‘Maternal care racism inquiry is important and long overdue’

By Nadeem Badshah

MATERNITY care needs an “ur­gent” shake-up, according to ex­perts who welcomed an inquiry into how alleged racism in the NHS impacts the care provided to pregnant women.

Women from south Asian back­grounds face nearly twice the risk of dying in pregnancy or child­birth compared to white women, according to recent data.

The investigation will look at how racial bias and discrimina­tion endured by patients is lead­ing to poorer health outcomes for ethnic minorities.

Campaigners said Pakistani women are also more likely to have a premature baby or neona­tal death in the UK, compared to their country of origin.

Dr Amina Yaqin, chair for the Centre for the Study of Pakistan at SOAS University in London, told Eastern Eye: “It is encouraging to see an inquiry that promises to look at the structural issues con­tributing to the ‘systemic racism’ in the NHS, so that informed and targeted action can take place for reform that is urgently needed.

“However, this disparity is not a new phenomenon. This is about issues of class, access, gender ste­reotypes and race.

“South Asian women are brought up to look after others in the family first and themselves last, [which] affects their nutrition, food choic­es and power relationships in in­ter-generation households.

“They are time-poor and the NHS requires a lot of time and knowledge to get through to the service that you need.

“Just think about the bureaucra­cy of appointments with your GP and, sadly, people who don’t make a noise get lost in that system. Deprivation, poor first-time expe­riences, language barriers, trans­port access, religion and educa­tion are all contributors to this.”

In 2020, 34 black women died among every 100,000 giving birth, compared to 15 Asian and eight white women, according to the research by Mothers and Babies: Re­ducing Risk through Audits and Confidential Enquiries (MBRRACE).

Dr Yaqin added: “My own ex­periences as a Pakistani woman in the NHS have shown me that ethnicity data is used as a stand­ard measure of how a diagnosis is decided for a particular group. This is not the only way a diagno­sis should be made.

“Someone who is linguistically disadvantaged or doesn’t under­stand the language of the NHS will feel isolated and igno­rant. Sadly, there is bully­ing and harrassment in the NHS, and I’ve heard this from nursing staff on a women’s leader­ship course. And this culture translates down the chain to patients.”

Barrister Shaheen Rahman was asked by charity Birthrights to chair the inquiry, which also includes an ex­pert panel comprising affected families, mid­wives, obstetri­cians and law­yers. The panel will consider the findings and hold hear­ings this sum­mer to identify solutions.

Research in 2013 found that women from minority ethnic groups had a poorer experi­ence of mater­nity services than white women.

They were more likely to deliver by emergency caesarean sec­tion, less likely to have pain relief during labour and receive fewer home visits from midwives.

Elizabeth Duff, senior policy advisor for NCT, a charity for par­ents, said: “We want to see high-quality care for all women through pregnancy, labour and the post­natal period. The current situa­tion in the UK, with Asian women at greater risk of maternal death than white women and their ba­bies at higher risk of neonatal death, is totally unacceptable.

“The Covid-19 pandemic has brought into sharp relief inequal­ities in maternal outcomes. We have posted information on our website to help women from black, Asian or minority ethnic (BAME) backgrounds stay in­formed, safe and supported:

The All Party Parliamentary Group on Muslim Women is cur­rently conducting its first re­search inquiry into Muslim women’s experience of maternity care via an online survey to make recommendations to help im­prove maternity care.

Jane Brewin, CEO of UK preg­nancy charity Tommy’s, said those involved in providing ma­ternity services need to work to­gether in order to address the disproportionately high risks fac­ing certain families.

She said: “While insight such as the MBRRACE report acknowledges that pregnancy and child­birth are safe experiences for most UK mothers, it also high­lights deeply troubling inequali­ties that need to be addressed.

“The government will not reach its goal to halve rates of stillbirth and neonatal death by 2025 with­out taking urgent action to ad­dress pre-term birth rates and un­derstanding why black and Asian mothers are more likely to lose their babies – and putting in place things we already know make a big difference to pregnancy safety, like having the same midwife through the journey to parenthood with ongoing risk assessments and frequent check-ups if needed.

“Tommy’s has recognised this need for some time and we urge all those involved in maternity care to make use of our freely available resources at tommys.org to help make pregnancy safer.”

Dr Rosena Alin-Khan, a Labour MP and NHS hospital doctor, said: “The racial disparity in maternity outcomes and experiences reiter­ate the urgent need to address health inequalities which are only being exacerbated by the govern­ment’s response to Covid-19. We need action by the government to address this inequality, but so far all we’ve had is empty rhetoric.”

The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) are working to racial dis­parities and racism in maternity.

The RCM’s Race Matters initia­tive sets out a five-point plan, in­cluding “supporting research and championing positive change in outcomes for pregnant women from black, Asian and minority ethnic backgrounds”.

The RCOG has a taskforce which aims to “highlight where health disparities exist, improve our un­derstanding of the causes behind inequalities and collaborate with government to create meaningful solutions to improve healthcare experiences and outcomes for all ethnic minority women.”

A new role of head of midwifery research has been created by NHS England to focus on health ine­qualities with maternity outcomes for mothers and babies from BAME families.

Munira Wilson MP, the Liberal Democrat’s spokesperson for health, wellbeing and social care, told Eastern Eye the “inquiry is incredibly important, urgent and long overdue.

“The allegations of racism in maternity care are deeply shock­ing. We need to know what is lead­ing to poorer health outcomes in maternity care for black, Asian and ethnic minority groups, and the reasons why black and Asian pregnant women are far more likely to be admitted to hospital with Covid-19. It is also vital that there is continuity of maternity care for all women.”

The Raham Project charity in Cambridgeshire holds monthly ‘Listening Events’ for mothers from BAME communities. A re­cent virtual event via Zoom invit­ed women to share their thoughts and experiences of pregnancy and childbirth.

Caroline Lee-Davey, chief ex­ecutive of charity Bliss, said: “It is deeply concerning that babies born to Asian parents in the UK have nearly a 60 per cent in­creased risk of neonatal mortality compared to white British babies .

“This points to ongoing health inequalities which must be ad­dressed as a matter of urgency.

“We welcome all initiatives which can help identify the ac­tions that need to be taken to en­sure every baby born premature or sick in the UK has the best chance of survival.”

Black or Asian and pregnant? What you need to know about Covid: www.nct.org.uk/pregnancy/ coronavirus-and-pregnancy/bame-and-pregnant-what-you-need-know-about-coronavirus. If you’re pregnant and from a BAME back­ground, find out how to stay in­formed, safe and supported during the pandemic at www.nct.org.uk.