At a time when racial inequality across society is under such scrutiny, getting to the heart of why Black women in the UK are five times more likely to die in pregnancy, birth or postnatally than white women should be a priority.
People from BAME backgrounds like mine are more likely to die from Covid-19, more likely to be sectioned in a mental health crisis, and less likely to receive adequate cancer pain medication than their white counterparts. A recent study showed that over half of all pregnant women admitted to hospital with Covid-19 were from BAME backgrounds. Babies born to Black parents have a 67% higher chance of dying than babies born to white parents.
This cannot be a coincidence, neither can it be solely dependent on biological factors. As a midwife of colour, every one of these statistics is just saddening. Not just the stats themselves – but that they have not improved over the years and in fact only seem to be getting worse.
So, why the disparities? We don’t really know for sure. But the vast discrepancies points towards elements of racial bias within maternity care. Elements that I myself have been privy to time and time again.
I qualified as a midwife back in 2009, and since cared for women around London in all maternity settings. My passion for caring and supporting women through pregnancy and birth has always been fuelled by wanting to make a difference to a person’s birth experience and to help them achieve the positive birth they deserve.
“Why the disparities? We don’t really know for sure. But the vast discrepancies points towards elements of racial bias within maternity care.”
In my early days of midwifery there was little awareness of the risks Black women faced – but I first began to notice evidence of racial bias In 2004, working as a maternity support worker in a hospital situated in a predominantly white area, and reading Culture, Religion & Childbearing in a Multiracial Society: A Handbook for Health Professionals for a course. Discussing the book, my colleague turned to me and said: “I won’t need to get this book, the majority of women who give birth in this hospital are white.” I sighed in disbelief – especially as I myself had given birth in that hospital not four years earlier.
That was my first experience of the disregard for ethnic minorities in my workplace. When I graduated, I worked in that same hospital for a few years before moving on to another in a more culturally diverse area. There, I thought things would be different, that perhaps the hospital would be more geared up to caring for women from ethnic minorities as they made up a large proportion of the local population. I was wrong.
While the vast majority of the healthcare staff were fantastic, supportive and caring to women, there were still trickles of racism that seeped deep into the maternity system. There were midwives who preferred to carry out community visits in the whiter, middle class areas further away, as opposed to the more culturally diverse, denser areas closer to the hospital. Staff would make subtle jokes about how certain patients smelled, how loud the women were or not explaining things to them properly as “they probably won’t understand anyway”.
“Every woman needs to know that they have the support and understanding of their midwife.”
Women were often lumped together in a ‘one size fits all’ category, not taking into account the variations in the size of women, length of pregnancy, pelvic shape and other factors that often vary between ethnicity. In the maternity sector, women are often measured against charts and values that are devised from that of a typical Caucasian female. For example Asian women should potentially have their BMI recorded under a different method of charting. This can make a difference as to whether a woman is classified as overweight (and therefore more at risk of complications) or not.
So, how do we meaningfully change these statistics? It starts by delving deeper into each case of BAME women that die, and committing to getting to the bottom of why this might be happening.
Every woman needs to know that they have the support and understanding of their midwife. They need to be able to raise a concern without fear of being brushed off and not listened to. But the problem doesn’t lay solely on the shoulders of the healthcare professionals and their mindset though. There needs to be more training available to healthcare staff that highlight the risks that women from the BAME community suffer when pregnant and that helps them to provide better care. If there are biological factors contributing to this higher risk, healthcare professionals need to take this into consideration when planning and executing personalised maternity care.
When I think of the women this will help, I think of my own daughter. When she is older and has a baby of her own, I want to be able to celebrate the birth of my future grandchild with her. I want to know Black girls like my daughter will always return home alive and well.
Marley Hall is a midwife, speaker, and mother of five. Follow her on Instagram at @midwifemarley
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