What on earth is going on when more women than ever are dying during or soon after pregnancy? It’s the highest mortality rate since 2003-05 and it’s a scandal.

Oxford researchers are investigating all women between January 2020 and December 2022 who died during pregnancy or within six weeks of their pregnancy ending. The shocking death rate emerges in a Saving Lives, Improving Mothers’ Care report which will be published later this year.

The maternal death rate in 2020-22 was 13.41 deaths per 100,000 ­maternities. This is significantly higher than the rate of 8.79 deaths per 100,000 maternities in the previous three years (2017-19). And when deaths caused by Covid-19 are excluded, the maternal death rate for 2020-22 (11.54 deaths per 100,000 maternities) is higher than the rate for 2017-19.

Blood clots in the form of ­thrombosis and thromboembolism were the leading cause of death in women who died during pregnancy or within six weeks of pregnancy ending. Covid was the second most common cause of death, followed by heart disease and mental health related causes. But what’s inescapable is that Black women remain three times more likely to die than white women.

The maternal death rate for women of Asian ethnic backgrounds is ­worryingly twice as high as that of white women. This, despite the fact the maternal death rate for women from Black ethnicities has decreased slightly from the rate in 2019-21.

And significantly women living in the most deprived areas still have a maternal death rate more than twice that of women living in the least deprived areas. Professor Marian Knight, director of the National ­Perinatal Epidemiology Unit, says: “The data shows that the UK maternal death rate has returned to levels that we have not seen for the past 20 years.

“The 2023 MBRRACE-UK maternal confidential enquiry report [looking at maternal deaths between 2019 and 2021 in the UK] identified clear examples of maternity systems under pressure, and this increase in maternal mortality raises further concern. Ensuring pre-pregnancy health, including tackling conditions such as being overweight and obesity – as well as critical actions to work towards more inclusive and personalised care – need to be prioritised as a matter of urgency now more than ever.”

Dr Nicola Vousden, co-chair of the Faculty of Public Health’s Specialist Interest Group for Women’s Health wants to see changes. She said: “Persisting inequalities in ethnicity and socioeconomic status indicate that we must think beyond maternity care to address underlying structures that impact health before, during and after pregnancy – such as housing, education and access to healthy environments.”