New analysis of NHS data has uncovered a stark disparity in childbirth outcomes, revealing that women of Asian ethnicity in England are almost twice as likely to suffer the most severe birth injuries during labour. Experts are raising the alarm that this heightened risk is not consistently understood by frontline healthcare professionals.
Shocking Disparity in Severe Tear Rates
Third- and fourth-degree tears, clinically known as obstetric anal sphincter injuries (OASI), represent the most serious forms of vaginal tearing. While up to 90% of women experience some tearing, these severe injuries extend into the muscle controlling the anus and its lining, leading to potentially life-altering consequences.
According to a Guardian analysis of NHS figures obtained via a freedom of information request, the rate for Asian women stood at 2,831 tears per 100,000 deliveries during the 2023-24 period. This contrasts sharply with rates of 1,473 per 100,000 for white women and 1,496 per 100,000 for black women.
A Multifaceted Risk with a Knowledge Gap
Geeta Nayar, a senior associate at Irwin Mitchell and advocate for birth injury charities, explains the reasons are "multifactorial – from anatomical and physiological differences to structural systemic issues." Nayar, who is south Asian and sustained a permanent third-degree tear herself, emphasises the need for change.
Lia Brigante, a professional policy adviser at the Royal College of Midwives, confirms a critical problem: "This knowledge isn't consistently reaching frontline staff, as many women tell us their midwife or doctor seemed unaware they were at higher risk." She notes the reasons for the disparity remain complex and unexplained, potentially involving differences in care, instrumental birth rates, and systemic inequalities.
Urgent Call for Personalised Antenatal Counselling
The analysis arrives against a backdrop of rising OASI rates across the board. Previous research indicates the number of mothers sustaining these severe tears increased by 16% between June 2020 and June this year, from 25 to 29 in every 1,000 deliveries.
Chloe Oliver, chief executive of the MASIC Foundation, states: "One of the major risk factors for sustaining an OASI is being of south Asian heritage, but... so few women are aware of their risk because it’s not routinely discussed." Both Oliver and Nayar are calling for urgent improvements in antenatal counselling, delivered in a culturally and linguistically appropriate manner, to ensure women can make fully informed choices about their care.
An NHS spokesperson responded, affirming a commitment to "tackling the disparities that affect Asian women and other communities" and ensuring "every mother receives the highest standard of support."
