The wide-ranging review and meta-analysis draw a range of existing research to expand on previous findings, including disproportionate maternal death rates for Black and Asian women (more than four to two times higher, respectively) in the UK. For Black and Indigenous women in the United States, maternal death rates are two to three times higher than those of white women.
The academics noted that their research aligns “with existing evidence on perceived racial discrimination as an important risk factor for adverse pregnancy outcomes”. They further connected the pervasive nature of racism in people’s daily lives has “far-reaching implications on the experiences of racialised individuals” in other ways outside of health – from employment to adequate housing, education, employment and poverty. And they called for a deeper, intersectional understanding of the socioeconomic factors that underpin racialised poverty.
One of the co-authors of the report, Kim van Daalen, a Gates Cambridge and PhD candidate at the Department of Public Health and Primary Care at the University of Cambridge, said: “Dismantling structures and policies that enable institutional and interpersonal racial discrimination, underlying racial and ethnic disparities in health and intersecting social inequalities, is essential to improve overall health in societies.
Partnerships of health care professionals with community-based reproductive justice and women’s health organisations who work in this area can improve health for racialised women in a community-centred way.”
Last month, a wide-ranging and important report from the APPG on Muslim Women revealed a shocking “culture of maternity abuse”. Examples included blame put on women for ‘putting their babies at risk’ as a Black Muslim woman described having to get a C-section due to apparent FGM. Some examples of racist behaviour were overt – as a midwife told a Black woman in labour, “All you people do is make babies”. Others described stigmatising, racialised assumptions remarks about breastfeeding.
Examples of microaggressions occurred across different staff, with Muslim women who wear the hijab as “aggressive” when asserting themselves after having their concerns and questions belittled or outright ignored. Some women described removing their headscarves so staff would listen to them – as an Indian Muslim woman described how to avoid bullying from staff during her second pregnancy, she did not wear her headscarf in the hospital. Microaggressions would only stop in some cases when Muslim patients revealed they, too, were doctors.
A lack of dignity and respect appeared regularly in the report, as did the feeling of ‘invisibility’ when raising health-related concerns (symptoms like sepsis, hypertension and excessive blood loss). Medical staff denied women opportunities to provide informed consent and pressured them into having induced labour, to the outright denial of receiving pain relief.
The APPG report revealed a hierarchical approach to healthcare for Muslim women, noting that those receiving the poorest care were “Black African, Bangladeshi, Arab, Asian Other women and mixed Ethnic Black / White women”. The reports’ responses from over 892 women revealed that Muslim women were more likely to have induced labour but less likely to receive the necessary pain relief. They were also more likely to have an instrumental birth or emergency caesarean and experience more profound blood loss and prolonged labours. In addition, a disproportionate number of women experienced stillbirths or neonatal deaths.
More broadly, audits of ethnic and socioeconomic inequalities in the NHS Maternity and Perinatal Care reveal that when compared to women from other ethnic backgrounds, Black women had higher occurrences of births without any intervention or pain relief.
In May, the BBC reported on racism in maternity care, drawing on another significant report that detailed how Black and brown women felt physically and psychologically unsafe during their care and interviewed women who described harrowing experiences.
In response to the APPG report, the Royal College of Obstetricians and Gynaecologists (RCOG), said: “This new report adds to the urgent calls from the Ockenden review, Five X More and Birthrights reports, to take urgent action to ensure that every woman is listened to, feels visible and is supported throughout their maternity experience. The RCOG is committed to supporting healthcare professionals provide individualised care that recognises a woman’s personal needs, risks, and concerns, so that their care can appropriately tailored.”