Inequality in the UK Maternity System
Photo by Domo
In 2017, Serena Williams had a close brush with death after her C-section (The Guardian, 2018). Her concerns were not taken seriously, and she ended up needing emergency treatment for a life-threatening embolism (blocked artery). There are thousands of these stories. There are undoubtedly many more people from all walks of life who don't feel able to use their voices when experiencing racism during maternity care.
I’ve had three decent experiences of NHS care during my pregnancies, births, and the postnatal period, but they weren't perfect. I’m white, and the father of my children is black. My care providers were not educated to deal with my mixed-race babies, even taking one of them away immediately because of apparent jaundice, which was down to nothing more than his natural skin colour.
In recent years, racism and other forms of inequality in the UK maternity system have come into the spotlight. The stories we hear come from people all over the UK, and of all ages, but one thing is for sure, black and brown women and birthing people are experiencing substandard care in birth. And it’s happening all over the world.
Treading the line between informing and instilling fear is a tricky one. For that reason, it is essential to point out that in the UK, compared to many parts of the world, maternal deaths are thankfully rare. This doesn't negate the fact that some minoritised groups of our population are more likely than others to suffer.
Where does this racism in maternity care come from?
Photo by Social History Archive
If you go far enough back, it’s down to the documented ‘findings’ of James Marion Sims. Known as ‘The Father of Modern Gynecology’, this 19th-century physician carried out research on enslaved black women by operating on them without anaesthesia. He claimed that women ‘clamoured’ for the operations, but there is no record of their consent. Even if there was consent, it isn’t always about “whether you can say yes; it’s also whether you can say no” (Bettina Judd, assistant professor of Gender, Women and Sexuality Studies at the University of Washington, 2017) He caused untold suffering as he operated on them under the racist notion that black people did not feel pain. The attitudes on which his work was based go back even farther than the 19th century. The belief that a Black person experiences pain differently than a white person persists today, with recent studies showing that these attitudes are still very much in daily use.
How can racism still be in daily use today?
Photo by Matt Nelson
Suppose modern-day midwives, consultants and other care providers have an ingrained belief that Black women don't feel the same levels of pain. In that case, they are more likely to disbelieve a woman of colour presenting with an unusual pain level, more likely to brush off what she says, and more likely to refuse to provide pain relief (MBRRACE, 2020). One study showed that while Black and Hispanic women are more likely to report pain after birth, they are less likely to receive medication for it (Reuters, 2019).
How can we end racism in maternity?
We need to talk about this more. The conversations have already begun on social media.
#FiveTimesMore
Black women in the UK are four times more likely to die in pregnancy and childbirth (MBRRACE, 2020). The number has been as high as five times more historically. Those who live in the most deprived areas or for whom English is not their first language are also at greater risk. Hence, the hashtag “#fivetimesmore”, started in 2019, has gained momentum in 2020/21 to raise awareness.
#NotSoNice
The National Institute of Clinical Excellence (NICE) shocked the birth scene recently with a draft of its updated guidelines; many in the birth community are still uncomfortable with. The final guidance, even after some alterations, which can be found here (NICE August 2021). The draft stated, among other things, that women from an ethnic minority family background should be medically induced at 39 weeks, even if their pregnancies are uncomplicated and are ‘low risk’. This essentially positioned a person’s ethnicity as the reason for higher mortality rates, rather than admitting that a big part of the problem is institutionalised racism in the maternity system. This led to the hashtag “notsonice”. Birth workers who are actively fighting anti-racism in maternity shouted so loudly that NICE changed the recommendations.
How can we hold people accountable?
Photo by Domo
Birthing people of colour can hold people accountable for decisions in the provision of care by asking midwives and consultants to note their decisions and actions in writing. For example, if you believe you are being refused pain relief or treated differently from another person, ask your midwife to put this in their notes. You can even ask to see it and sign it. It is a great idea to have a well-prepared birth partner who can advocate for you, if necessary. Another thing to remember is to ask for the ‘absolute risk’ instead of, or as well as the ‘relative risk’. The difference is explained here. Birth preparation should be more than just teaching you how to breathe through contractions. It should include a complete understanding of your options, what informed consent means, and how to make sure you're not being coerced into a decision that you don't want or don’t understand. As allies, we also need to call people out when we see it happening. It's not enough just to know about it; change takes action.
Here are some great accounts to follow on social media to learn more about what's going on and how to take action against it:
@kemibirthjoyjohnson
@doula.luiza @_marslord
and you can follow me too at @doulajuliaiddir
