Background Stillbirth and infant mortality rates in Birmingham remain consistently above those seen in the West Midlands and England & Wales. Over half of the maternity population are from minority ethnic groups.

Methods Numerator data 2006–2010 (deaths/anomalies) were selected from the regional, population-based, anomaly and mortality registers, covering a birth cohort of 85,734. Denominator data for 2010, including ethnic group, consanguinity, and folate use, were available within the regional denominator database (www.pi.nhs.uk/peer/peerdata_collection.htm).

Results Deaths from congenital anomaly comprise 29.3% of stillbirths and infant deaths in Birmingham. Mortality rates were significantly higher in Pakistani (odds ratio 3.0) and Bangladeshi mothers (odds ratio 2.1) compared to White Europeans. Pakistani mothers had significantly higher mortality rates from metabolic disorders, neural tube defects, and renal anomalies. In terms or primary and secondary screening, the prevalence of antenatal folate use was low in most minority ethnic groups. 49.4% of stillbirths and infant deaths had at least one anomaly that was amenable to detection by fetal anomaly screening programmes. However, in 5.1% of Birmingham births, the first booking appointment took place at 20 weeks or later. Pakistani mothers have the highest rates of consanguineous unions (49.9%, CI 48.1–51.7, compared to 15.9% (CI 15.3–16) for all ethnic groups combined.

Conclusion Ethnic groups in Birmingham have an excess of perinatal mortality due to congenital anomalies. Interventions for these groups need to focus on improved folate uptake, timely access to screening services, and referral for genetic risk assessment.