Adverse birth outcomes in England – including stillbirth, premature birth, low birth weight and death of the mother during pregnancy or after birth – are closely linked to inequality.
A report on maternal deaths in the UK has found that compared to white women, black women are four times more likely to die during childbirth. Asian women, or women of mixed ethnicity, have twice the risk of dying. Reports from previous years have documented similar results.
Furthermore, a recently published study found that a mother in England who is Black or South Asian is at increased risk of stillbirth, premature birth or low birth weight, as indicated by lower socioeconomic status. Happens in the background mother. The risk increases manifold for a woman who is both poor and black or South Asian. These women are most likely to experience an adverse birth outcome.
While the greatest disparities were seen among the most socioeconomically disadvantaged Black and South Asian women, adjusted data demonstrated that socioeconomic deprivation, smoking and body mass index (BMI) had little effect on outcomes for women from ethnic minorities .
This means that a Black or Asian woman who is not poor, does not smoke and does not have a BMI outside the recommended range may still have a higher risk of an adverse birth outcome than a White woman of a similar economic and health background. Is. It points to racism as a cause.
Evidence of Racism
One of us (with colleagues Sally Pezzaro) and the Mary Seacole Awards funded research surveyed a sample of 20 midwives in London to explore the care provided by midwives for ethnic minority women with high-risk pregnancies. did. The findings, while specific to a small group of midwives in a single location, provide evidence of racism and prejudice.
Black and Asian women were reportedly not listened to or taken seriously. One midwife participant said that “things could have been different” if the woman she was caring for had listened to her earlier. Another midwife observed that “there are a lot of stereotypes that black women don’t want to take their health seriously”. The study found that some midwives held negative attitudes towards migrant women who were ineligible for free healthcare. In turn, these women were often too afraid to seek care for fear of being charged for care.
Broader social issues add further complications. One participant in the research suggested that families from minority backgrounds that relied on zero-hour contracts or did not have adequate childcare provision would be less able to attend appointments.
Asylum-seekers and refugee women face particular difficulties in obtaining help when pregnant, as described in a report by One of Us (Amanda Firth), the findings of the research also financed by the Mary Seacole Awards. nourishes. This study looked at mental health care and found that asylum seekers and refugee women had difficulty communicating, often because they were not offered the use of an interpreter. Difficulty accessing interpreter services meant that midwives resorted to the use of Google Translate, or preferred communication about physical rather than mental health.
looking for solutions
Tips to address the adverse birth outcomes faced by black and Asian women are often too narrowly focused or misguided. One proposed recommendation, for example, is that women from ethnic minority backgrounds should consider having their pregnancy induced (when labor is artificially initiated) at 39 weeks, as this would reduce the risk of stillbirth. can go.
Such proposals may reinforce racial profiling and prejudice about women from minority backgrounds and their pregnancies. Instead, there is a need for an approach to risk management that considers each woman and her pregnancy individually.
Evidence shows that continuity of care – when a specialized midwife follows women through pregnancy, birth and the postpartum period – can make a real difference. This continuum extends to consistently positive outcomes for women and children in socially disadvantaged and ethnic minority groups.
Another recent study found that targeted caseload midwifery, which prioritizes continuity of care and involves more and longer appointments, some of which are at home, had a positive effect. In a disadvantaged and diverse inner-city population, this model of care reduced premature births and births by caesarean section.
Ultimately, such measures can be part of the solution. Fundamental policy and system changes that prioritize anti-racism, along with educational interventions, are needed to ensure that all pregnant women receive the care they need.
The authors do not work to consult, own shares in, receive funding from any company or organization that would benefit from this article, and have not disclosed any relevant affiliations beyond their academic appointment.