Systemic racism within UK maternity care is risking the safety of people from Black, Asian and mixed ethnicity backgrounds, often with devastating consequences, according to a report by the childbirth charity Birthrights.
More than 300 people with lived and professional experience of racial injustice in a maternity setting gave evidence to an expert panel chaired by Shaheen Rahman QC, a barrister who specialises in clinical negligence, as part of the charity’s year-long inquiry into the issue.
Rahman said: “Black women in the UK are four times more likely to die in pregnancy and childbirth than white women; Asian and mixed-race women are twice as likely. This glaring inequality prompted Birthrights to … examine how race discrimination impacts upon maternity care.”
Feeling unsafe was the most common theme in the testimonies provided via written evidence, in-depth interviews and focus groups, with two-thirds of those who shared their stories saying they did not feel safe some or all of the time.
Common themes included women not being listened to, their concerns about pain and contractions being routinely dismissed, and racist stereotypes impacting negatively on their safety.
There were numerous testimonies about serious medical conditions – such as jaundice or sepsis – not being recognised due to skin colour, owing to policies and training that focuses on white bodies as the norm.
Respondents also described feeling “dehumanised”, being patronised or spoken down to and even threatened.
One woman said she was shouted at by a doctor during an intimate examination, and another said she faced invasive questions about her immigration status while partially undressed.
The panel heard from healthcare professionals who said colleagues described Black women and babies as having “thick, tough, skin”, or said a ward “smells of curry” when south Asian families were being cared for, or that Chinese people were “dirty”.
Midwives described a “toxic” working environment where staff bullied each other, and a “blame culture” that meant there was a fear of speaking up or calling out racism.
One student midwife of mixed ethnicity described how she felt ground down by the racism she witnessed on a daily basis at a hospital in the Midlands. She said: “I feel completely ‘othered’ and have to bear witness to abhorrent behaviours, yet at the same time I feel the power imbalance and consequences of speaking out.
“During one training session we were told about a maternal death of which the conclusion was drawn that Asian women have a weaker immune system and this was the reason given. I was really shocked.”
She said proper training and real consequences for racist behaviour was vital. “People need to be able to report their colleagues without fear. It shouldn’t be left to the visibly non-white person on the team,” she said.
The report, Systemic Racism, Not Broken Bodies, calls for changes that address racism as the root cause of many of the inequalities in maternity care.
These include creating a safe inclusive workplace culture and improving maternity curriculums and guidance so that student midwives and medics are taught how to better assess women and babies with darker skin tones.
The report also demands policy changes to break down structural barriers to racial equity, such as ending NHS charging for migrant women, and ringfenced investment for NHS interpreting services.
The Department of Health and Social Care said a taskforce established in February this year “will level up maternity care for all women, particularly those living in deprived areas or from ethnic minority backgrounds”.
A spokesperson said: “It will focus on improving access to effective maternity care and care for women trying to conceive and will address factors linked to unacceptable disparities in quality of care, experiences and outcomes.
“We are also developing the first ever government-led women’s health strategy for England, and fertility, pregnancy, pregnancy loss and postnatal support will be a priority area.”
The NHS is investing £7m to tackle maternity inequalities and is working to make sure at least 75% of pregnant Black, Asian and minority ethnic women are cared for by the same midwives during and after pregnancy by 2024.
In the run-up to her baby’s birth, Dina was seeing a mental health midwife for tokophobia – or fear of pregnancy. The 36-year-old, who is Sri Lankan, said: “We know women of colour have more birth trauma and adverse birthing experiences, so this was compounding my anxieties.”
But despite seeking out the extra support, it was clear her pregnancy phobia had not been communicated to other midwives when she turned up having contractions at the London hospital where she was to have her baby.
Dina, who did not want to give her surname, recalled: “Worse still, I experienced a lot of gaslighting, and essentially I was denied care. When I went to the birthing centre, one midwife told me I was in early labour and said ‘from looking’ at me that I was having short contractions.
“I explained I was a GP who had worked in obstetrics and gynaecology and that I recognised active labour, but it didn’t make any difference and I was sent home. They told me to contact them when I was in ‘unrelenting pain’, which was incredibly scary.”
Later Dina started bleeding and called midwives to express her concerns, but it was repeated to her that she sounded as if she was in early labour. But the haemorrhaging got worse and she lost nearly two litres of blood.
She said: “I was in agonising pain and passing massive blood clots. It was only when I turned up at hospital and they saw the blood that they finally listened to me. I was frightened but I was almost relieved I was bleeding so much as I thought at least they will listen.”
On examination Dina was 10cm dilated, meaning she was ready to give birth. She was rushed to theatre and her baby was delivered via a ventouse suction cup.
The next day a consultant came to check on her in the postnatal ward. “She said to me: ‘I read what happened and in 20 years I’ve never seen anything like this,’” Dina said. “This woman’s tone made me feel like I was an idiot and that somehow what happened was my fault.”
She sought the advice of another obstetrician consultant, who gave a different view – they said it was not unusual she had developed a blood clot after being left for hours in labour and not monitored.
“I should have been in hospital but they denied me care,” Dina said. “It made me wonder why I’d been ignored and spoken down to and it felt ethnicity related. The consultant saying to me ‘I’ve never seen anything like it’ made me feel like she saw women of colour as alien. The whole experience was dehumanising.”
Dina, whose baby girl is now two, has had treatment for post-traumatic stress disorder, which she developed after the birth. “It’s left me with a deep mistrust of maternity services,” she said.