EKHUFT Maternity Board Data: Ethnicity Recording Gaps and Higher Emergency Caesarean Rates for Some Groups

Maternity services at East Kent Hospitals University NHS Foundation Trust have been a known area of concern in the past. That history matters, because it raises the bar for what “reassurance” looks like today. Against that backdrop, a set of maternity charts in the Trust’s Board papers lands with real weight. They do not prove wrongdoing. But they do show something the Trust cannot afford to wave away: gaps in ethnicity recording for some communities, and marked differences in how women giving birth experience key interventions and outcomes.

In short: the Trust is telling its own Board that it can’t see some groups clearly in its data — and that several maternity measures vary sharply between groups in ways unlikely to be down to chance. For a service already under scrutiny historically, that combination is not a footnote. It is a governance issue.

What these charts are — and the key limitation the Trust is effectively admitting

The slides use “Origins” software, which estimates likely cultural/ethnic/linguistic background from forenames and surnames by matching names against very large reference libraries. Put simply, it uses names as a proxy for background.

That is important for two reasons. First, it is not the same as self-declared ethnicity. Second, the fact the Trust is relying on a proxy tells you the underlying issue: routine ethnicity recording is not reliable enough, on its own, to answer basic equality and safety questions confidently.

Red flag one: ethnicity is “unknown” far more often for some groups

The Trust’s table on under-recording is stark. It compares “origin of name” with the percentage of patients whose ethnicity is recorded as “not known” or “declined to answer”.

For names linked to Britain and Ireland, the unknown/declined rate is 5.38%. For several other name-origin groups it is around three times higher: 15.35% (Baltic States), 16.51% (Nigeria), 18.02% (Romania or Moldova) and 18.04% (Bangladesh).

In plain English: the Trust is most likely to be missing ethnicity data for some communities where language barriers, confidence in services, or inconsistent asking/recording may play a part. This is not a technical quirk. If you cannot see groups clearly in your own data, you cannot reliably monitor whether outcomes are equal — and you cannot confidently prove you are spotting risk early.

Who gives birth at EKHUFT: maternity serves a different mix of women to the Trust overall

The Board papers also make a simple but crucial point: women who give birth in East Kent are not demographically the same as the Trust’s overall patient population.

Across 47,253 births in the dataset, some groups are far more common in maternity than in the Trust’s overall base. “Eastern European” name-origins account for 6.3% of births compared with 2.5% in the Trust’s overall patient base. “Muslim” name-origins are 3.0% of births versus 1.4% overall. “Black African & Caribbean” are 1.7% of births versus 0.9% overall. “Hindu South Asian” are 2.0% of births versus 1.3% overall. Meanwhile, “Anglo-Saxon” name-origins form a smaller share of maternity than the overall Trust base (65.2% versus 71.9%).

The practical meaning is straightforward. If maternity serves a more diverse population than the Trust’s general “average patient”, then maternity care has to be designed and resourced for that reality — including communication support, interpretation where needed, and culturally safe, consistent pathways.

What happens in labour: the three headline findings the Trust needs to explain

The next set of charts looks at births from 2016–2023 and compares groups using a statistical approach (funnel plots) designed to highlight results that are very unlikely to be random. The charts use strict “99% limits”, meaning the highlighted points are not small wobbles: they are differences big enough that a Board should treat them as a prompt for proper investigation.

A quick guide to terms. An elective caesarean is a planned C-section. An emergency caesarean is an unplanned C-section, usually because labour is not progressing safely or there is concern for mother or baby. Induction means starting labour artificially (for example with medication) because waiting is judged riskier.

Planned caesarean (elective)

Across the Trust, the average planned caesarean rate is 14.11%. The chart flags one group clearly above that: “Hindu South Asian” name-origin births at 18.57% (176 planned caesareans out of 948 births), above the strict upper threshold.

Planned caesareans can reflect clinical risk, previous caesarean, maternal age and informed choice. But the Trust should be able to explain why this group is higher, with evidence.

Emergency caesarean

The Trust-wide emergency caesarean average is 20.08%. The chart flags several groups above the strict threshold:

Black African & Caribbean name-origin births at 28.50% (230 emergency caesareans out of 807 births).
Hindu South Asian name-origin births at 28.38% (269 out of 948).
Muslim name-origin births at 23.96% (335 out of 1,398).

This is the most sensitive part of the data. Emergency caesarean is often where complications, late escalation, delayed decision-making, or higher underlying clinical risk show up. Higher rates can be driven by underlying medical factors — but they can also be influenced by how quickly concerns are recognised, how well communication works in labour, and how consistently escalation decisions are made.

Induced labour

The Trust-wide induction rate is 30.66%. Two groups are flagged below the strict lower threshold:

Eastern European name-origin births at 26.13% (783 inductions out of 2,997 births).
Muslim name-origin births at 26.75% (374 out of 1,398).

Lower induction rates are not automatically “good” or “bad”. They may reflect different clinical risk profiles or preferences. But they raise a simple question the Trust has to answer: are women in these groups getting the same timely review, the same explanation of options, and the same support to make informed choices?

A serious harm outcome: severe tears

The pack also examines third–fourth degree tears. These are severe tears involving the anal sphincter (and in fourth degree, the lining of the rectum). They can have long-term physical and psychological consequences.

The Trust-wide rate shown is 1.86%. One group is flagged above the strict limit: “Hindu South Asian” name-origin births at 3.69% (35 out of 948 births).

What this does not prove — and what it absolutely does prove

These charts do not prove discrimination. They do not, by themselves, prove staff are making wrong decisions. They also do not adjust for “case mix” — factors such as age, deprivation, diabetes, high blood pressure, BMI, previous caesarean, multiple pregnancy or late booking, all of which can affect intervention and outcome rates.

But the charts do prove something else: the Trust has identified patterns that are too large to ignore, and that need a clear explanation.

A Trust can only reassure the public if it can demonstrate two things at the same time: that it records ethnicity reliably (so it can genuinely monitor equality of outcomes), and that where differences exist, it understands why and can show what it is doing about them.

The questions the Board should now insist on answering, plainly

If maternity has been a known problem area in the past, the Trust does not get to treat these findings as “interesting”. It needs to answer, in plain English:

Why is ethnicity more often “unknown/declined” for some communities — is it inconsistent asking, inconsistent recording, lack of interpreter support, or lack of trust in why the question is being asked? Are the higher emergency caesarean rates driven by clinical risk, or by differences in pathways, escalation and decision-making? Do women with language barriers get interpreters early enough, reliably enough, and in the moments that matter? Are these patterns consistent across sites, or driven by one hospital or one pathway? And what is the Trust doing now, in practical terms, to reduce severe tears and to make emergency escalation safer and more consistent for every woman who gives birth in East Kent?

For a Trust with a past maternity shadow, this is the test. It is not enough to say “we’re improving”. The Board papers show the Trust has the beginnings of the right questions. The public should now see the answers — and the evidence that those answers are changing care on the ground.

The Shepway Vox Team

Dissent is NOT a Crime