The rise in maternal mortality rates among vulnerable pregnant women across Europe is potentially underreported and much greater political commitment is required to ensure equal access to maternal health care for vulnerable cultural subgroups in all countries of the European Union (EU) as levels of migration within and into Europe increase. That’s according to a new study carried out by the Women Political Leaders (WPL) Global Forum and funded by MSD for Mothers.

Launched at the WPL Forum by Marian Knight, Professor of Maternal and Child Population Health at the University of Oxford the study is the latest in a growing cache of studies and literature highlighting the challenge of increasing mortality rates of mothers and babies from vulnerable backgrounds as these groups struggle to gain access to primary and maternal health care in countries across Europe. These groups include migrants, ethnic minorities, homeless people, refugees and people living in rural areas.

The research, which included interviews with leading policy makers and health care professionals in the 28 EU countries, as well as a survey of European political leaders, sought to further assess the state of maternal health care, and in particular, barriers to access within vulnerable populations in Europe. It also drew on data from leading organisations such as Doctors of the World - Greece, the World Health Organisation (WHO), The Organisation for Economic Co-operation and Development and the United Nations.

Key findings of the study include:

  • The number of vulnerable pregnant women is growing in every country of the EU, in part due to the rapid influx of migrants, but also because of growing numbers of disadvantaged and homeless people;
  • The issue of rising maternal mortality rates is potentially significantly underreported across Europe and no useful data is currently being gathered to assess and address the challenge of increasing mortality of mothers and babies;
  • The delivery of maternal health care often fails to be tailored to the cultural background of patients and many countries lack specific plans for action on migrant health;
  • Few countries have a clear commitment to equitable care for vulnerable groups, such as refugees;
  • Political commitment is a key barrier to addressing the issue; and the rise in discriminatory and xenophopic attitudes towards vulnerable groups and conservative policies could compound the issue;
  • Many vulnerable women are likely not seeking maternal care because they fear it will impact their ability to stay in a country;
  • In terms of securing equal access, the cost of health care remains prohibitive for vulnerable pregnant women in a number of countries;
  • The Maternal Mortality Ratio in low-income countries can be up to 50 times higher than in high-income countries and unless decisive action is taken future mortality ratios among vulnerable pregnant women in Europe are likely to far exceed ratios currently witnessed in Europe.

“Despite the growing number of reported instances of migrant women giving birth in Europe in very difficult circumstances with little professional assistance we have virtually no information about the outcomes of pregnancy for these and other vulnerable women and their babies,” said Professor Knight. “This research clearly shows that our health care systems are not being tailored to meet the needs of these women. In the very small number of EU countries where the issue has been examined, maternal mortality rates have been shown to be at least four-fold higher in specific groups of vulnerable women.”

“Unless we ensure vulnerable pregnant women gain equal access to vital maternal health care, we risk escalating this disparity in maternal mortality rates,” Knight continued. “Only by recognising the importance of care for vulnerable pregnant women can we help to prevent mothers from dying, and prevent a widening of the health gap between women from different cultural, ethnic, geographic and national backgrounds.”

“Tragically, too many women die from preventable causes during pregnancy and childbirth,” said Gabriele Grom, associate vice president, Central Eastern Europe Lead in MSD and Executive Ambassador of MSD for Mothers. “Women who are living in poverty, or migrants, or from minority ethnic groups, are the most likely to have poor maternal health outcomes because they lack access to quality care. Equal access to quality maternal health care can save lives and reduce pressure on health care systems in countries across Europe. We encourage policy makers, NGOs and health care professionals to work together to implement the recommendations made in this study.”

In a preface to the study Director General of the EU Directorate-General for Health and Food Safety, Xavier Prats Monné, said high level of political will and a strong policy focus was required to address the issue: “We must believe, and hope, that times are changing for women, that discrimination and inequalities that were tolerated in the past are becoming unacceptable to civilized society […] The recommendations of the Women Political Leaders Global Forum report are clear and to the point. We know what must be done and how to do it, and we have the means to do it. It is time for action,” he said.

The key recommendations outlined in the study and discussed at the WPL Forum include:

  • Ensuring that accessing maternal health care does not threaten the ability of vulnerable women to remain in a country due to their immigration status;
  • Mandatory training for health professionals across Europe in delivering culturally sensitive care;
  • Guaranteeing a basic benefits package for vulnerable pregnant women that covers maternal health care to include information on family planning services; access to contraception and antenatal, delivery, neonatal and post-natal care;
  • Significantly enhancing education and awareness within communities about the rights of vulnerable pregnant women;
  • Further investigating the effectiveness of standards of maternal health care of vulnerable pregnant women in Europe;
  • Addressing the significant shortage of comprehensive and reliable data on maternal health.

“The research clearly highlights the gap in equitable access to maternal healthcare for women living in Europe and that we have significant work to do to address this. Over the coming months, WPL will work with our partners to outline the findings of our latest study and present them, along with actionable recommendations, to policy makers across Europe. Now is the time to take action and work together to address this social issue,” said Silvana Koch-Mehrin, president of the WPL.

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