Asian women in England are nearly twice as likely as white or black women to suffer the most severe forms of vaginal tearing during childbirth, according to an analysis of NHS data. The findings, obtained via a freedom of information request, show that in 2023-24, Asian women experienced third- and fourth-degree tears at a rate of 2,831 per 100,000 deliveries, compared with 1,473 for white women and 1,496 for black women.
Third- and fourth-degree tears, known as obstetric anal sphincter injury (OASI), extend into the muscle or lining of the anus and can cause life-changing physical and mental harm, including bowel incontinence, chronic pain and post-traumatic stress disorder. Up to 90% of women experience some tearing during labour, but most are less severe.
Geeta Nayar, a senior associate at Irwin Mitchell and advocate for the MASIC Foundation and Birth Trauma Association, said the reasons for the disparity were “multifactorial – from anatomical and physiological differences to structural systemic issues”. She added that women should be given information about individual risks antenatally “in a culturally and linguistically acceptable manner”.
Lia Brigante, a professional policy adviser at the Royal College of Midwives, noted that while studies have shown Asian women face a higher risk, “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 called for personalised care and honest conversations about risks.
Chloe Oliver, chief executive of MASIC, said: “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 in antenatal appointments.” She urged “urgent improvements in antenatal counselling”.
An NHS spokesperson said: “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.”
