Births and Deaths: Black Women and the NHS

Births and Deaths: Black Women and the NHS

‘Black women are four times more likely to die from childbirth than white women.’

Racism within the UK’s institutions is something that is being reported on more and more in the UK. The Casey Report highlighted disparities of how black people can be treated compared to white people within the police force but the NHS, another British institution, is unsurprisingly also having issues.  

Black women are stereotyped as many things. Some common ones are that black women are strong and capable, loud, harsh and angry.  Black people are also stereotyped as having a higher pain threshold than people of other cultures creating disparities in how black people are treated within the healthcare system. The belief that black people have a higher pain threshold isn’t restricted to just laypeople, but also to medical staff.

‘-a substantial number of white laypeople and medical students and residents hold false beliefs about biological differences between blacks and whites and demonstrates that these beliefs predict racial bias in pain perception and treatment recommendation accuracy. (Racial bias in pain assessment and treatment recommendations. and false beliefs about biological differences between blacks and whites.)

This belief that black and white people are fundamentally, biologically different has been around for centuries. In America, various pseudo-scientific writings and journals were produced to ‘prove’ this belief, when in fact it was just used by scientists, physicians and slave owners alike to justify slavery and the inhumane treatment of black people during medical research. During the 19th century prominent physicians looked to find specific physical differences to distinguish black people from white. These ‘peculiarities’ they ‘found’ included the ‘fact’ that black people had thicker skulls, their skin was thicker, and they were less sensitive than white people. They also believed that the black body was physically stronger than the white body. These beliefs presented as fact were as false then as they are today. 

It is also a documented belief among white laypersons that these false biological differences mean that black people have a higher pain threshold. 

 

Research has shown that some medical students also believe that the black body is biologically different from the white body. Research also provides evidence that these beliefs are ‘associated with racial bias in perceptions of others’ pain, which in turn predict accuracy in pain treatment recommendations.’ This research addresses an important social factor that may contribute to racial bias in health and health care. (Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites)

Because of this, research has shown that black patients are less likely to be given pain medication, and if they are given pain medication, they are given it in lower doses.

A study in the US found that black patients were significantly less than white patients to receive analgesics for extremity fractures in the emergency room (57% vs. 74%), despite having similar self-reports of pain. 

‘This disparity in pain treatment is true even among young children. For instance, a study of nearly one million children diagnosed with appendicitis revealed that, relative to white patients, black patients were less likely to receive any pain medication for moderate pain and were less likely to receive opioids—the appropriate treatment—for severe pain.  For example, a study examining pain management among patients with metastatic or recurrent cancer found that only 35% of racial minority patients received the appropriate prescriptions—as established by the World Health Organization guidelines—compared with 50% of nonminority patients.’ (Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites)

In the UK, black patients are also treated differently to white patients, more specifically a recent report examining how black women are treated when pregnant. As a result of these medical disparities and false assumptions about black people, black women are more likely to die in childbirth than white women. A new report out this month in the UK by The Women and Equalities Committee states that black women are four to five times more likely to die in childbirth than their white counterparts. The black community, similar to how they judge their interactions with the Metropolitan Police, have long since recognised that there are disparities. This report (published in April 2023) states:

 ‘Maternal mortality for Black women is currently almost four times higher than for White women. Significant disparities also exist for women of Asian and mixed ethnicity. These disparities have existed and been documented for at least 20 years, but only received mainstream attention and Government action since around 2018.’ (https://committees.parliament.uk/publications/38989/documents/191706/default/)

During the years of 2018-2020, over two million women within the UK gave birth. A shocking 229 women died during or up to six weeks after the birth of their child. 

In 2017, the Government and NHS said they wanted to reduce stillbirths, neonatal and maternal deaths and neonatal brain injuries by 50% by 2025. However, little progress has been made on reducing rates of maternal deaths. Excluding maternal deaths from Covid-19, maternal mortality between the period 2010–2012 and the period 2018–2020 has increased by 3%.

For many years, Black women have faced greater risks to their health from discrimination because of those in the profession that do not take their complaints seriously and link with the idea of black women supposedly having higher pain thresholds. That, and the fact that they simply are not believed.

Tinuke Awe told her story in 2020. She was diagnosed late with having pre-eclampsia – a condition which can result in the death of the baby as well as the mother, and so she was given advice by her midwife: 

‘-go straight to the hospital, your life could be in danger. Once there she was given a vaginal pessary to induce labour and told to expect nothing to happen for at least 24 hours. But a few hours later she was in agony. “I kept saying ‘I’m in pain, I’m in pain’, but I was completely dismissed and fobbed off – no one looked at me,” -Tinuke Awe.

When rushed into a treatment room and when midwives finally discovered she was on the verge of giving birth, Tinuke found she was too exhausted to push and her son was delivered with the help of forceps. “I was just left feeling like I didn’t matter, that no one really cared about me,” she says. (Something Has to be Done -  Alexandra Topping 2020)

This was two years ago, and yet there has been little movement for change despite there being calls for change. The State of Black Britain Report states:

Worryingly, around 60% of Black respondents said they did not see the change needed to address these experiences coming from the institutions, or those responsible for the institutions, that had discriminated against them: Only 41% of respondents said that local government would have a lasting difference, 40% said central government and shockingly, 32% said the police could have such an impact.

As previously mentioned, the majority of black people in the UK have experienced prejudice from healthcare professions in the NHS. A report commissioned by the Black Equity Organisation - a national civil rights organisation launched earlier this year to tackle systemic racism in the UK, revealed that younger people specifically feel discriminated against. 

‘Almost two thirds (65%) of black people who responded to a survey said that they had experienced prejudice from doctors and other staff in healthcare settings. This rose to three quarters (75%) among black people aged 18 to 34.’ (The State Of Black Britain Report)

During the Women and Equalities Committee meeting: Black maternal health, Chair, Caroline Nokes asked the following question to a panel of guests.

“There has been evidence for many years about the disparities in health outcomes, particularly for black mothers but also for other ethnic minorities, yet there has been very little action. I think we have 20 years' worth of evidence. Have you seen a step change of action over the last few years?”

 Amy Gibbs, Chief Executive Officer, Birthrights, gave the following response:

“The statistics around mortality, with black women being four to five times more likely to die, and South Asian women being twice as likely to die, are more well-known now. We have seen initiatives like the Royal College of Obstetricians and Gynaecologists’ taskforce, which Dr Ekechi will no doubt talk about, which are really positive, but the action is too slow.” (Amy Gibbs Women and Equalities Committee.)

Professor Marian Knight, Professor of Maternal and Child Population Health, National Perinatal Epidemiology Unit; also gave the following response:

“The best news I can give you is that there has not been a worsening of the disparity. The maternal mortality rate for black women is not increasing. I cannot say statistically that it has decreased, but it has not increased. One challenge I have is the delay in data. The latest figures that I have published are from 2019, because it takes that long for me to get the full data through to enable me to produce the rates.”

The Black Equity Organisation also acknowledges the issues.

The report cited particular issues around the experience of black women in maternity care and the diagnosis of certain special educational needs. Survey participants felt as though they were not seen and that their concerns were not listened to or incorporated into their treatment decisions.

“Specific to Black women, participants felt that due to the misguided stereotype of ‘strong Black women,’ practitioners were dismissive of their pain,” the report said. The State of Black Britain Report also says how discrimination still prevalent as well as their resistance.

This rare extensive research is the biggest ever opinion poll of Black people speaking about their experiences living in Britain and was commissioned by the Black Equity Organisation, the national civil rights organisation launched earlier this year to tackle systemic racism in the UK.

The figures in the report are a timely reminder of the lived experiences of Black people in Britain and shine a light on the issues people from those communities continue to have to navigate in their everyday lives.

The research, conducted by market researchers Survation reveals:

  • 65% of Black people said they had been discriminated against by healthcare professionals because of their ethnicity
  • Over 60% said they had been passed over for promotion or employment due to their ethnicity
  • 59% said they or someone close to them had experienced stop and search or wrongful arrest
  • 42% said they or someone close to them had experienced stop and search more than once
  • 50% of parents with children under 18 said their children do not see themselves represented in either the teaching workforce or curriculum materials uses.

These findings are concerning, but not entirely surprising to the black community. Miriam Deakin interim deputy chief executive of NHS Providers gave the following comment: 

“Racism has no place in the NHS. Time and again, we hear how patients from ethnic minority backgrounds have worse experiences of healthcare than their white counterparts.

“This must be addressed, and everyone—including the NHS and government—must work together to do more to tackle racism within health and care. It is only by recognising these facts and having an honest conversation about racism, its structural roots, and its impact, that we can achieve change.”

As with the Casey report, issues have been identified, changes are being called for, but as of yet we are to see any action.

Read the full reports below.