royal London Hospital. European Journal of Obstetrics and Gynaecology and Reproductive Biology. 2016; 206

Steel A, Lucke J, Reid R, Adams J. A systematic review of women's and health professional's attitudes and experience of preconception care service delivery. Family Practice. 2016; 33:(6)588-595

Stapleton HM, Murphy R, Kildea SV. Insiders as outsiders: bicultural research assistants describe their participation in the evaluation of an antenatal clinic for women from refugee backgrounds. Qualitative Social Work. 2015; 14:(2)275-292

Stephenson J, Patel D, Barrett G, Howden B, Copas A, Ojukwu O, Pandya P, Shawe J. How do women prepare for pregnancy? preconcep/on experiences of women attending antenatal services and views of health professionals. PLOS ONE. 2014; 9:(7)

Reducing maternal mortality.: Human Rights Centre: University of Essex; 2010

World Health Organization. Sexual and reproductive health. 2013. (accessed 21 October 2019)

World Health Organization. WHO recommendations on health promotion interventions for maternal and newborn health 2015. 2015. (accessed 21 October 2019)

World Health Organization. Making every baby count: audit and review of stillbirths and neonatal deaths. 2016. (accessed 21 October 2019)

Widdows K, Reid HE, Roberts SA, Camacho EM, Heazell AE. Saving babies' lives project impact and results evaluation (SPIRE): a mixed methodology study. BMC Pregnancy and Childbirth. 2018; 18:(1)

Woods JR, Heazell AE. Stillbirth: is it preventable?. Obstetrics, Gynaecology and Reproductive Medicine. 2018; 28:(5)148-154

Yelland J, Riggs E, Szwarc J, Brown SJ. Ending preventable stillbirths among migrant and refugee populations. Perspectives. 2019; 210:(11)

Young S, Guo KL. Cultural diversity training: the necessity of cultural competence for healthcare providers and in nursing practice. The Health Care Manager. 2016; 35:(2)94-102

Reducing the incidence of stillbirth in black women

02 May 2020
13 min read
Volume 28 · Issue 5
 Pregnant women from minority groups need to have access to preconception and antenatal care to reduce stillbirths
Pregnant women from minority groups need to have access to preconception and antenatal care to reduce stillbirths


Black and black British women have an increased risk of stillbirth in the UK. The stillbirth rate for the UK in 2017 has reduced to 3.74 per 1 000 total births. However, mortality rates remain high for black or black British women, despite stillbirth rates for these groups reducing over the period 2015–2017 from 8.17–7.46 per 1 000 births (Draper et al, 2019). These facts raise the question of why these trends continue and what steps can be taken to address this issue. This paper explores the possible reasons why black and black British women continue to be at increased risk for stillbirths. Recommendations will be made on reducing the risk of stillbirth and the importance of tailoring health services for black and black British women. For the purpose of this paper, the term ‘black women’ will be used for black and black British women.

A stillbirth is a baby delivered at or after 24 weeks of pregnancy showing no signs of life, irrespective of when the death occurred. The UK is noted to have one of the highest stillbirth rates in high-income countries (NHS England, 2016a). The stillbirth rate for the UK in 2017 has reduced to 3.74 per 1 000 total births from 4.20 in 2013 which represents 350 fewer stillbirths (Draper et al, 2019). However, stillbirth rates continue to be high for black women in the UK at 7.46 per 1 000 births in 2017 (Draper et al, 2019). This prevalence is also reflected in other European countries.

In a systematic review involving 13 separate studies in the UK, US, Denmark and Norway, which included 15 124 027 pregnancies and 17 830 stillbirths, it was found that black women were 1.5–2 times more likely to experience a stillbirth (Muglu et al, 2019). The stillbirth rate is an indicator of quality care in pregnancy (de Bernis et al, 2016). A fact that should move the prevention of stillbirth to the top of any national health promotion agenda. It is argued that the need to develop and implement a plan to improve maternal and neonatal health in any country should include a focus on reducing stillbirths (Goldenberg et al, 2011). Suggestions include increasing awareness of stillbirths in high-risk groups with the use of appropriate interventions targeted at high-risk communities (Flenadyl et al, 2016).

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