In March 2023, the Women and Equalities Committee published their sobering report on Black Maternal Health.
Following the horrifying statistic that black women are four times more likely to die in childbirth than white women, the committee identified reasons and suggested solutions.
Their report laid bare some of the biggest problems with the standard of maternal care in this country, including chronic underfunding, racism and knowledge gaps.
The analysis and conclusions make for difficult reading, but for black women and their families, it must be devastating and terrifying.
Let’s take a closer look at the report and its recommendations.
What we’ll be deep diving into:
- What are the causes of disparities in maternal care for black women?
- Racism and micro-aggressions in the maternity workforce
- Black women are struggling to be heard during pregnancy and childbirth
- The complex factors leading to black maternal morbidity
- The changes needed to address disparities
The mental toll on black mothers
Maternal health isn’t just about what happens physically during pregnancy – it encompasses mental wellbeing too.
At a time when you may be anxious about changes to your body or navigating a completely new experience, these statistics may increase fear and stress levels.
In a heartbreaking post for advocacy and activism group Five X More, mum Kate* shared her harrowing birth story and the impact on her mental health.
Kate wrote: “This whole experience has really made me depressed. I can no longer go out on my own I have to rely on my mum for everything.”
*Name was changed
What is causing the disparity in care for mothers of colour?
In their report, the committee identified several contributing factors to disparities in mortality rates for women of colour.
They include pre-existing conditions and co-morbidities, socio-economic factors and maternity care.
Statistics prove that Asian and mixed-race women also face a higher risk of dying during childbirth than white mothers.
In a searing opinion piece in The Guardian, author and journalist Candice Brathwaite spoke of her own experience of maternity care.
She said: “Black women are still too often struggling to be heard in healthcare settings. I have had two children and have seen these attitudes first-hand.
“If we want to make any meaningful change to maternal outcomes, we must first accept that these issues extend far beyond the maternity ward.”
Issues of Race in NHS maternity care
Dr Matthew Jolly, the National Clinical Director for the Maternity Review and Women’s Health at NHS England, told the committee that “there was a ‘growing insight’ that there were some areas where the NHS as an organisation could be considered ‘structurally racist’.”
According to Dr Jolly, the default for the understanding of women’s bodies is white European and recognising health conditions in babies was too “white-centric”.
As such, healthcare providers may have knowledge gaps when treating black, Asian or mixed-race mothers and their babies.
In his pivotal role in NHS England, Dr Jolly said he was committed to improving cultural competence, training and working with activism groups to ensure women’s voices are heard.
Where are care providers failing black mothers?
In November 2022, group MBRRACE-UK (Mother and Babies Reducing Risk through Audits and Confidential Enquiries) delivered their report on the commonalities of care received by black women who died during childbirth.
They found that healthcare staff often viewed black mothers as “not like me” and failed to consider their patients’ cultural and socio-economic backgrounds.
In doing so, they were unable to provide the person-centred, individual care these mothers needed, opting for a ‘one size fits all’ approach.
The report also said that the multiple and complex problems in the cases of the deceased mothers played a part because various parts of the maternity system didn’t communicate effectively to give them the required continuity of care.
It also found that microaggressions by health professionals were a factor in these tragic outcomes.
Why aren’t black women being heard?
In a survey by Five X More, 42% of black mothers said they felt discriminated against during their maternity care.
Anecdotal evidence supported claims that black women’s wishes were ignored during labour, they were subject to racist assumptions and had their legitimate concerns disregarded.
Founder Tinuke Awe called for significant change, saying: “One of the key messages from the campaign is that black women should be involved at every single level when it comes to decision-making about their care.”
Micro-aggressions, racism and gaps in care knowledge made for a dangerous combination that resulted in poor care and some fatal outcomes.
Maternal death disparity is a complex issue
Many factors contribute to these devastating black maternal morbidity outcomes.
The MBBRACE-UK report found that cardiac disease was the largest single indirect cause of death, with neurological causes in second.
The report concluded that thrombosis and thromboembolism were the leading direct cause of death during or up to six weeks after pregnancy.
Maternal mortality rates were highest among women who live in the most deprived areas.
The Women and Equalities Commission concluded, “The causes of the appalling disparity in maternal deaths are multiple, complex and still not fully understood.
“Fixating on any one cause risks over-simplifying the problem and placing blame on the very women who are most at risk.”
What can be done to redress the balance?
As Candice Brathwaite pointed out, “The UK is very good at producing reports, but in the meantime, black women are dying.”
The need for immediate change is vital, but can the Government and the NHS meet the moment?
Here’s a look at what the Black Maternal Health report suggested…
Training for the Maternity Workforce
There is no doubt that having comprehensive training to better understand racial disparities and how to mitigate them is fundamental to change.
The committee said, “The maternity workforce must be properly equipped to understand and recognise the significant disparities that exist and to use that knowledge to deliver personalised, effective and respectful care.”
They have called for organisations, including Health Education England, the National Midwifery Council, the Royal College of Midwives, and the Royal College of Obstetricians and Gynaecologists, to work together to deliver evidence-based training and professional development.
They want to ensure maternity health providers know how to “deliver culturally competent, personalised and evidence-based care.”
Continuity of care
Like any good relationship, communication and trust is absolutely fundamental.
Black mothers should be able to build trusted relationships with their health teams over multiple appointments.
Although the Government and NHS are committed to providing continuity of carers, this is often impossible due to the staffing shortages in services.
The committee believes that “a fully-staffed, properly funded maternity services workforce is fundamental to delivering safe, personalised care, and a pre-requisite to rolling out any measures to combat inequalities.”
Their recommendation is an increase of the maternity services budget of £200-350 million in the next financial year.
Whether that figure can be met in the Government budget is still unclear.
Black mothers should be able to build trusted relationships with their health teams
Collecting better data on black women
One issue for policymakers is that black women are underrepresented in research and data.
Without an equal level of participation, it’s more challenging to understand where the issues lie and to measure the impact of any policy change.
The committee has requested that the NHS, the Office for National Statistics and all relevant stakeholders need to minimise delays in delivering data and prioritise capturing ethnicity data.
They also said: “The Maternity Disparities Taskforce must ensure a minimum number of seats or spaces at each meeting is reserved for representatives of organisations run by and for black women.”
The campaign for change
Activist groups like Five X More and Birthrights are working tirelessly to make an impact and bring vital change to maternity services.
Their collaboration on this report with the Women and Equalities Committee can only be a good thing.
As a society, we need to demand change so our black and brown sisters get the maternity care they are entitled to, and change can impact these appalling statistics.
Many campaigners say that having more people of colour in all areas of maternity care would greatly help.
At Kari Health, we stand with those campaigners and demand that the Government takes the committee’s recommendations on board.
We must stop women of colour and their families from suffering in such a devastating and needless way.
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