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Gender and Race Inequality in the NHS: Maternal Care

The British National Health Service (NHS) is renowned for its expert care and quality service since it was founded in July 1948. Its establishment, and its expert staff, have saved the lives of millions of people both from the UK and abroad. However, in recent years there have been notable flaws in the system regarding maternal health care. The UK has one of the lowest maternal mortality rates in the world [1]. Yet, this publicly funded healthcare system has come under scrutiny for the glaring and shocking disparities in the maternal outcomes for women depending on their ethnicity [2]. This issue is not exclusive to the UK; in the US there are stark racial disparities in maternal and infant health care which have persisted for decades, despite advancements in healthcare, and the spread of awareness on these issues [3]. These disparities and experiences of black and ethnic minority women have been known to us for over twenty years, yet little action has been taken to improve the maternity care for these women.


Statistics

Considerable data has been collected over the last two decades and extensive research has found that black and ethnic minority mothers face major issues with NHS services when falling pregnant, during childbirth and post-partum. Drawing attention to the issue of childbirth, studies have confirmed that out of more than two million women giving birth between 2018 and 2020, 229 died in childbirth [4]. However, the BBC has found that death rates vary according to ethnicity:


  • 34 per 100,000 for Black women;

  • 16 per 100,000 for Asian women;

  • 9 per 100,000 for White women;

  • 8 per 100,000 for Chinese women. [5]


These figures demonstrate a serious issue in maternity care which needs to be rectified. Further research has revealed that these inequalities are created by systemic bias and the unequal treatment of, and thus poorer services provided for, non-white women.


Furthermore, black mothers are nearly four times more likely than white mothers to die within six weeks of giving birth, and Asian women are 1.8 times more likely [6]. There are also notable socioeconomic differences: women from the poorest areas of the country, where a higher proportion of babies belonging to ethnic minorities are born, are twice as likely to die than those from the richest [7]


Causes

The unfair treatment experienced by black and other ethnic minority women before, during and after pregnancy is no coincidence and this comes down to a multitude of reasons. Underlying socioeconomic factors like education, unemployment and poverty are clear factors contributing to healthcare inequalities [8]. The Women and Equalities Committee report notes that structural racism in the UK has also played a key role in creating health disparities [9]. Consequently, this racism trickles into all areas of society, impacting the daily experiences of non-white individuals in multiple sectors and institutions.


As mentioned above, black women are the most likely ethnic group to die within six weeks of childbirth. This immediately informs us that these women are the prime targets and thus victims of racial abuse and neglect when seeking maternal care. For example, a black mother, Sandra Igwe spoke to the BBC about the traumatic births of her two daughters, stating that on both occasions she was not listened to and that those caring for her “didn’t believe I was in pain” [10]. This example is just one of the multiple unacceptable and shameful encounters black mothers deal with when receiving maternal ‘care’ from the NHS. The British Medical Associations Report found that there also exists ethnicity-based discrimination in the private sector, with white patients more likely to receive NHS-funded care delivered by the independent sector than those from other ethnicities [11].


This treatment is more common than one may think and many individuals from non-white families will have at least one family member who has experienced neglect from maternity care professionals. For instance, my family is of Jamaican descent and in 2009, upon the birth of her first child, my older cousin slid into a coma due to excessive blood loss and improper care from midwives post-partum. She was not listened to by healthcare professionals, and consequently, her life hung in the balance. Thankfully, she made a miraculous recovery, however, the lack of communication, and disregard of her personal needs and concerns placed her in grave danger after giving birth.


Consequences

Though it must be acknowledged that some black and ethnic minority women have experienced positive relationships with their midwives, the British Medical Journal (BMJ) has noted that this group does not represent the experiences of the majority of non-white expecting mothers [12]. The overall review of maternal healthcare found much evidence of negative interactions, stereotyping, disrespect, discrimination and cultural insensitivity, resulting in these women from ethnic minority groups feeling “othered”, unwelcome and poorly cared for [13]. This results in poor health, increased risk of death post-partum, minimal or no trust in the NHS and in the long term, fears to expand family size thus potentially impacting relationships in the domestic sphere. 


Next Steps

There is no shortage of information on the inequalities faced by non-white women when encountering the NHS, especially when it comes to maternity. As a society we must all come together to take the necessary action to reduce the unequal treatment, stereotyping and poor communication experienced by black and ethnic minority mothers before, during and after pregnancy. There are multiple solutions to move forward and help these women who are facing unequal treatment, and to pave the way for the future generation of non-white mothers:


  1. Raising Awareness - people need to be made aware of the reasons behind racial disparity in maternal care instead of just knowing it exists. These disparities, need to continue to be voiced to encourage change and educate the coming generations. Once the reason behind these disparities is apparent people will have a better understanding and will advocate for change.

  2. Individualised Approach - Women should have more options available to them when it comes to maternity care. A ‘one-size fits all’ approach will not work for black and minority ethnic mothers. A more personalised, effective and respectful approach is needed.

  3. Better Communication - health care professionals need to communicate more efficiently with black and minority ethnic mothers to better understand their needs. Making assumptions and conforming to stereotypes is not acceptable. For those women whose first language is not English, they should have access to interpretation services to ensure they achieve optimal maternity care, and a proper understanding is reached between the mother and their midwife/doctor.

  4. Training - The NHS is severely understaffed and the issue surrounding unequal healthcare cannot improve unless there are more midwives. To ensure this is possible more training and placements are needed. Also, it would be beneficial for those who are already qualified to take up extra training to tackle this issue as this would encourage the problem to be taken more serious by staff as well as encourage improved treatments and care plans. 

  5. Collecting Data - To track the rate of progress being made data needs to continue to be collected. Having written evidence will also help to build a case should there be minimal, or no progress being made and helps to chart improvements made over time. 


Written by Zanté Hylton, Thrive Research Hub Member


 

References


[1] House of Commons Women and Equalities Committee, ‘Black Maternal health’, Third Report Session 2022-2023. Available online here.

[2] ibid

[3] Latoya Hill, Samantha Artiga and Usha Ranji, ‘Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them’, November, 2022. Available online here.

[4] BBC News, End Racial Disparities in Maternal Deaths- MPs, April 2023. Available online here.

[5] ibid

[6] ibid

[7] ibid

[8] British Medical Association (BMA), Race Inequalities and Ethnic Disparities in Healthcare. Available online here.

[9] BBC News, End Racial Disparities in Maternal Deaths- MPs, April 2023. Available online here.

[10] ibid

[11] Anya Devaja, “Health Inequalities: the unintended consequences of private healthcare policy?”, The Bulletin of the Royal College of Surgeons of England, vol 5, no. 6, 2023. Available online here.

[12] BMJ 2022;376:o382 , Racial Health Inequality is Stark and Requires Concerted Action, Says Review, February 2022. Available online here.

[13] ibid



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