In April, the Department of Health and Social Care (DHSC) published a refreshed Women’s Health Strategy which contained commitments to listen to women*, tackle inequalities in health outcomes and improve performance in services that matter most to women, including enhancing miscarriage support. Whilst the strategy defers to the upcoming National Maternity and Neonatal Investigation and Taskforce, we’re pleased that it recognises the challenges facing maternity and neonatal services and commits to improving them. While individual commitments are welcome, the investigation and taskforce must consider how they are embedded in system-level changes.  

Using patient feedback to listen to women’s concerns  

Defined as a ‘golden thread’, it is encouraging that listening to women’s concerns and their experiences has been prioritised throughout the strategy. This echoes our review of reports into maternity and neonatal services which highlighted ‘failing to listen’ as a key issue. Listening must include involving women and birthing people in service design, using patient experience data to evaluate service performance, and responding to individual concerns in real time and after harm has occurred, which will require a more comprehensive approach than the measures outlined in the strategy.  

The Patient Reported Experience Measure (PREM) is currently being piloted for maternity and neonatal services to improve how patient experience is evaluated. The pilot should consider how to capture the experiences of bereaved parents and other vulnerable groups, creating versions in different languages and formats to improve accessibility and referring respondents to additional support if required. While improving the underlying measure is helpful, how the measures are used is of equal importance. Currently, the Friends and Family Test is all too often used to seek comfort rather than sense problems. One Trust pointed to positive Friends and Family Test results as a sign that the service had improved, despite an average response rate of only 3.9% over the past five years, according to our analysis.  

Successive reports have highlighted the need to improve how health care professionals listen to the service users in front of them in real time, an issue which the strategy doesn’t sufficiently cover. Martha’s Rule is currently being piloted in maternity services and, if it is found to have an impact, may give patients and families the ability to escalate concerns if they feel they are not being heard.  

Finally, bereaved parents want answers about why their baby died and deserve to be treated with compassion. The current system for reviewing baby deaths is complex, disjointed and unaccountable. It must be fundamentally restructured to centre bereaved families’ needs, with learnings embedded to have a system that truly listens to women and families.  

Efforts to close the Black and Asian maternal mortality gap should be accompanied by a focus on perinatal outcomes and disparities by deprivation 

There is welcome recognition of the need to tackle health inequalities, alongside broader commitments to support women to lead healthy, prosperous lives. Disparities within maternal and perinatal outcomes are stark and persistent, with women and babies from minoritised ethnic backgrounds and areas of higher deprivation continuing to experience worse outcomes. Whilst the target to close the Black and Asian maternal mortality gap is important, this must be expanded to include a focus on perinatal outcomes and a commitment to end inequalities by deprivation. 

The focus on pre-conception health will be critical to tackle inequalities as many of the priorities disproportionately affect minoritised ethnic groups, and women and birthing people from deprived areas. For example, socioeconomic status and ethnicity is associated with low folic acid supplementation and smoking throughout pregnancy is higher among those under 18 years old and from lower socio-economic backgrounds.  

Improving miscarriage care must be accompanied by better data collection 

We welcome the commitment to review the results of Tommy’s Graded Model of Miscarriage Care pilot study and to consider wider rollout across the NHS. However, we were disappointed that the strategy did not include a commitment to improving data collection. The number of miscarriages that occur each year in the UK is not systematically measured or reported. Routine data collection is needed to better understand the scale of miscarriages that occur, monitor trends over time, identify inequalities, and evaluate the impact of policy and service changes. 

In our briefing, we have set out three opportunities to improve miscarriage data collection: using birth outcome data to record mid-trimester losses, integrating primary care data and utilising population-wide surveys. We are disappointed that the strategy did not revisit the 2023 Pregnancy Loss Review recommendations to collate and publish data on mid-trimester losses, as well as commission research into the feasibility of data collection for miscarriage before 12 weeks’ gestation.  

From listening to action 

The publication of this renewed strategy signals a continued commitment to reducing the gender health gap and ensuring that women receive better care. To end inequalities and truly listen to women, care must be taken to the most vulnerable and those who have experienced the worst outcomes, with the commitments embedded into system changes going forward. 

*The Sands & Tommy’s Joint Policy Unit is committed to inclusivity and ensuring that everyone feels heard and seen. To recognise transgender and non-binary gestational parents, we refer to women and birthing people within our own work. However, when referencing the strategy within this blog, we have mirrored the language used to avoid introducing inaccuracies.