New analysis of NHS data has uncovered a stark disparity in childbirth injuries, revealing that women of Asian ethnicity in England are almost twice as likely to suffer the most severe forms of vaginal tearing during labour. The findings have prompted urgent calls for better awareness and personalised antenatal counselling.
Alarming Disparity in Birth Injury Rates
According to a Guardian analysis of figures obtained via a Freedom of Information request, the rate of the most serious tears – known as third- and fourth-degree obstetric anal sphincter injuries (OASI) – was 2,831 per 100,000 deliveries for Asian women in 2023-24. This stands in sharp contrast to rates of 1,473 per 100,000 for white women and 1,496 per 100,000 for black women.
While up to 90% of women experience some form of tearing during childbirth, most are minor. However, a third-degree tear extends into the muscle controlling the anus, and a fourth-degree tear goes further into the anal lining. These injuries can lead to life-altering consequences, including chronic pain, bowel incontinence, and post-traumatic stress disorder.
A Critical Gap in Frontline Awareness
Despite several Western-based studies highlighting the increased risk for women of Asian heritage, experts warn this crucial information is not consistently reaching those providing care. Lia Brigante, a professional policy adviser at the Royal College of Midwives, stated that many women report their midwife or doctor seemed unaware of their higher risk.
"The reasons for this disparity are complex and remain unexplained," Brigante said. "Difference in care, rates of instrumental births, nutrition and inequalities in how women’s needs are recognised during labour may all contribute."
Geeta Nayar, a senior associate at Irwin Mitchell and advocate for birth trauma charities, emphasised the need for change. Nayar, who is south Asian and sustained a permanent injury from a third-degree tear during her own delivery, stressed that adequate, culturally sensitive information about individual risks must be provided antenatally.
Urgent Call for Improved Antenatal Counselling
The analysis coincides with a worrying broader trend: the rate of severe perineal tears in England has risen by 16% since June 2020. Chloe Oliver, chief executive of the MASIC Foundation, which supports women with severe birth injuries, highlighted the urgent need for improvement.
"One of the major risk factors for sustaining an OASI is being of south Asian heritage, but like several other risk factors... so few women are aware of their risk because it’s not routinely discussed," Oliver explained. She called for enhanced antenatal counselling to empower women to make informed choices with their healthcare professionals.
An NHS spokesperson responded, stating: "Every woman deserves safe, high-quality, compassionate and equitable maternity care. We remain firmly committed to tackling the disparities that affect Asian women and other communities."
The consensus among advocates and professionals is clear: to improve outcomes, the healthcare system must ensure every woman receives personalised care and honest conversations about their specific risks long before they go into labour.
