Kirsty Kitchen, Director of the Birth Companions Institute, shares her initial reflections on Baroness Amos' landmark report
Today’s report from the National Maternity and Neonatal Investigation, led by Baroness Amos, lays bare what families facing the greatest disadvantage have long told us directly: that the maternity care you receive is often dependent on who you are, where you live, and what systems already know or think about you.
The report’s findings are systemic and wide-reaching. It should be read in full, with time to digest and reflect – and then translated into the huge amount of work that must follow. Endless summaries and hasty responses cannot do the findings of this report justice. But for today, as we reflect on the evidence women in our Lived Experience Programme fed into this investigation, and as we look ahead to the work I will be doing in my role on the Maternity and Neonatal Taskforce’s expert reference group on equity, I wanted to provide some initial thoughts.
Racism and discrimination – structural, institutional and interpersonal – have no place in maternity care, and Baroness Amos is right to deploy the saying ‘culture eats strategy for breakfast’. These are not easy issues to address, but addressing them can and will create a system that supports every woman, birthing person, baby and family better. This isn’t only dependent on the maternity system though – it involves looking at the way that system interacts with others in the wider health space and far beyond. It involves engaging, as Baroness Amos points out, with how societal attitudes affect what happens in maternity care. For example, the report finds that families with criminal justice or social services involvement experienced visible shifts in staff behaviour once this became known, exposing respect as conditional rather than universal. It also highlights how poor coordination across maternity, neonatal, and wider health and social care can worsen outcomes for women in poverty, in insecure housing, or experiencing violence including FGM, who are less likely to receive the right support at the right time. And it confirms that women from deprived areas, minoritised communities, and those with English as an additional language face later referral and longer waits for antenatal care – disparities that community-based approaches, maternity navigators, peer support, and interpreter-supported education have been shown to address.
The Birth Companions Institute will be pressing for this report to translate into sustained, structural change rather than another cycle of acknowledgement without reform. Central to that must be improving how the system captures and acts on “social factors” – poverty, housing insecurity, trauma and abuse, contact with the criminal justice system, children’s or adult social care, and insecure immigration status. Without better data on these intersecting circumstances, services cannot engage with the complexity of women’s lives, cannot coordinate effectively across systems, and cannot narrow the stark and widening inequalities this report and others have made visible.
A reformed maternity system must deliver care that is safe, compassionate and equitable for everyone – including those who face the deepest structural and interpersonal barriers, including bias and racism. That work needs to start now, while the findings are fresh and the political and public attention is focused here. The Birth Companions Institute stands ready to contribute the evidence, lived experience insight, and practical expertise needed to make that happen, and we look forward to working with the new Maternity and Neonatal Commissioner.
Read the report in full:
National Maternity and Neonatal Investigation, Final Report and Recommendations
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