- Black and Asian women are significantly less likely than white women to receive epidural pain relief during labour, a major UK study has found.
- Researchers analysed more than 2.7 million births and found persistent differences in pain management across ethnic groups.
- Medical bodies are calling for better data collection and action to tackle what experts describe as an "ethnicity pain gap".
Women from Black and Asian backgrounds in the UK are less likely than white women to receive epidural pain relief during childbirth, according to one of the largest studies of its kind. The findings have renewed concerns about racial inequalities in UK maternity care and what experts describe as an ethnicity pain gap across the healthcare system.
The research, based on more than 2.7 million births recorded over a decade until 2021, found that women from Bangladeshi, Pakistani and Black Caribbean backgrounds were noticeably less likely to receive an epidural during vaginal births than their white counterparts. The study has prompted doctors and campaigners to question whether unconscious bias, communication barriers and wider systemic issues are affecting the quality of maternity care offered to ethnic minority women.
The numbers reveal a worrying pattern
Published in the journal Anaesthesia, the study found that Bangladeshi women were 24 per cent less likely to receive an epidural during labour, while Pakistani women were 15 per cent less likely. The figure for Black Caribbean women stood at 8 per cent.
Researchers also identified disparities in caesarean births. Black Caribbean-British women were 58 per cent more likely than white women to receive general anaesthesia during planned caesarean sections, while Black African-British women were 35 per cent more likely.
Regional anaesthesia, including spinal or epidural blocks, is generally considered the safer option because mothers remain awake during the birth and recovery is usually quicker. General anaesthesia is typically reserved for emergencies where there is not enough time to administer regional pain relief.
The findings come shortly after an independent review into maternity services led by Labour peer Valerie Amos, which highlighted widespread failures in maternity care and pointed to institutional racism as one of the deeper problems affecting outcomes for women from minority ethnic backgrounds.
The latest research also forms part of a wider picture emerging from healthcare studies in the UK, US and Australia, all of which have reported racial disparities in pain management across different medical settings.
Researchers point to trust, communication and systemic bias
Alongside the clinical data, researchers from University of Oxford explored women's experiences of labour and pain relief. Many Black and Asian mothers reported feeling ignored when asking about pain management, while others said they were reluctant to speak up because they feared they would not be taken seriously.
The study suggested that many women felt excluded from decisions about their own pain relief and described an atmosphere of mistrust between healthcare professionals and patients from minority ethnic communities.
Lisa Hinton, who led the qualitative research, reportedly said ethnic inequalities in maternity care are shaped not only by access to treatment but also by communication and trust between patients and healthcare staff. She said women need meaningful conversations about their pain relief options rather than simply being offered choices.
Campaigners say the findings add to longstanding concerns about racial stereotypes influencing medical care. Bell Ribeiro-Addy, chair of the All-Party Parliamentary Group on Black Maternal Health, reportedly said the evidence leaves little room for doubt that racial assumptions continue to influence care. She said the findings reflect a broader history of Black patients' pain being underestimated and linked the issue to stereotypes such as the "strong Black woman", as quoted in a news report.
Nuala Lucas, president of the Obstetric Anaesthetists' Association and co-author of the study, reportedly said effective epidural pain relief is particularly important for women with health complications or those giving birth prematurely, making the disparities even more concerning.
Medical organisations say the findings underline the need for more detailed data on pain management across different ethnic groups.
Four UK medical royal colleges have called for improved monitoring after evidence suggested that patients from minority ethnic backgrounds are more likely to have their pain dismissed across several areas of healthcare, including emergency medicine, cancer care and maternity services.
