The risk of death or complications for BAME women in pregnancy and childbirth is much higher than for white women in the UK. But what are the reasons behind the problem?
For UK-born Asian women, maternity mortality rates are one and a half times higher than they are for white women in the UK. More shockingly still, black British maternity mortality rates are five times higher than for white women, and the babies of black British women are under threat from infant mortality rates which are twice as high as those of white children.
Maternity and infant mortality is tragic. The fact that it disproportionately affects BAME women is highly concerning, and deserves explanation. While the government has commissioned research from Oxford University into the causes and possible solutions, some possible reasons for this inequality have already been suggested, with Brexit and the state of the NHS a key concern.
The standards of care in the NHS are at risk following a drop in the number of EU migrants coming to work for the health services. 3500 midwifery jobs are empty at present; meanwhile last year 3000 midwives quit their jobs, largely due to unhappiness with understaffing and limited time to provide the care they want to be able to give. Last year, only 33 trained midwives moved to the UK from the EU, compared to previous years in which hundreds moved over annually. At a time when BAME women are already at much higher risk of maternity-related injury and mortality, this decrease in staffing and consequently in the standards of care in the NHS will directly hit the most vulnerable women.
There are biological reasons why black women may be more likely to experience complications in pregnancy and childbirth, such as the higher risk of preeclampsia. However, Candice Brathwaite, a black British mother, is one of many who expects racial prejudice could be an important reason for the high rates of maternal mortality for black women. In a blog post about her own experience and thoughts on the topic, she begins by addressing the issue that black women in the UK often only have access to information about what’s happening to African Americans in the US. Generally, the lack of information about black British experience is an obstacle to the understanding of black British experience, an issue also expressed by Reni Eddo-Lodge in her book Why I’m No Longer Talking to White People About Race. Brathwaite expresses relief that finally, UK statistics are being published for the sake of black women’s health.
Secondly, Brathwaite explains the presence of the myth that black women can somehow withstand more pain than others. She also noted a lack of empathy and meaningful listening from healthcare professionals, compared to the way she saw white mothers being treated. When she went into labour, she was told her verbal reactions to the pain were over the top; most women will recognise this down-playing of very real pain to ‘overreacting’ or being ‘over-emotional.’ In medical situations, this attitude and dismissal of women’s concerns can of course be very dangerous. After a C section, it took 5 days before her feeling that something ‘was not right’ before doctors and nurses actually took action to treat what had become a serious problem.
It was this experience that made Brathwaite want to speak out about the prejudice faced by black women in the healthcare system. She realised she was lucky, and that so many other women had died or suffered severe injuries because their concerns were not taken seriously due to race and gender stereotypes.
Until women of all ethnic origins are taken seriously in their concerns, and until there are enough NHS staff to take the time to really listen to their patients, women and particularly women of colour will be at risk of maternal mortality and complications in childbirth. Tragically, countless women have died avoidable deaths in the healthcare system due to these problems. It’s crucial to talk about these issues and make everyone, including prospective mothers and healthcare professionals themselves, aware of these risks.
The research being funded by the government will be used to inform future strategies, and plans are in place to improve the experience of BAME mothers. For example, by 2024, 75% of women from BAME communities should be getting continuity of care with their midwife. This can help to reduce premature birth and labour complications. This is a step in the right direction, but it is crucial to also take action to spread awareness of risks and change deeply ingrained social prejudices that lead to the different treatment of BAME women, and of women generally compared to men in the health system.
Here at JAN Trust we have been supporting women of all ethnic and religious backgrounds for 30 years now. Listening to women with an understanding of cultural differences and personal perspectives is invaluable, and in the field of medical care it can be lifesaving.
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