For decades, research has demonstrated how black, Asian and mixed-ethnicity women are more likely to experience baby loss, become seriously ill and have worse experiences of care in pregnancy and childbirth compared to white women. Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) publishes stark findings every year, with each report more shocking than the one before. The organisation’s previous report, published in November 2020, demonstrated how black women were four times more likely to die in pregnancy and childbirth, while it was two times more likely for mixed-ethnicity women and almost twice as likely for Asian women.
For too long, explanations for racial inequities in maternal outcomes have focused on black and brown bodies being the problem – regarding them as “defective”, “other” and a risk to be managed.
The starting point for a year-long inquiry by Birthrights, a childbirth charity, was that systemic racism exists in the UK and in public services. We set out to understand how it manifests within maternity care and to drive action to end it. Our subsequent report of findings – titled Systemic Racism, Not Broken Bodies – uncovers the stories behind the statistics and demonstrates that racism is at the root of many inequities in maternity outcomes and experiences. This is an urgent human rights issue and urgent action must be taken to address it.
In evidence given to the inquiry, which was supported by law firm Leigh Day, black, brown and mixed-ethnicity women and birthing people reported racism, microaggressions and harmful cultural assumptions from their caregivers, as well as coercion, incidents of physical and psychological harm, and lack of choice and informed consent.
We heard how black, brown and mixed-ethnicity people are subject to dehumanisation in maternity care, manifested by disrespect, rudeness and lack of empathy that breaches basic human rights principles of dignity and respect. The feeling of not being seen as an individual, or even as human, can act as a significant barrier to accessing maternity care, further entrenching the inequalities seen in outcomes and patient experiences, and causing long-lasting trauma.
We heard that many felt unsafe during maternity care. Two-thirds of people who shared their stories described not feeling safe some or all of the time; that racism and racial discrimination had a direct impact on their sense of safety. Human rights law protects the fundamental right to access safe, appropriate maternity care, which encompasses both physical and psychological safety. Yet existing research shows that black, Asian and mixed-ethnicity women experience far higher rates of unsafe outcomes, including death. Our evidence supports this research, showing that many black and brown people do not feel safe during their care, regardless of clinical outcome.
We received numerous accounts from people who felt their voices were not heard during their maternity care. Failing to listen to people, disbelieving and dismissing their concerns, constitutes a serious failure to meet the legal standards set out in the Human Rights Act. It is essential that caregivers establish respectful relationships with the people in their care and respond appropriately to their concerns.
We found serious and routine violations of the right to informed consent for black, brown and mixed-ethnicity people. The evidence showed that consent was not always sought for medical procedures, caregivers sometimes used coercion and obstetric violence, and there was a lack of choice about maternity care. These findings reveal a maternity service struggling to serve women, birthing people and families, or to support its staff. They are not unique to black, brown and mixed-ethnicity people’s experience, as we have seen from the Ockenden report into maternity services. However, they are even more dangerous when combined with systemic racism, as they reinforce inequalities and cement feelings among black, brown and mixed-ethnicity women and birthing people that they are unsafe within the maternity system.
But this didn’t all come from just women and birthing people.
Shockingly, testimony from healthcare professionals also reported a discriminatory culture that included a lack of representation at senior level – and prejudice, ignorance, thoughtlessness and racist stereotyping within the workforce. And women, healthcare professionals and lawyers all gave testimony about serious medical conditions – such as jaundice or sepsis – not being recognised due to skin colour, due to policies and curriculums that centre white bodies as the norm. Racism and discrimination deeply affects the maternity workforce on a personal and professional level, which has serious consequences for equitable and non-discriminatory provision of care to women and birthing people.
Black and brown women and birthing people’s safety, dignity, choice, autonomy and equality is in serious jeopardy. Racism is a fundamental violation of the right to be treated without discrimination, protected by both the Human Rights Act and the Equality Act 2010. As well as being unlawful, our evidence has suggested that racism plays a part in the inequalities in health outcomes for mothers and infants. Crucially, it is the persistent and prolonged exposure to microaggressions that causes harm.
We need urgent action at all levels as set out in our calls to action. We welcome the recent focus on maternal health disparities and the impact on the human rights of black and ethnic minority groups, as highlighted in the joint committee on human rights report Black People, Racism and Human Rights.
But the government, NHS initiatives and other policymakers must recognise the role that racism plays in the worst outcomes and experiences for black, brown and mixed-ethnicity women and birthing people.