Racism in UK maternity care puts safety of black, Asian and mixed women at risk – study | Race
Systemic racism within maternity care in the UK puts the safety of people of Black, Asian and mixed ethnicity at risk, often with devastating consequences, according to a report by childbirth charity Birthrights.
More than 300 people with lived and professional experience of racial injustice in a maternity ward gave evidence to an expert panel chaired by Shaheen Rahman QC, a clinical negligence lawyer, as part of the investigation of a year of the charity on the matter.
Rahman said: “Black women in the UK are four times more likely to die during pregnancy and childbirth than white women; Asian and mixed-race women are twice as likely. This stark inequality prompted Birthrights to…examine the impact of racial discrimination on maternity care.
Feeling insecure was the most common theme in testimonials provided through written evidence, in-depth interviews and focus groups, with two-thirds of those who shared their stories saying they did not feel safe from time to time or all the time.
Common themes included women not being listened to, their concerns about pain and contractions being routinely dismissed, and racist stereotypes negatively impacting their safety.
There were many testimonies of serious medical conditions – such as jaundice or sepsis – going unrecognized because of skin color, due to policies and training that focus on white bodies as the norm.
Respondents also described feeling “dehumanized,” being patronized or looked down upon and even threatened.
One woman said she was yelled at by a doctor during an intimate examination, and another said she was faced with intrusive questions about her immigration status while partially undressed.
The panel heard from medical professionals who said their colleagues described black women and babies as having “thick, tough” skin, or said a ward “smelled like curry” when South Asian families were neat, or that the Chinese were “dirty”. .
Midwives described a ‘toxic’ work environment where staff bullied each other, and a ‘culture of blame’ which meant there was a fear of speaking out or speaking out against racism.
A mixed-ethnic student midwife has described how she felt overwhelmed by the racism she witnessed daily at a hospital in the Midlands. She said: “I feel completely ‘altered’ and having to witness some heinous behavior, but at the same time I feel the power imbalance and the consequences of speaking out.
“During a training session, we were told about a maternal death where the conclusion was drawn that Asian women have a weaker immune system and this is the reason given. I was really shocked.
She said proper training and real consequences for racist behavior were vital. “People should be able to report their colleagues without fear. It shouldn’t be left to the visibly non-white person on the team,” she said.
The report, Systemic Racism, Not Broken Bodies, calls for changes that tackle racism as the root cause of many inequalities in maternity care.
These include creating a safe and inclusive workplace culture and improving maternity curricula and counseling so that midwifery students and physicians learn to better assess women and babies at darker skin.
The report also calls for policy changes to remove structural barriers to racial equity, such as the end of NHS fees for migrant women and earmarked investments in NHS interpreting services.
The Department of Health and Social Care said a task force set up in February this year “will improve maternity care for all women, especially those living in deprived areas or from ethnic minorities“.
A spokesperson said: ‘It will focus on improving access to effective maternity care and care for women trying to conceive and address factors related to unacceptable disparities in quality of care, experiences and the results.
“We are also developing the first-ever government-led women’s health strategy for England, and fertility, pregnancy, pregnancy loss and postnatal support will be a priority area.”
The NHS is investing £7m to tackle maternity inequities and is working to ensure that at least 75% of black, Asian and minority pregnant women are cared for by the same wise people -women during and after pregnancy by 2024.
“The whole experience was dehumanizing”
Before her baby was born, Dina was seeing a mental health midwife for tokophobia – or fear of pregnancy. The 36-year-old, who is Sri Lankan, said: ‘We know women of color have more birth trauma and adverse childbirth experiences, so that added to my anxieties.
But despite seeking further support, it was clear her pregnancy phobia had not been communicated to other midwives when she presented in labor to the London hospital where she had to give birth.
Dina, who did not want to give her last name, recalls: “Worse still, I suffered a lot of gaslighting, and basically I was denied treatment. When I went to the birthing center, a midwife told me I was in early labor and said “looking at me” that I was having short contractions.
“I explained that I was a general practitioner who had worked in obstetrics and gynecology and that I recognized active labor, but it made no difference and I was sent home. They told me to contact them when I was in ‘unrelenting pain’ which was incredibly scary.”
Later, Dina started bleeding and called midwives to express her concerns, but was told again that she looked like she was in early labour. But the bleeding got worse and she lost nearly two liters of blood.
She said: ‘I was in excruciating pain and massive blood clots. It wasn’t until I got to the hospital and they saw the blood that they finally listened to me. I was scared but almost relieved to bleed so much I thought at least they would listen.
On examination, Dina was 10 cm dilated, meaning she was ready to deliver. She was rushed to the theater and her baby was born via a suction cup.
The next day, a consultant came to see her in the postnatal ward. “She said to me, ‘I read about what happened and in 20 years I’ve never seen anything like it,’ Dina said. “The tone of this woman gave me the feeling like an idiot and that what happened was my fault.”
She sought the advice of another consultant obstetrician, who expressed a different view – they said it was not unusual for her to develop a blood clot after being left in bed for hours. unsupervised work.
“I should have been in the hospital but they refused me treatment,” Dina said. “It made me wonder why I had been ignored and looked down upon and it seemed to be related to ethnicity. The consultant who told me ‘I’ve never seen anything like it’ gave me the impression that she viewed women of color as aliens. The whole experience was dehumanizing.
Dina, whose baby girl is now two, was treated for post-traumatic stress disorder, which she developed after birth. “It left me with a deep distrust of maternity services,” she said.