TThe fact that black mothers in England are almost twice as likely to have their births screened for potential NHS safety failings is shocking and unacceptable – but to me it’s not entirely surprising. As a co-founder of Five X More after my own stressful birth experience, i find these statistics to be very true. The higher screening rates among black mothers reflect a stark reality: black women and their babies in the uk face significantly greater risks during childbirth.
For every 1,000 births by black women, 2.3 are investigated, compared with 1.3 for white women, The Guardian found – figures that highlight the deep-rooted systemic problems in our health system. They are also four times more likely to die during pregnancy and childbirth, and are more likely to suffer serious complications than their white counterparts. Black babies in England are three times more likely to die than white babies and are also more likely to suffer brain damage. These are not isolated incidents, but part of a wider, systemic problem that demands urgent action.
My horrible experience with the birth of my son began with undetected preeclampsia, a condition that carries serious risks for both mother and baby. Despite showing clear signs throughout my pregnancy, my condition was not detected until very late, leading to my being induced. The labor itself was extremely difficult; everything happened quickly and I was in severe pain and vomiting. When I alerted the midwives, I was discharged and told that it would be 24 hours before the induction would begin. It was almost too late before they realized that my contractions had progressed significantly and that I was close to giving birth. Throughout this ordeal, I felt unheard and unable to speak up for myself when I needed the most support.
The underlying cause of these disparities is not just individual bias, but also institutional failures. A 2016 study found that white medical students held false beliefs about biological differences between black and white people, leading to significant racial bias in pain perception and treatment. These misconceptions contribute to the systematic undertreatment of pain in Black patients compared to their white counterparts. This is just one example of how entrenched biases can lead to poorer health outcomes for Black women.
More recently, our Five X More Report on the experiences of black women highlighted that Black women continue to face significant disparities in maternal health care, with many feeling unheard and ignored by health care professionals. These negative experiences were found to fit within a framework of three interrelated constructs that revolve around the attitudes, knowledge, and assumptions of health care professionals.
Attitudes included the use of offensive and discriminatory language and the dismissal of concerns. Knowledge referred to a poor understanding of the anatomy and physiology of black women and the clinical presentation of conditions in their infants. Assumptions included race-based beliefs about black women’s pain tolerance, education level, and relationship status.
Unfortunately, stereotypes persist that Black women are uneducated and from lower socioeconomic backgrounds, which I believe leads to disparities in their treatment. However, our Black Maternity Experiences report refutes these stereotypes. The majority of respondents who reported poor experiences were qualified or above, earned above the national average salary, and were in a relationship at the time of their pregnancy. This evidence clearly shows that education and economic status do not protect Black women from systemic bias and mistreatment in maternal health care. It underscores the need for comprehensive reforms to address these deep-seated biases and ensure equal care for all mothers, regardless of race or socioeconomic status.
For pregnant women who are concerned about these differences, there are proactive steps you can take. First, know your rights and the standards of care you can expect. Speak up if something doesn’t feel right and don’t hesitate to seek a second opinion. Bringing someone with you to appointments can provide additional support, and documenting your interactions with healthcare providers can be crucial if you need to escalate your concerns. Reporting incidents of discrimination or inadequate care through the appropriate channels is also essential to effecting change.
While we are grateful to play a part in making a difference to women’s lives through our free resources and campaigns to change positions in parliament, systemic change is essential. Healthcare professionals need better training to recognise and address their biases, and there needs to be comprehensive data collection to fully understand and address these disparities. Given the findings of our report, we recommend implementing an annual pregnancy survey specifically targeting black women; increasing knowledge about identifying and diagnosing conditions that disproportionately affect black women; and improving the quality of ethnic coding in medical records, as not all trusts and hospitals currently use the same codes to collect data.. More community-based approaches, such as working with grassroots organisations that are closer to those who are underserved, should be used to improve outcomes for mothers. In addition, there should be an improved system in the NHS for women to submit their feedback and complaints about maternity care.
The urgency to address these issues cannot be overstated. We must take action now to prevent more mothers and babies from suffering from systemic bias. When we implement changes that specifically address the disparities Black women face in maternal health care, we improve the system for all women. With collective effort and dedication, we can hope for a future where health care outcomes are equal for all mothers, regardless of race.
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Tinuke Awe is the co-founder of Five X More, an organisation that campaigns for black maternal health in the UK. This article was co-written by its co-founder, Clotilde Abe
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