Black women in the UK are four times more likely to die in pregnancy and childbirth than white women. The fact this figure has changed little in the two decades since the data started being published is nothing short of a scandal.
The Women and Equalities Committee report into black maternal health, released this week, made clear that the government and NHS have taken insufficient action to address these glaring inequalities, and failed to acknowledge the extent to which racism plays a role.
All women and birthing people deserve to feel safe and heard throughout their pregnancy and birth. Since the inception of Birthrights ten years ago – the UK charity that champions respectful maternity care by protecting human rights – we’ve seen report after report saying the same things. From Morecambe Bay to Ockenden, we know that too often, many voices are ignored or dismissed. Considering the racialised experiences of Black and Brown people that have been highlighted in reports by Birthrights, FiveXMore and the Muslim Women’s Network, the inequalities are unsurprising.
How many more reports or statistics do we need to see about the racism that exists in the structures, cultures and practices that govern maternity care in the UK before serious and meaningful action is taken?
Birthrights’ report Systemic Racism, Not Broken Bodies, published in May last year, uncovered the stories behind the statistics. The year-long inquiry was led by an expert panel and heard testimonies from Black and Brown respondents. It documented the traumatic experiences of those who felt unheard and dehumanised through their pregnancy and birth.
We heard of concerns that were dismissed, pain ignored and relief denied. Accounts of racial microaggressions and stereotyping, failure to identify serious medical conditions due to skin colour, lack of respect for culture and religion, breaches of consent, and trauma were described. Healthcare professionals told of a culture of blame and fear within the NHS, a lack of diverse representation among senior roles, as well as witnessing and experiencing racist behaviour with no safe or clear routes to escalate it.
So what needs to happen to eliminate the disparities?
The first step has to be recognising the role that racism plays and how it infects institutions, systems, policies and attitudes. As one woman told our inquiry: “There was one point in my labour right near the end where I remember looking at [my partner] and saying, I’m going to be a Black statistic.” Once racism is acknowledged as the central driver of inequity, work can meaningfully begin to overhaul cultures and practices within maternity provision, decolonise maternity curriculums and guidance, and use national policy levers to dismantle the structural barriers that hold back racial justice.
Care that puts the informed decisions of the people affected at its centre cannot be delivered without sufficient and meaningful investment in maternity services. As the Women’s Equalities Committee concluded “a fully staffed, properly funded maternity… workforce is fundamental to delivering safe, personalised care”. The failure of the government to respond to calls for greater investment in maternity care and improvements in pay and conditions for the healthcare workforce is having serious implications, but it continues to disproportionately impact Black and Brown people.
Positive accounts of maternity care, documented in the Birthrights race inquiry, focused on good communication, person-centred and culturally sensitive care. Everyone must be confident they will be offered safe maternity care that fully respects their right to bodily autonomy, self-agency and accepts their lived experience – even in times of crisis.
To make this the norm requires a concerted collective effort across government, the health service and wider maternity sector, and an investment of time, money and resources.
We need to wake up to the reality that unless there is a concrete and properly funded effort to acknowledge and address systemic racism in maternity care, we will see yet another report outlining the same stark figures, with little hope for change.
The charity Birthrights provides advice and legal information to women and birthing people, trains healthcare professionals to deliver rights-respecting care, and campaigns to change maternity policy and systems.