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Advent Reflections – Mary and Maternal Mortality

28 Nov 2022

Alice Watson, The Queen’s College, Oxford

Free public domain CC0 photo.

At this time of year, as we enter into the season of Advent, a season of expectation and preparation as we ponder on the coming of Christ, both in tiny fragile human form, and as the one who will return as judge, we also find ourselves swept up in the rush of festivities and more mundane preparations.  The familiar images of Christmas are presented to us as a backdrop to our December lives; of jolly Santas, glittering decorations, and of course, traditional nativity scenes; in cards, as wooden cut-outs in our public spaces, in school plays, and sung in carols in churches, street corners, and shopping centres.

Interpretations of the precise set-up of Mary’s birth narrative are many, but I imagine it to be less perfect, less sterile, than how it has often been portrayed and presented to us. We know the scene – a peaceful Jesus (no crying he makes) a doting mother (meek and mild), gentle animals, and a comfortable manger. It can feel a long way from the mess and magic of childbirth. A long way from the fear and anxieties of a young couple giving birth away from home, knowing perhaps, that their next journey was not towards home, but flight into a strange land.

Although traditionally, childbirth has not inspired much theological reflection, we can perhaps use this time of year to dwell with Mary in her final days of pregnancy and her childbirth, and to enter into solidarity with those today, facing birth in uncertain or dangerous situations. For birth remains a risky business.

Despite maternal mortality rates falling worldwide, the number remains too high, with 152 maternal deaths per 100,000 live births in 2021.[1]  The vast majority of these are in the global south.  In addition, a UN report published in 2021 states that in the previous three years, a million children were born as refugees[2], their early lives echoing the infant Christ, born in a temporary home, and dependent upon powers and forces beyond their control, yet each birth bearing the potential to bring hope, with life continuing despite its most gruelling circumstances.

And yet, here in the UK, we fool ourselves if we can compartmentalise this as a ‘far away’ problem, and return to our cosy Christmases, unmoved or unaffected. Birth shows us that the ‘dangerous’ margins are not only geographical – a cause for which we might donate a charity Christmas card. The margins where Mary can be found standing in solidarity are those of race, ability, and class here in the UK. Examining them, should draw us into a desire to seek to improve birthing conditions worldwide, as we reflect upon our common humanity.

A recent report published by the University of Oxford as part of the MBRACE Project (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK)[3] revealed that, excluding deaths from COVID, maternal mortality had increased by almost 20% in the UK in the period 2028-2020. The leading direct cause of death amongst pregnant people, or those within 6 weeks of birth, was suicide. Those facing ‘multiple adversities’ including a history of trauma or abuse were more likely to die, and that ‘women living in the most deprived areas were more than twice as likely to die as those in the most affluent part of the UK’.[4]

As we are seeing across all sectors, the cracks are widening between those who can live lives of relative safety, and those who cannot.  Black women are already 3.7 times more likely to die in childbirth than white women, and are more likely to feel unheard and less able to advocate for themselves and for their child. In a 2021 article in The Independent, Chine McDonald writes of having to leverage her ‘husband’s whiteness to ensure the protection of my baby and myself’.[5]

These disparities we see in birth draw attention to the same disparities which exist across society, that the world we live in is a world tilted to the voices, lives, and experiences of the able, the white, the wealthy, and the male. The agony faced by women seeking treatment for common gynaecological conditions such as endometriosis shows just how unimportant female health so often is viewed as. As the lead researcher of the MBRACE study, Professor Marian Knight describes, these appalling conditions are simply ‘bleak’. 

Reflecting on the state of maternity care this advent, it feels as though the humble and meek, the forgotten and excluded, are only being further cast down, stepped over or ignored by those with power. This picture feels at odds to the sentiment of Mary’s own song, the Magnificat. During her own pregnancy her voice is raised to sing of the world which God will bring about – where the proud are scattered, the hungry fed, the rich sent away empty, and the lowly lifted up.  We fail to see the image of God in these women, and fail to see the presence of Mary, in birthing solidary besides them.

Images and icons of Mary have long been used as devotional aids by women, as ways to petition for Mary’s prayers, to share in her life, and the life of her son. In recent times, new icons, such as Mark Dukes’ icon ’Our Lady Mother of Ferguson and all those killed by gun violence’ have highlighted God’s presence with those who suffer violence and oppression, and call for our Christian solidary. This solidarity must firstly be expressed in the transformation of our own hearts, to stand alongside those who face unsafe births, to amplify their voices, and to raise our own voices to attempt to transform their experiences.

At Christmas the reality of our Christian faith comes into focus with the incarnation, that God is a God who chooses to become human. A God for whom flesh and blood matters, and who knows what it is to be born, a God who is present amongst the suffering of the world. When we gaze upon images of the nativity this Advent and Christmas we should be reminded of the risk of birth, of the God who is familiar with the mess of the manger, and of Mary, Mother of God, who, in giving birth to Jesus, is ever giving birth on the margins of society. 

May we use this as a chance to reflect on those giving birth this Christmas, in fearful situations, in refugee camps, and in inadequately staffed hospitals, including those facing trauma, and those whose voices will not be heard, and commit ourselves to doing what we can to ensure that childbirth is safe and supported.

When Christ returns, how will he judge us for what we have done for the least amongst us?

Alice is the Chaplain of The Queen’s College Oxford and her academic work focuses on liturgy and childbirth. Her contact details are alice.watson@queens.ox.ac.uk, Twitter: @alicelydiajoy


[1] Gates foundation – https://www.gatesfoundation.org/goalkeepers/report/2021-report/progress-indicators/maternal-mortality/

[2] UN – https://www.unhcr.org/pk/13229-1-million-children-born-as-refugees-in-three-years-globally.html

[3] University of Oxford, Oxford Population Health. Report accessed here – https://www.npeu.ox.ac.uk/mbrrace-uk/reports

[4] The Guardian – https://www.theguardian.com/society/2022/nov/10/sharp-rise-in-number-of-women-in-uk-dying-in-pregnancy-or-shortly-after

[5] The Independent – https://www.independent.co.uk/voices/black-women-maternity-deaths-b1823918.html

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