An urgent inquiry into systemic racism in the NHS and how it manifests itself in maternity care was recently launched. The inquiry ‘Systemic racism, not broken bodies: An inquiry into racial injustice and human rights in UK maternity care,’ was undertaken by UK charity Birthrights. It came off the back of the latest report by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK), in which the data showed that women from ethnic minorities continue to be more likely to suffer an adverse outcome in pregnancy and childbirth compared to white mothers.
Common Themes Found in the Study
Several common themes emerged during the inquiry.
Lack of physical and psychological safety
This was the most prominent, recurring theme from Birthright’s findings. Two-thirds of the women who shared their stories described not feeling safe, and many participants reported that racism and discrimination had directly impacted their safety. Examples included a failure to recognise serious complications such as jaundice and sepsis in ethnic minority mothers and babies. Unsafe care such as this can lead to medical negligence claims.
Being ignored and disbelieved
Several accounts described being ignored during their maternity care, and in particular, having their pain minimised and concerns dismissed.
Racism by caregivers
The inquiry found multiple accounts of healthcare professionals who displayed racist attitudes, behaviours, or beliefs, with two-thirds of respondents believing that their race, ethnicity or religion negatively impacted the care they received. Many of those who responded to the inquiry reported being subject to microaggressions, which have been shown to cause significant harm to health.
Dehumanisation
The inquiry found that ethnic minority people are frequently subject to dehumanisation in maternity care. There was a lack of respect and empathy and women reported feeling blamed when their bodies did not behave ‘as expected’ during pregnancy, labour and birth.
Lack of choice, consent and coercion
Across maternity services, there are issues with consent not being properly sought, women being coerced into procedures or situations they’re not happy with, a lack of choice and sometimes even obstetric violence. These are not unique to ethnic minority groups, as demonstrated by the Ockenden Report. However, when combined with systemic racism in the NHS, they can make women from ethnic minorities even more unsafe during their maternity care.
Structural barriers
This included a lack of interpreters in maternity care and NHS charging for those with refugee, migrant, or asylum seeker status. At times, these barriers posed serious risks to care.
Workforce representation and culture
The inquiry also investigated the views of professionals working with maternity services and found that racism and discrimination affected healthcare workers’ abilities to provide high-quality care to birthing people and their families.
How Human Rights Apply to Maternity Care
Human rights are enshrined in maternity care. Article 2 of the Universal Declaration of Human Rights (UDHR) is the right to life. Every birthing person has the right to safe maternity care and if they are harmed as a result of poor maternity care due to systemic problems then the state has violated this.
Article 3 prohibits inhuman and degrading treatment. In maternity care, this might be violated if a professional performs a procedure without gaining consent, fails to provide adequate pain relief or through racist abuse or behaviour.
Article 8 of the UDHR protects the right to private and family life and relates to maternity care as it includes choice about where and how to give birth. Meanwhile, article 9 protects a person’s religious beliefs, customs and choices, including those relating to healthcare, birth and parenting. Finally, article 14 of the UDHR prohibits discrimination on any grounds.
What Can Be Done to Improve Healthcare For All?
It is clear that changes need to be made to make maternity care safer for ethnic minority groups. Based on the evidence Birthrights gathered through the inquiry, they set out five calls to action in order to achieve racial equity in maternity care.
- Commit to being an anti-racist organisation
- Decolonise maternity curriculums and guidance
- Make women of all ethnicities decision-makers in their care and also in the wider maternity system
- Create workforce cultures that are both safe and inclusive
- Utilise national policy change to dismantle structural barriers to equality
At the start of 2022, the government set up a new task force to level-up maternity care and tackle disparities. The focus of this task force will be to improve access to maternity care and address current inequalities to improve experiences and outcomes.
