Championing racial equality in maternal care
By Integrated Care Journal-
Tracey Bignall, Senior Policy and Practice Officer at the Race Equality Foundation about racial disparities within maternal healthcare.
In 2020, MBRRACE UK found that black women are four times more likely to die in childbirth than white women.The statistic has hardly changed from that of past reports. “There is consistent evidence that women within the black, Asian and minority ethnic (BAME) communities are suffering from poor maternal health. Local and national data says the same thing every time. ”
MMBRACE UK runs reports every two years, and the last reports identify poor experience primarily for black and Asian women. Tracey says “Asian women are twice as likely to die during the maternity period, but the report doesn’t necessarily identify why this is happening. ” There are high levels of mortality among women born abroad, especially in countries with a high black or Asian population such as Pakistan and Nigeria.
What is more, findings published in the British Medical Journal Professor Marian Knight highlighted that 50 percent of pregnant women admitted with Covid-19 during the first wave of the pandemic were from the BAME communities.This has led to further outcries on what needs to be done to tackle the poorer health outcomes for BAME women.
Structural racism is embedded within maternity services
Racial stereotypes present a huge problem when dealing with pain management. ‘There is this perception that black women have higher pain thresholds,’ Tracey argues, ‘racial stereotypes around black women being strong are ingrained. In the same way, there is a perception around South East Asian women that there will be an extended family ready to shoulder the burden of having a child. ’
Despite having access to one of the best maternal healthcare systems in the world, ‘there are numerous stories of black women being ignored when asking for pain relief, because the assumption is that the pain is not as severe as what is being suggested. ’ Poor and traumatic experiences are the result.
Tracey says that BAME women often feel disrespected, not listened to and in some cases, simply ignored when giving birth. Intersectional links are also important. Due to structural racism, women from BAME communities are more likely to live in areas of deprivation, making quality maternity services even more crucial. ‘I would argue when you are providing a service, you have to look at the wider inequalities. Whether that is the case with maternity care is questionable. ’
Access is a problem. ‘Many women have difficulty in accessing services. For ethnic minorities such as Roma or Traveller women, receiving continuous care is difficult. ’ Shockingly, Tracey says ‘some women are even refused maternity services because they have been unable to register with a GP due to immigration status. ’ There are issues around women from ethnic minority backgrounds not attending ante-natal clinics early enough. ‘But when you have a poor experience with any healthcare professional you would be reluctant to engage again. ’
Communication is also an issue. ‘We have done work in the past to ensure women know they have choices when it comes to the birth of their child. Speaking to Somali women or Albanian women, very few were actually aware that there was a choice at all. It is about how messages are filtered down. ’
One in ten British people do not have English as a first language.3 Despite the NHS commitments to provide necessary medical information in different languages, maternity language support interpreters are scant. ‘It should be a matter of course for women who need them. For women whose grasp of English is poor, how can we be confident that these women are really understanding what is being said so they can make informed choices? ’
Poor experiences across the board have created a civil movement among women themselves. ‘Women themselves really want to do something about this. Movements have been set up. There is more media coverage of black women supporting other black women through their maternity period. ’
Civil movements: women supporting each other
FIVEXMORE is one example. Launched in response to high mortality rates referenced above, the campaign is calling on those in power to change the outcomes for black women.
‘But it’s shocking that these organisations have to exist because the health sector and the NHS isn’t responding quickly enough to address these disparities. Grassroots organisations cannot make the structural change needed. ’
In April of last year, The Race Equality Foundation ran an event in partnership with Maternity Action, a charity aimed at improving maternity care and outcomes for women. Covering issues around employment, the event exposed how many BAME women find it difficult to attend appointments, being on zero-hour contracts or working in shift jobs.
‘A day later, the Care Quality Commission released their annual State of Care report. We highlighted to them the need to assess some of the actions that should already be in place and how the Commission is addressing the disproportionality in terms of black women’s maternity experiences. ’
But what is being done beyond a grassroots level?
The NHS has been criticised in the past for treating equality within healthcare provision as a box-ticking exercise. Are systems in place to reverse the trend? ‘More needs to be done, definitely. Otherwise, we would not be in a position where black women are dying more than their white counterparts’ Tracey says, ‘overall, pregnancy and maternity in the UK is at a really good level. We don’t expect everyone to be satisfied all the time, but generally black women have a really poor service. ’
The NHS Long Term Plan makes a commitment to achieving race equality, ‘but at some level there needs to be a facility where women themselves are listened to. Co-producing services is the key,’ Tracey suggests.
Maternity Voices Partnership is an NHS working group aimed at ensuring women, midwives and commissioners work together to improve maternity experiences. ‘But it is questionable how many women from BAME backgrounds are involved, are the right voices being heard? ’
Much more must be done to ensure the four times more statistic decreases. However, it is clear our ability to decrease it will only begin when we begin valuing the lived experiences of BAME mothers, and the vital wisdom they can bring in ensuring maternal care is fair for all.
Public Policy Projects is exploring health inequality in more depth in its State of the Globe report A Women's Health Agenda: Redressing the Balance. For more information, please contact firstname.lastname@example.org
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