Five X More report on maternity care highlights embedded racism and inequality
Responding to the 2020 report by MBRRACE investigating UK maternal deaths that highlighted that black women have a fourfold higher risk of dying in pregnancy compared to a white woman, Five X More began its campaign to improve maternal outcomes for Black and Black mixed women nationwide.
This week, Five X More published the findings of its report reacting to a survey asking black women about their experiences of maternity care in the UK.
What emerged was deeply embedded racism and racial inequality within maternity care, perpetuated both by individual clinicians and systemically by NHS maternity services. While some such interactions left women with the uncomfortable feeling of discrimination, others undoubtedly contributed to serious harm.
Statistics on the disproportionate maternal death rate facing Black and Black mixed women illustrate discriminatory practice throughout all stages of maternal care, but the majority of the women's stories referred to labour, birth and early postnatal experiences within inpatient maternity services.
It is within these settings that women most frequently described experiencing negative attitudes, assumptions and racialised knowledge-claims.
A reoccurring stereotype of the ‘strong Black woman’ sees women perceived as 'tough' and somehow better able to endure physical and emotional pain compared to white women, which affected attitudes to pain relief and is indicative of the continuous process of 'othering' – that Black bodies differ from the baseline of white women's. Forty-three percent of Black and Black mixed women reported that their pain relief options were not explained to them.
As a result, not only are women impacted clinically, causing more emergency outcomes, but Black and Black mixed women reported significant psychological impact, affecting their confidence, self-esteem and contributing to sadness and short and long-term anxiety, causing women to disengage and to -fear further pregnancies.
Describing their overall experience of healthcare professionals during pregnancy, 22% rated theirs as negative. On average, 27% of women surveyed felt that they received a poor or very poor standard of care during pregnancy, labour and post-natally. Of those that thought the standard of care was poor or very poor (16%) less than a quarter (23%) made a formal complaint, with women identifying as Black 10% less likely than Black mixed women to make a formal complaint to the hospital or Trust providing their care.
Black and Black mixed women’s reports of adverse experiences and dissatisfaction with treatment throughout and following pregnancy far outweighed the cases in which women stated that they were happy with the care that they received.
Five X More will continue to work towards highlighting racism and racial inequality within maternity care, specifically calling for:
- An annual maternity survey targeted specifically at Black women, similar to the CQC maternity survey that takes place annually every February
- Increased knowledge on identifying and diagnosing conditions that are specific to and disproportionately affect Black women
- Better quality of Ethnic coding in health records
- More community-based approaches to improve maternal outcomes
- An improved system for women to submit their feedback and/or complaints specifically for maternity
- Individuals involved in training health care professionals are aware of and appreciate the disparities in maternity outcome.