Recent Mothers and Babies: Reducing Risk through Audits and Confidential Enquires across the UK ( MBRACCE-UK) reports state that Black women are four times more likely to die from pregnancy related complications than their White counterparts. A statistic known since the 1970’s, yet we have seen very little improvement in this reality for Black women from then to present day.
But death is only the tip of the iceberg and a low bar. The World Health Organisation estimates, for every woman dying during childbirth, there are another 20-30 cases of “near misses”. These “near misses” are women who may experience life-altering or life-threatening health challenges due to a mismanaged or the unexpected result of childbirth. Furthermore, Black women are also more likely to experience discrimination and disrespectful care during their pregnancies and childbirth.
You might be wondering, why is this happening to Black women? Many assume that these disparities are due to biological differences. However, there is no evidence to support these claims. There isn’t a physical difference in the Black body that makes them have poorer outcomes, after all, this unfortunate trend is only seen in White majority countries.
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Another answer is the compound effects of social and cultural constructs such as classism, ableism, heterosexism among others, which create societal advantages or disadvantages for people. But these social constructs affect all people regardless of their race, therefore, it can’t be the only explanation. This brings us to a hard truth, one that evidence over the last few decades has brought to light. It is not about biology—it is about bias. A major cause for these poorer birthing outcomes between Black and White women is structural racism.
Structural racism is a public health challenge, and a cause of health inequalities across the UK. It can be simply described as institutional and social systems that create disadvantages for people based on their race or ethnicity. Structural racism is on the macro-level and causes harm to many because of the colour of their skin.
The NHS is not immune to this phenomenon, there are many documented examples of policies, processes, and systems within the NHS that result in poorer health outcomes for those within these communities, this was particularly noticeable during COVID19 and resulted in the formation of the expert group on Covid19 and ethnicity by the Scottish Government. Unfortunately, those that perpetuate these may not be aware of its impact and may contribute to it unknowingly- or worse be trained to do so.
The recent report by Nothing About Us Without Us (NAUWU) an initiative to improve pregnancy and birthing experiences and outcomes for Black women and birthing people in Scotland. Is supported by KWISA Woman of African Heritage (a community led advocacy organisation dedicated to improving the lived experiences of women of African heritage in Scotland), in partnership with NHS Lothian Maternity Voices Partnership in Edinburgh. This report offers a roadmap and a clear call to action for positive change in maternal health disparities.
Through courageous community engagement and collaborative research, they have given Black women the platform they deserve to share their experiences and influence policies that affect their health.
Last December NAUWU launched a report from their collaborative research which highlighted the experiences of women of African and Caribbean Heritage with NHS maternity services. The NAUWU collective consists of women with diverse levels of expertise with the health and social care system as well as lived expertise of existing as women of Black, African Caribbean heritage.
This group conducted community events and workshops allowing Black women to discuss their experiences. These workshops were held at community centres around Edinburgh where key stakeholders communed for various events and services. Participants had a mixture of positive and negative experiences with care services, but overwhelmingly most agreed some areas needed to be improved.
While some of the women felt they were listened to, other women conveyed how they felt ignored, and had concerns about how easily their pain and discomfort were dismissed by NHS service providers. The dismissal of Black women’s pain can be historically found throughout accounts of racism in medical practice and is well cited in academic studies. The wrongful assumption is that Black people are able to endure more pain than their White counterparts.
Participants also shared stories where jaundice and new-born vital signs were incorrectly recorded, indicating some additional education is needed to improve cultural awareness among service providers. Participants felt that adverse outcomes and experiences of Black women with the NHS was due to the system not being suited to meet the needs of the women of African and Caribbean heritage.
The NAUWU findings echo findings from published research, AMMA Birth Report and FiveXMore Black Maternal Health Survey. It is time to stop describing disparities and instead act collaboratively to reverse them.
Therefore, based on common themes identified in the extensive community listening exercise, the collective identified some key recommendations for NHS Lothian Health board:
- Provide enhanced perinatal care and specific support for Women of African and Caribbean Heritage (WACH)
- Increase Consistency of maternity staff knowledge, awareness, and competence through specific training
- Improve service systems to track and eliminate minority ethnic disparities
But change requires all of us.
As members of the Scottish community, as healthcare professionals, policymakers, and citizens, we must rally around these recommendations and hold our systems accountable.
We must advocate for mandatory cultural awareness training for healthcare staff. Demand consistent, equitable maternity care that centres the experiences of Black women.
Black women deserve more than survival; they deserve dignity, respect, and the confidence that they will be cared for with the same urgency as any other woman.
Scotland has an opportunity to lead in addressing these disparities. Let us not look back in regret for failing to act. Together, we can create a healthcare system where no woman’s life is at risk simply because of the colour of her skin.
- Dr Kizanne James, is a multi-award winning, renowned physician and Chevening Scholar and leader in healthcare access for marginalized communities. She is writing as a representative of KWISA.