The racial disparities in British maternity deaths

Racial disparities in maternal death rates in Britain have been condemned as as “nothing short of a scandal”, after an MPs’ report warned that black women are nearly four times more likely to die in pregnancy and childbirth than white women.

A scandal undoubtedly, said Candice Brathwaite in The Guardian, yet “I wish I could still feel shocked”. A 2018 report revealed that black women were five times more likely to die than white women. “Five years on, the data hasn’t changed much.”

What’s the current situation?

Between 2018 and 2020, just over two million women gave birth in the UK, according to the newly published report by the Women and Equalities Committee. During this period, 229 women died during or up to the six weeks after the end of pregnancy from causes associated with their pregnancy.

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Black women were 3.7 times more likely to die than white women, and Asian women were 1.8 times more likely to die than white women.

Black and Asian women are dying from the same causes as other women “but more frequently”, said BBC health reporter Philippa Roxby. Cardiac disease is the largest single cause of indirect maternal deaths, followed by epilepsy and stroke. Deep vein thrombosis remains the leading cause of direct maternal death during or up to the six weeks after the end of pregnancy.

Experts told the committee that the vast majority of women who die, across all ethnicities, have multiple and complex health problems – but that “their risks were not always communicated to relevant staff”, Roxby reported.

The lawmakers’ report noted that women from the poorest areas of the country, where a higher proportion of babies belonging to ethnic minorities are born, are two and a half times more likely to die than those from the richest.

What is the biggest problem?

The reasons for ethnic disparities in mortality are not fully understood.

However, a shortage of staff in maternity care has been cited as a core issue, with greater investment in maternity services desperately needed.

As the cost of living continues to rise, “it is becoming unaffordable to live on a public sector salary”, which is driving away “many great women dedicated to anti-racism who want to be midwives”, said Brathwaite in The Guardian.

The Royal College of Midwives (RCM) estimates that the NHS in England is short of the equivalent of around 2,500 full-time midwives. The orgaisation’s head of policy, Sean O’Sullivan, told the Daily Mirror that with fewer staff in place, there was also more pressure on those who remain.

“It’s a vicious circle so the more that leave, the more pressure is on those who remain and that tends to be breeding ground for toxic cultures for bullying and discrimination,” he said.

To what extent is racism a factor?

There is also a “clear racial barrier” between suitable healthcare and black women, said Open Access Government, with black women frequently overlooked or ignored.

The first step to eliminating disparities “has to be recognising the role that racism plays and how it infects institutions, systems, policies and attitudes”, said Janaki Mahadevan and Shanthi Gunesekera, CEOs of the Brithrights charity, in The New Statesman.

The charity has heard accounts of “racial microaggressions and stereotyping, failure to identify serious medical conditions due to skin colour, lack of respect for culture and religion, breaches of consent, and trauma”, the duo wrote. And that black maternal death rates have “changed little in the two decades since the data started being published is nothing short of a scandal”.

There have been numerous reports of black women being ignored or told they were overreacting when complaining of pain. Tinuke Awe, who co-founded an organisation called Five X More after the traumatic birth of her son, told BBC Radio Four's Today programme that her her pain was “actively dismissed”.

“There is a stereotype of black women not feeling pain and being quite aggressive and loud, very strong, so we're able to take more pain,” she said.

Brathwaite agreed in The Guardian that “tropes still abound about black skin being thicker than white; that black people don’t need as much pain relief as our white counterparts”.

A 2016 study of white medical students in the US found that nearly half of those quizzed held false beliefs about biological differences in black patients, including thicker skin and less sensitive nerve endings.

What needs to change?

According to a Department of Health and Social Care spokesperson, the UK government has invested £165m since 2021 “to grow the maternity workforce” and is “promoting careers in midwifery”, with an extra 3,650 training places per year.

But campaigners and some politicians say more needs to be done to reduce the number of non-white women dying in childbirth.

The government has set targets for halving the total number of stillbirths and neonatal deaths by 2025 compared to 2010 levels. But targets are also needed specifically for reducing deaths among black women, Janet Fyle of the RCM told the Mirror.

“Targets allow you to adjust what you’re doing. Unless they have targets, they’ll never know what does or doesn’t make a difference”, she said.