London: Asian women in England are almost twice as likely to experience the most severe birth injuries during labour, with many healthcare professionals unaware of this increased risk, an analysis has found.
The most serious vaginal tears, known as third- and fourth-degree tears or obstetric anal sphincter injuries (OASI), extend into the muscles and lining controlling the anus.
While up to 90 percent of women experience some tearing during childbirth, most injuries heal quickly and have a minor impact. However, third-degree tears extend into the anal muscles, and fourth-degree tears go further into the lining of the anus, potentially causing long-term physical and psychological harm, including chronic pain, bowel incontinence, and post-traumatic stress disorder.
NHS figures revealed that in 2023–24, Asian women experienced third- and fourth-degree tears at a rate of 2,831 per 100,000 deliveries. This compares with rates of 1,473 per 100,000 for white women and 1,496 per 100,000 for Black women.
Geeta Nayar, senior associate at Irwin Mitchell and advocate for the MASIC Foundation and Birth Trauma Association, said that the reasons Asian women are at higher risk are “multifactorial – from anatomical and physiological differences to structural systemic issues.”
Lia Brigante, Policy Adviser at the Royal College of Midwives, added that although studies have shown women of Asian ethnicity face higher rates of perineal trauma, “this knowledge isn’t consistently reaching frontline staff, as many women tell us their midwife or doctor seemed unaware they were at higher risk.”
Brigante emphasized that the causes of this disparity are complex and not fully understood, citing differences in care, rates of instrumental births, nutrition, and inequalities in recognising women’s needs during labour. The Policy Advisor added that, “Every woman deserves personalised care and honest conversations about possible risks and options available. Asian women must be supported with evidence-based practices and feel heard and respected throughout labour and birth.”
Nayar, who is South Asian and personally experienced a third-degree tear during childbirth, leaving her with permanent injuries, stressed the importance of providing adequate antenatal information about individual risks in a culturally and linguistically appropriate way.
The analysis also highlighted a broader trend: the number of mothers sustaining a third- or fourth-degree perineal tear has risen from 25 in 1,000 deliveries in June 2020 to 29 in 1,000 in June 2025, representing a 16 percent increase.
Chloe Oliver, Chief Executive of MASIC, noted that, “At MASIC, we see the impact of OASI birth injuries every day, and the lifelong emotional and physical consequences they carry.”
Oliver added that being of South Asian heritage is a major risk factor, alongside others such as forceps delivery, carrying a large baby, older maternal age, or shorter maternal height. Oliver called for urgent improvements in antenatal counselling to ensure women are aware of these risks and can make informed choices with their healthcare professionals.
An NHS spokesperson reaffirmed the commitment to providing safe, high-quality, compassionate, and equitable maternity care, and stated that, “We remain firmly committed to tackling the disparities that affect Asian women and other communities, ensuring that every mother receives the highest standard of support throughout pregnancy, birth, and the postnatal period.”
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