In 2010 the Equality and Human Rights Commission (EHRC) report noted (among other things) the disparity of maternal outcomes between white women and women from ethnic minorities, in particular, that asylum seekers of African descent were seven times more likely to die in childbirth.
Therefore, it is dispiriting to learn that in the intervening ten years, the statistics continue to show that black women remain at much greater risk of dying when giving birth than white women. According to the MBRACCE-UK: Saving Lives, Improving Mothers' Care 2020 report: “There remains a more than four-fold difference in maternal mortality rates amongst women from Black ethnic backgrounds and an almost two-fold difference amongst women from Asian ethnic backgrounds compared to white women, emphasising the need for a continued focus on action to address these disparities.”
Channel 4 Despatches highlights inequality
This inequality of outcome was the subject of a recent Channel 4 Despatches documentary, Black Maternity Scandal, where black women recounted their experiences of being pregnant and giving birth. Their testimonies were delivered against a backdrop of evidence gathered by the campaigning group, 5 X More, and MBRACCE-UK, the organisation that compiles and analyses maternity statistics in the UK and Ireland. This is an issue that is gathering pace: in 2020 5 X More gathered 187,579 signatures for a petition calling for better maternity outcomes for black women (which will be debated in the House of Commons on 19 April 2021). At the same time, the Parliamentary Joint Committee on Human Rights considered the disparity in maternity outcomes between black and white women as part of a review entitled ‘Black people, racism, and human rights’.
Various reasons have been cited why the maternal outcomes for black women are so poor relative to those for white women, although none to date are conclusive. Indeed, Professor Jacqueline Dunkley-Bent, Chief Midwifery Officer, who was called before the parliamentary committee to give evidence noted that: “I am still not confident that we know why there is an inequality in health outcomes between a black woman and a white woman. We have plausible explanations and the evidence on comorbidities is compelling, but there is something more.”
Continuity of care builds trust
It is acknowledged the maternal outcomes for disadvantaged and vulnerable women are generally worse than for other groups and a disproportionate number of black women fall into this category. Although no single solution has been identified to help these women, Professor Dunkley-Bent considers that providing women with continuity of care throughout their pregnancy and the birth would be a significant step in the right direction; such continuity builds trust, enabling women to be more confident about revealing aspects of their lives that might contribute to a poor outcome such as mental health, domestic abuse and substance abuse. An ongoing relationship with their midwife also encourages them to discuss any concerns about their pregnancy in the knowledge they will be taken seriously. Additionally, in the spirit of the NHS ‘Better Births’ initiative that highlights the importance, not only of continuity of care but also of locally-led initiatives, Newham Hospital in London is holding a weekly pregnancy support group, delivered by BAME midwives, which gives BAME women a forum in which to discuss their experiences and which, according to Despatches, is already helping to deliver a better standard of care.
Equality of outcome is a human right
Nonetheless, it is clear that too many ordinary black women, who are neither disadvantaged nor vulnerable, and quite capable of speaking up, have had harrowing experiences of childbirth. Their testimonies aired on Channel 4 Despatches described a catalogue of failures including not being listened to throughout their pregnancy and during childbirth, and experiencing hostility in the labour ward towards both them and their partner. Although the NHS remains one of the safest healthcare systems in the world, every unnecessary death is one too many and all women have a right to be treated equally regardless of ethnicity or background. The very fact that this is an acknowledged problem that needs answers – and quickly - is the first step in the right direction. Hopefully other hospitals will follow where Newham is leading, and start ensuring that outcomes are equal for all.