‘Maternal care racism inquiry is important and long overdue’
ASIAN WOMEN ARE AT MUCH HIGHER RISK OF PREGNANCY RELATED DEATHS, FIGURES REVEAL
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 n Aamna*, an asylum seeker from Pakistan, speaks English well but was left distressed by patronising and rude comments made by some NHS staff.
She said: “There was a nurse – maybe she has a special view of foreigners. I mean, I’m not speaking perfect English, but it was obvious I could speak English. When she was talking to me … she was always using her hands.
“She had to make these gestures. A lady looks Asian, a foreigner, and wears the hijab, so maybe she thinks I don’t understand any English. She was insisting on using her hands. It was very annoying for me, because it was obvious I could speak English.” *Name has been changed to protect her identity 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 highquality 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.” n Black or Asian and pregnant? What you need to know about Covid: www.nct.org.uk/pregnancy/ coronavirus-and-pregnancy/bameand-pregnant-what-you-needknow-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