The Guardian’s take on maternity care failings: Black women and babies hit hardest | Editorial
CChildbirth is a vulnerable time for any woman. Black women have particular reason to be anxious. Their births are almost twice as likely to be investigated for potential failings in the NHS, the Guardian revealed this week, with the head of the Royal College of Midwives (RCM), Gill Walton, blaming institutional racism. For every 1,000 black births, there were 2.3 investigations, compared with 1.3 for white women.
Black women are up to six times more likely to experience some of the most serious birth complications than their white counterparts and nearly four times more likely to die during pregnancy, childbirth, or postpartum, while Asian women are nearly twice as likely to die. Black babies are nearly twice as likely to die as white babies; Asian babies are also at greater risk.
These shocking statistics highlight the convergence of two problems: failings in maternity care and poorer health outcomes for black, Asian and minority ethnic communities. Although the UK has one of the lowest maternal mortality rates in the world, a recent report found that around one in three births are traumatic. The Care Quality Commission found that almost two-thirds of maternity units are not safe enough.
Factors may include poor administration; a hierarchical culture that makes it difficult for other staff to challenge consultants; mistrust between midwives and doctors; a lack of transparency; pressures on the NHS that make it difficult to retain experienced staff; and the prioritisation of vaginal births. Although hospitals were told to scrap targets aimed at reducing caesarean sections two years ago, many feel there is still a cultural bias.
These problems are not easy to solve, but could be alleviated if the health service listened better to women and provided them with clear information. Instead, the UK’s patient safety commissioner warned this month that women who raised concerns were often fobbed off or dismissed as “difficult” – a trope often attributed to black women in particular.
Black, Asian and other minority households are more likely to live in the most deprived areas than their white counterparts. But social and economic disadvantage is no adequate explanation of poorer outcomes. Donna Ockenden, the expert on pregnancy who is currently leading a review of services at Nottingham University Hospitals NHS Trust, told the Guardian that expectant mothers experience overtly discriminatory and racist treatment, including ridicule for their accents and refusal of interpreters. Black, Asian and minority ethnic women are more likely than white patients to report withholding adequate pain relief.
Broader issues of cultural competence also play a role. Medical staff may not be aware that some complications are more common in certain communities, or that symptoms may present differently. Textbooks still treat the white European body as the standard. Even pulse oximeters can be influenced due to skin pigmentation.
The Women and Equality Commission warned last year that the government and NHS had underestimated the role of racism in the failings of maternity care. The RCM has begun to decolonise the curriculum and Labour’s manifesto pledge to set an explicit target to close the gap between Black and Asian maternal mortality is welcome. Improving maternity services generally is essential. But to make them work for everyone, specific measures are needed and a willingness to acknowledge and tackle racism.