According to the Care Quality Commission, who in 2022 published their annual assessment of health and social care, mortality rates are considerably higher for women from ethnic minority backgrounds. Their findings also revealed that women from ethnic minority backgrounds are more likely to be re-admitted into hospital following giving birth.
In more recent findings in 2023, the ONS (OFFICE for National Statistics) revealed that black babies stillborn rates are at almost twice the rate of white babies.
Tinuke Awe, the co-founder of Five X More, a campaign group to improve black maternal health, said the figures divulged by the ONS were not a surprise. She said:
“We know that these numbers have been higher for black women and their babies for decades now, that’s why it’s not a surprise to us. The data has been there for a while. It’s just a shame that it’s going up instead of going down”.
Clotilde Rebecca Abe, also a co-founder of Five X More, said the figures highlighted that little was known about the causes of the disparities:
“We need to find the root of the issue. I want to know, in terms of stillbirth, why are black babies dying more? And what are the causes behind it? Are black babies dying from the same thing that white babies are dying from? What are the causes of this? Should we be looking at the mother’s history and the mother as well? Is it because black women aren’t being listened to? So when they say reduced fetal movements and things should be done, is it not getting done on time? Are they having traumatic births? Is it because they are having rushed C-sections? What is the issue that is affecting the child? Is it a condition that the mother had that went undiagnosed during a pregnancy? What exactly is it?”
These concerning 2022-23 findings echo a previous report published by MBRRACE in 2018, which revealed that black women are five times more likely, and Asian women twice as likely, to die in the perinatal period than white women. In a more recent report by MBRRACE in 2022, the organisation divulged that these stark disparities in maternal mortality rates remain.
In response to MBRRACE’s most recent 2022 findings, Birthrights has pleaded for a collective effort to devise a solution that would achieve racial equality. However, the recent move by the Secretary of State for Health & Social Care to scrap the Government’s long-promised white paper on health inequalities, significantly undermines such a vision.
Despite this unfortunate setback, in February 2022, the Minister for Patient Safety and Primary Care amongst others joined forces to formulate a taskforce that intended to explore inequalities in maternity care and identify how the UK Government can improve outcomes for women from ethnic minority communities. Although, it remains to be seen what impact this will have, it has received a positive reception.
For instance, Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists (RCOG) supports this new taskforce. He said:
“We strongly welcome this new Maternity Disparities Taskforce, which will aim to tackle the unacceptable inequalities that exist for women from black, Asian and minority ethnic backgrounds when it comes to maternity outcomes.
The colour of someone’s skin should never dictate whether they have a positive or negative birth experience. The RCOG’s Race Equality Taskforce is committed to working with this new taskforce to understand why these disparities exist and create meaningful solutions to improve healthcare experiences and outcomes for all ethnic minority women”.
Commenting, the Royal College of Midwives (RCM) Director for Professional Midwifery, Mary Ross- Davie said;
“The disparities in outcomes and experience of maternity care for black and Asian women and women from other ethnic minority backgrounds are shocking, so the RCM welcomes the creation of the Maternity Disparities Taskforce and is keen to be part of the work in finding solutions. The RCM has long called for more consultant and specialist midwife posts in trusts and health boards to provide better support to women with pre-existing conditions such as increased BMI, high blood pressure, diabetes, and mental health conditions. In many parts of the UK, these midwife roles either do not exist or are very limited, yet they could make a huge difference to black and Asian women in particular.
There is some excellent work being done in some areas, so it would be good to see that experience shared across maternity services. Improvement of outcomes relies on sharing what works and what doesn’t, so that we can bring about effective, consistent change. We look forward to working with colleagues on the taskforce to highlight the current problems and find ways to address them in a positive way.”
To support maternity staff and families further, the NHS is increasing the maternity workforce further with a £95 million recruitment drive to hire 1,200 more midwives and 100 obstetricians.
Nevertheless this is a significant feat, given Birthrights itself produced a report in May 2022 on racial inequalities within NHS maternity care titled “Systemic racism, not broken bodies” which investigated the perspectives of over 300 brown, black and mixed ethnicity women. In doing so, they uncovered some common and utterly unacceptable themes of experiences of women, including:
- a lack of physical and psychological safety;
- being ignored and disbelieved;
- racism by caregivers;
- a lack of choice, consent, and coercion;
- structural barriers;
- workforce representation and culture.
These are findings which are echoed by Five X More, who also in May 2022 published a survey which also explored the experiences of maternity care of more than 1,300 women from ethnic minority backgrounds. Their findings, like Birthrights’s, revealed that a high proportion (43%) of ethnic women felt that their race impacted the care they received.
Moreover, Birthrights also found that stillbirth rates in babies of black and black British ethnicity were more than twice for white babies. These are findings which have been supported by the RCM (Royal College of Midwives) who also are rallying for urgent attention to address the high levels of racism in the NHS.
Further, the report produced by Birthrights details upsetting case studies such as jaundice not being detected in a black baby, resulting in the baby suffering brain damage. Another case involved a baby suffering a brain injury due to hypoglycaemia (low blood sugar), caused by a lack of feeding support and information for a non-English speaking mother; the NHS failed to arrange interpretation services either antenatally or postnatally to ensure the safety of both the mother and her baby.
Indeed, the lack of interpretation services has been reported just this week by HSIB (Health Safety Investigation Branch) for a mother who died at Gloucestershire Royal Hospital in 2021 after suffering a post-partum bleed. Ms Abdelkarim was Sudanese and spoke little English, she did not have the support of an interpreter and suffered from language barriers at her ante natal appointments and didn’t appreciate that she was sent to hospital for induction and did not give proper consent to that procedure.
In the conclusion of its report, Birthrights called on the UK Government and NHS to recognise the role that racism plays in dire outcomes for brown, black and mixed ethnicity women.