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An urgent inquiry to investigate how suspected systemic racism in the NHS manifests itself in maternity care will be launched on Tuesday with support from UK charity Birthrights.
The survey will apply a human rights lens to examine how claimed racial injustice – from overt racism to prejudice – leads to poorer health outcomes in maternity care for ethnic minority groups.
Data released last month by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Inquiries across the country) showed that black women were four times more likely than white women to die during pregnancy or childbirth. in the UK, while women of Asian descent. face twice the risk.
Lawyer Shaheen Rahman QC, who will lead the investigation, said: “In addition to these startling statistics, there are concerns about higher rates of maternal illness, worse maternity care experiences and the fact that black and Asian pregnant women are much more likely to be admitted. in hospital with Covid-19.
“We want to understand the stories behind the statistics, examine how people can be discriminated against because of their race, and identify ways to address this inequality.”
A group of experts including a human rights lawyer, a clinical negligence lawyer, doulas – trained health companions – obstetricians and midwives will oversee the investigation.
Rahman will be assisted by two co-chairs, including Benash Nazmeen, director of the Association of South Asian Midwives. “As a 13-year-old midwife and aunt, I have witnessed, heard and felt the discrimination that South Asian communities face,” she said.
“The repeated questions based on racial stereotypes, dangerous prenatal conversations due to cultural and communication barriers, and the appalling statistics that Pakistani women are more likely to have a premature baby or neonatal death in the UK by in relation to their country of origin – there are also many concerns that need to be explored and addressed. “
Research published in 2013 found that women from ethnic minority groups had a poorer experience of maternity services than white women. They were more likely to deliver by emergency cesarean, less likely to provide pain relief during labor, and received fewer home visits from midwives. Baby loss rates are also higher for these groups, according to the findings of MBRRACE-UK.
Amy Gibbs, CEO of Birthrights, said: “Many black and brown people in the birthing world are understandably frustrated with calls for more research when what is needed is to act. This survey will assume that racism exists in our society, so it must exist in the NHS.
Gibbs added, “We know that many healthcare workers provide safe and respectful care to everyone, regardless of ethnicity. But the evidence shows persistent inequalities in motherhood outcomes and experiences. We want to understand how racial prejudice and systemic racism impact people’s basic rights during pregnancy and childbirth, so that we can be honest about the harm done and what needs to change.
The investigation is particularly urgent given how existing inequalities have been exacerbated by Covid-19. Black pregnant women are eight times more likely and Asian women four times more likely to be admitted to hospital with Covid-19 than white women.
A new role of head of midwifery research has been created by NHS England to focus on health inequalities associated with maternity outcomes for mothers and babies from Black, Asian and ethnic minority families. Professor Jacqueline Dunkley-Bent, Head of Midwives for England, said: “Research is just one of the tools we will use to improve maternity care for these mothers and their babies.”
She added: “Everyone working in maternity wards wants all women to receive the safest care possible, which is why as soon as there is evidence of increased risks for pregnant women from black, Asian and ethnic minorities giving birth during the pandemic became evident, these women were stimulated.
An initiative where women from these ethnic groups are seen by the same midwife and the same team throughout their pregnancy, childbirth and postnatal period to ensure continuity of care is being accelerated by the NHS.
Case Study: “ The Midwife Was Trying To Turn Me On ”
After giving birth with agonizing contractions in March 2016, Sandra Igwe went to the hospital and was sent home five times before finally being admitted. Previously, she had felt judged and suffered alleged racism during a pregnancy appointment, which led to a letter of apology from the hospital.
But she says she was shocked that during childbirth and while feeling the most vulnerable, she was once again faced with such treatment. “They wouldn’t believe I was in active labor,” she explained. “The midwife said my cries of pain did not coincide with my contractions and that they withheld an epidural for hours.
“The midwife was trying to turn me on, it was horrible. They kept asking “why are you screaming?” and I said I was “rude”.
She says it wasn’t until her baby’s heart rate dropped and she was sick that she was taken seriously.
The experience led her to suffer from postnatal depression which was not diagnosed. Feeling isolated after the birth of her daughter, she created a social enterprise to amplify the voice of black mothers called Motherhood Group which has continued to support hundreds of women.
Igwe, who will co-chair the investigation, said: “Racism in maternity care in the UK is insidious and because it is secretive and subtle it is difficult to describe how you feel. The strong streotype of the black woman is killing us. We should be allowed to be vulnerable and to cry out in pain.
She fears that too many mothers have postpartum depression that goes undiagnosed. “Black mothers don’t trust the health care system and they don’t seek support because when we do, we are fired and ignored and the information we share is used against us.”
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