Gatekeeping and gaslighting: why are Black British mothers dying in our healthcare system?
Today marks a year since George Floyd tragically took his last breath at the hands of - or more precisely the knee of - a white police officer. For Black people worldwide, today also marks a year of us trying to process this traumatic event which was so publicly displayed across our TV and phone screens. Our collective awareness that this could have easily been our brother, father, husband or son sparked a global racial justice movement.
The past year has brought into sharp focus how racism literally kills and snuffs out the lives of our loved ones. Some may argue that the UK isn’t nearly as racist as the US, where Black and Brown people are gunned down by police in broad daylight. While Black people are not being murdered as openly in Britain, racism here is more insidious, seeped into the foundation and culture of institutions and in the very fabric of society. Despite the recent high profile Commission on Race and Ethnic Disparities report stating the contrary, structural and institutional racism continues to significantly disadvantage Black people living in the UK.
A prime example is to look at the disparity in maternal mortality across different ethnicities in the UK. According to the MBRRACE report, from 2015-2017 Black women in the UK were 5 times more likely than white women to die during pregnancy and in the 6 weeks after childbirth. Research conducted by the Nuffield Department of Population Health in 2014 found Black women of African descent were 83% more likely and Black women of Caribbean descent were 80% more likely to suffer severe maternal morbidities compared to white women. These are known as ‘near misses’: when a woman nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy and are left with long term morbidities. It is estimated that for every maternal mortality, there are 100 severe maternal morbidities- near misses.
As a Black Caribbean woman who has dedicated her career to improving health globally and now expecting my first child in two months’ time, these statistics terrify me. Pregnancy can be an anxious time for women; now layer that with the reality that I am 5 times more likely to die than my white neighbour, white colleague, white friend and 80% more likely to suffer a near miss - all because of the colour of my skin. This gross injustice must be urgently addressed.
The Government has commissioned numerous reports into maternal mortality over the years. In 1998, Black women were found to be 3 times more likely to die during pregnancy and childbirth and sadly this figure rose to 5 times more likely to die between 2015-2017. Over 20 years have passed since the 1998 report and we seem to be pedalling backwards.
The reports suggest some possible reasons why Black women are more than 5 times as likely to die, including:
1. Inherent racial bias and stereotyping of Black women within healthcare services in terms of providing an equal service
2. Poor management of higher risk pregnancies
3. Substandard care: failure of diagnosis and treatment
A poll from the Joint Committee on Human Rights found 78% of Black women felt the NHS would not give them equal treatment. Black women have lived experiences of the structural and institutional racism that exists in the healthcare system, with many recounting not being listened to during the course of their care and their symptoms being dismissed by healthcare providers.
The maternal health disparities between Black and white women is not limited to the UK. In the US, leading tennis player Serena Williams publicly shared how she literally had to advocate for herself to save her life in 2017. Soon after giving birth to her daughter by emergency C-section Serena, who has a history of blood clots, began experiencing shortness of breath. She worried she had a pulmonary embolism (a life threatening condition where blood clots travel to the lungs), however medical professionals ignored her pleas for a CT scan to check for clots, instead ordering an ultrasound. When nothing showed up on the ultrasound, her doctors finally ordered a CT scan which showed she was right. She had several blood clots in her lungs.
Just a year before Serena gave birth, a 2016 survey which included 222 white medical students and residents in the US revealed about half endorsed false beliefs about biological differences between blacks and whites. Many believe Black people feel less pain on average, resulting in racial bias in pain treatment recommendations. Simply put, Black Americans are systematically under-treated for pain relative to white Americans and this can have detrimental results.
Over the past seven months, I’ve been hyper alert during my own high risk pregnancy, asking medical professionals the same questions, sometimes three or four times if I need to, to fully understand what is happening at any given point and why a particular clinical decision has been made. Having recently been hospitalised due to my complications, I am equipping myself before birth, researching online, listening to podcasts and prepping my husband to advocate for me in case I am not in a position to, so that I do not end up being part of the five times more statistic.
I signed an online petition in 2018 to improve maternal care for Black British women. I later learnt this campaign was the brainchild of the FivexMore campaign - led by two Black women who are raising awareness of the shocking statistics and petitioning the Government to improve maternal health outcomes for Black Women. The petition gained over 187,000 signatures and was recently debated in Parliament on 19th April 2021.
While we await the Government’s next steps after the debate, Black women continue to carry the mantle and raise awareness around Black maternal health disparities, however we cannot do this alone. We desperately need allies who will amplify our voices and highlight the constellation of biases we face which result in our poorer health outcomes. We need white women, white mothers to scream their outrage that their black neighbours, black colleagues, black friends are dying five times more than they are during pregnancy and childbirth. We will no longer accept lip service. We need true allyship from white women and men in positions of power, from fellow women in global health, from the sexual and reproductive health and maternal health community to speak up for Black women and advocate on our behalf when they are in decision-making rooms we don’t yet have access to. Health is a fundamental human right and we need global health advocacy groups to sound the alarm on the unacceptable maternal health disparities occurring in the UK. There is no justifiable reason in the 21st century for a woman in the UK to be more likely to die than another, while bringing new life into the world, based on the colour of her skin.
Since its inception, global health efforts have been focused on low and middle income countries (LMICs). While the need is still greatest in these countries, the UK maternal health statistics has shone a light on the inequity of health service provision and differential health outcomes for Black women living in one of the most developed countries in the world. The UK Government admits we need to better understand the causes of the maternal mortality disparities between ethnic groups in the UK, however as a black woman with over twelve years’ experience in global health, I know this is not enough and I urge the Government to go further. We desperately need to address the bias in healthcare services offered to Black women in the UK, similar to how LMICs have been tackling healthcare biases towards particular groups such as pregnant adolescents or people living with HIV. The Government also needs to better understand how the social determinants of health - poverty, housing, socioeconomic status, occupation, education - affect Black women’s health even before she becomes pregnant. Women in global health have a pivotal role to play here. We are well placed to use our expertise from global health programmes around the world to inform healthcare bias training and support in developing targeted initiatives with the UK health system to reduce Black women’s five times risk of maternal morbidity and mortality. Black women deserve and demand more. We will keep lobbying for change until we see improvement and transparent progress in maternal health outcomes for Black women across the UK.