Social factors affecting pregnancy include poverty, deprivation, ethnicity and refugee status. Drug and alcohol misuse, poor nutrition and obesity also have harmful effects. Reports in the 1930s included information on social circumstances of the women who died but early CEMD Reports contained virtually none. In 1977 the Labour government commissioned an enquiry by Sir Douglas Black into social determinants of health but in 1980 the Black Report was all but suppressed by the new Conservative government. In the 1990s further reports appeared at a time when the future of the CEMD was in doubt because of its focus on clinical care. In 1994-6 the scope of the Enquiries broadened. The Reports stopped blaming women and focussed on barriers to accessing care. Shockingly the Enquiries revealed that mortality rates were much higher in deprived areas and among ethnic minorities, particularly Black women.The data stimulated a raft of well-meaning NHS initiatives but the lofty policy declarations remained disconnected from reality. In 2016-18 three quarters of women who died had pre-existing medical or mental health conditions and 90% were in some measure socially vulnerable.