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Racial inequalities in maternity must be addressed

Praful Nargund
December 12, 2023

Black women are almost four times as likely to die during or shortly after pregnancy than White women. Asian women are almost twice as likely to die. Let that sit for a second.

These kinds of health inequalities arise from compounded experiences over months and years – interventions during pregnancy and labour may be too late. Rectifying such a pervasive injustice requires us to look further back than the day of delivery, further back even than the point of conception.

An effective preventative approach has to reach back before pregnancy to the time when women are starting to think about having children. That’s why the CREATE Health Foundation has undertaken research to better understand the pre-pregnancy experiences of BAME women. We surveyed more than 300 women and produced a report with key recommendations based on the experiences that they shared.

Our results raised concerns. BAME women in our survey were 1.5 times as likely to report feeling discriminated against by healthcare professionals during pre-pregnancy. Asian and Black women expressed lower levels of trust in healthcare services in the UK than White women.

One woman interviewed, Brianna, described the compounding discrimination she experienced throughout her maternity journey. Before she became pregnant, she felt judged for having children because of her socioeconomic status. Throughout her pregnancy, Brianna felt her concerns were continuously dismissed and ignored. This culminated in a four-day long labour where she wasn’t given enough pain relief. The trauma that Brianna experienced in her labour did not start and end that day. It began with her experiences before she even became pregnant and lasted long after her delivery.

Our recommendations in the report go straight to tackling the root causes of this inequality. Many of our proposed solutions are very low-cost: for example, developing NICE guidelines on pre-pregnancy advice and support specifically for BAME women could be a pivotal first step. This begins to create a standardised framework for maternity care which addresses the unique needs and challenges faced by different ethnic groups in their maternal journeys.

It should go without saying, but all healthcare professionals should have a nuanced understanding of the racial disparity in maternal outcomes. Education on culturally unbiased conversations should begin as early as medical school and would help create a more caring system.

Education on culturally unbiased conversations should begin as early as medical school and would help create a more caring system. Quote

Our report is only the starting point, however, and we need more extensive data to better understand current pre-pregnancy services. On the back of our findings, we are also calling for the implementation of a national data collection system to understand the link between women's holistic pregnancy experiences and maternity outcomes. This is not merely about statistics; it's about gaining a comprehensive understanding of the factors influencing maternal health within different communities. National data collection will be a cornerstone in our quest for informed policy changes and effective interventions to improve the maternal care and outcomes of BAME women.

As well as the immediate benefits for maternal health, addressing racial healthcare disparities has far-reaching implications for our society as a whole. When we invest in the wellbeing of BAME women from the pre-pregnancy stage, we're not just ensuring safer pregnancies; we're fostering healthier communities. The problem of poor experience of BAME women in pregnancy and maternity care is longstanding, and we need to break the intergenerational cycle which can harm trust and undermine confidence in our healthcare services.

By focusing on reforming pre-pregnancy care, we can help to prevent problems earlier in the journeys of BAME women. This is a chance to reshape the foundations of healthcare practices, to bridge the gap in understanding, and to create a system that treats every woman seeking maternity care – from before conception to after delivery – with respect and compassion, regardless of their ethnicity.

Praful Nargund photo approved Dec 2023

Praful Nargund is a Trustee of CREATE Health Foundation.

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