Asian women in England People are almost twice as likely to suffer the most severe birth injuries during childbirth, with many healthcare workers unaware of this higher risk, the analysis found.
Third and fourth degree tears, also known as obstetric anal sphincter injury (OASI), are the most severe forms of vaginal tears during childbirth.
Up to 90% of women experience ruptures during childbirth, with most of these injuries healing quickly and having a relatively minor impact. A third-degree tear extends into the muscle that controls the anus, and a fourth-degree tear extends further into the lining of the anus.
According to Guardian analysis National Health Service Asian women experienced third- and fourth-degree tears in 2023-24, with a rate of 2,831 tears per 100,000 births, according to data obtained through a freedom of information request. This compares to 1,473 per 100,000 for white women and 1,496 per 100,000 for black women.
Such injuries can lead to life-altering physical and mental harm, including bowel incontinence, post-traumatic stress disorder and chronic pain.
Geeta Nayar, a senior fellow at Irwin Mitchell and an advocate for the MASIC Foundation, which supports women who have suffered serious injuries during childbirth, and the Birth Trauma Association, said the reasons why Asian women are at greater risk of serious tears during childbirth are: “multifactorial – from anatomical and physiological differences to structural and systemic problems.”
Leah Brigante, professional policy adviser at the Royal College of Midwives, said that while several Western studies have shown that Asian women face a higher risk of perineal injury, “this knowledge does not always reach frontline staff, with many women telling us that their midwives or doctors did not seem to know they were at higher risk.”
Brigante said: “The reasons for this disparity are complex and remain unexplained. Differences in care, instrumental birth rates, nutrition and inequalities in how women's needs are recognized during childbirth may all contribute. However, there is not enough evidence to fully understand why this gap exists.”
She added: “Every woman deserves personalized care and an honest conversation about the risks and options available. Asian women should be supported through evidence-based practices and feel heard and respected during childbirth.”
Nayar, a South Asian woman who suffered a third-degree tear at the birth of her daughter, leaving her with permanent injuries, added that it is necessary to focus on what can be changed for the better to improve outcomes. She said: “Adequate information about individual risks, including the increased risk of OASI, should be provided to women before birth in a culturally and linguistically appropriate manner.”
This analysis is based on the fact that previous studies have shown that number of mothers who suffered a third or fourth degree perineal tear during childbirth rose from 25 out of 1,000 in June 2020 to 29 out of 1,000 in June this year – an increase of 16%.
Chloe Oliver, chief executive of MASIC, said: “At MASIC we see the impact of OASI birth injuries every day and the emotional and physical consequences they have throughout life.”
She added: “One of the main risk factors for maintaining OASI is being of South Asian descent, but like several other risk factors – such as having a forceps birth, carrying a large baby, older maternal age or short maternal stature – so few women are aware of their risk because it is not usually discussed at antenatal appointments.
“Urgent improvements are needed in antenatal counseling to inform women of their risks and enable them, together with their healthcare provider, to make informed choices about the best and safest birth for both mother and baby.”
An NHS spokesperson said: “Every woman deserves safe, high quality, compassionate and equitable maternity care. We remain firmly committed to tackling the inequalities that affect Asian women and other communities by ensuring every mother receives the highest level of support throughout pregnancy, birth and the postnatal period.”
