Healthy Mind
Maternity Outcomes for Women of Colour
Eloise Edington | 18 Oct 2021
Maternity death rates for women of colour and their babies are considerably higher than those of white women, which is the fault of systemic racism and medical bias that is more prevalent today than it ever has been. For women of colour, the fear that their pregnancy could result in danger either to themselves or their baby will undoubtedly cause a lot of stress.
At Fertility Help Hub, we want to make sure you have access to campaigns and advice that could potentially help you while you are TTC or pregnant and are worried about your birthing experience. To find out what steps are being taken to tackle racism and protect women of colour from medical neglect, read on.
By Katherine Compton
Why are more women of colour dying in or after labour compared to white women?
Pregnancy and maternity outcomes for women of colour are much worse than for white women due to systemic and institutionalised racism that is still very much prevalent in education and medicine today. In the US, black women are 3-4 times more likely to die in childbirth or during the year following childbirth. Meanwhile in the UK, women of colour are five times more likely to die from the same instances when compared to the mortality rates of white women.
The statistics of maternity-related deaths for women of colour and white women are staggeringly different as shown in the results of this study conducted in 2017:
White women -17.3 women died out of 100,000 births
Black women – 41.7 women died out of 100,000 births
Disparities in maternal and infant mortality are rooted in racism. Structural racism in health care and social service delivery means that African American women often receive poorer quality care than white women. It means the denial of care when African American women seek help when enduring pain, or that health care and social service providers fail to treat them with dignity and respect.
– The Centre for American Progress
Is it safer to have a home or hospital birth?
Giving birth in a hospital can be one of the most terrifying aspects of being pregnant as a black woman. However, home births are not recommended by the NHS if this is your first pregnancy and most insurance providers in the US do not cover home birth costs as it is now considered a luxury for those that can afford it, instead of a necessity for those who need it.
However, home births can offer a sense of control over your birth experience and the surrounding professionals can consist of trusted fertility specialists chosen by you. Home births can also offer better survival rates to women of colour, provided that the patient had their first birth in a hospital and has discussed this decision with their midwife, medical provider or fertility specialist.
A need for more women of colour in perinatal job roles
Research would indicate that women of colour have reportedly safer birth outcomes when in the care of midwives or fertility specialists that are from an ethnic minority background or of a similar heritage to the patient. Professor Dunkley-Bent found evidence that women prefer to be taken care of at all stages of fertility, pregnancy, birth and aftercare by “someone who looks like them.”
Jamille Fields Allsbrook, the director of the Women’s Initiative at the Centre for American Progress, says: “There is a shortage of doulas and midwives of colour and that has an impact on maternal outcomes for women of colour and black women. We need to improve and diversify the workforce.”
Midwives and doulas are a cultural norm for indigenous women and women of colour and yet over time they have both become a privilege for wealthy, white women. This has made midwives and doulas essentially inaccessible to women of colour from poorer backgrounds.
Midwifery has become a profession that consists of predominantly white women. This creates additional safety anxiety for women of colour as they are more likely to be cared for by a white midwife who could potentially neglect to listen to their concerns. Now more than ever there is a greater demand for midwives who are women of colour.
Jamille Fields Allsbrook says: “Women, in general, are more likely to have any of their complaints about pain ignored. Black women are even more likely to have their pain ignored — especially around childbirth.” She continues: “If people like Beyonce and Serena Williams are having trouble getting the right maternal and postpartum medical care that they need, just imagine the barriers that other people of colour are facing.”
Fields Allsbrook is a specialist in health care for women of colour, and through her findings she discovered that systemic racism is the driving force of medical neglect against women of colour. She says: “Even when you divide the data up for protective factors, geographic location, education, etc., all these things that supposedly lead to better health outcomes — racism comes up again and again.”
What action is being taken to protect women of colour?
There are some things that have been set in place in both America and the UK to attempt to improve the current circumstances that lead to higher maternity death rates for women of colour. This need for change was initiated by the Black Lives Matter movement:
- The American Public Health Association (APHA) and several states acknowledge that racism is a public health crisis
- The Black Maternal Health Momnibus Act of 2020 aims to extend postpartum healthcare coverage to a year (it currently only covers 60 days following birth) and fund local community care groups to improve medical care and maternity outcomes by diversifying the perinatal workforce. This bill was presented in March 2020 but no further action has been taken since
- The Perinatal Workforce Act of 2020 aims to fund education that studies medical care that takes into consideration preferred cultural values and beliefs of the patient. The bill was put forward in March of 2020 but no further action has been taken on it since
- The University of Manchester NHS Foundation Trust are encouraging women of colour to seek out midwifery as a career option as part of a new £95m programme. This will include funding for maternity services, related projects and training more midwives from an ethnic minority background
- The Race Equality Taskforce launched by the Royal College of Obstetricians and Gynaecologists (RCOG) is attempting to reduce the greater risk for women of colour.
- On 20th April, new guidelines were established by the National Institute for Health and Care Excellence. These guidelines demonstrate that women of colour are dying disproportionately to white women shortly after giving birth. These guidelines have been created in the hopes that healthcare professionals will understand that they need to offer equal and considerate care to all their patients.
Other, more promising movements for change are those created by independent persons and organisations such as:
Five X More – an organisation co-founded by Tinuke Awe, whose pains and concerns were ignored while giving birth, leaving her without pain relief for the entirety of her labour, which ultimately led to her exhaustion and assisted birth requiring forceps. Due to this awful experience, Tinuke Awe started the Five X More campaign to help empower women of colour.
BAME Maternity Matters or “Birthing With Colour” – another promising group that also seeks to inform women of colour about healthcare and pregnancy services.
The Black Lives Matter movement has also helped to educate people about racism and encourage action for change while exposing the way that racism negatively impacts the care people of colour receive in hospitals and other such environments.
What else can be done to change things?
Diversify the perinatal workforce — this begins with raising awareness amongst women of colour about career opportunities to work in the perinatal workforce and making education more affordable (through grants and scholarships) and therefore more accessible
Address institutionalised bias and racism — this should be incorporated into training and education for all medical staff
Improve healthcare insurance coverage — in the US, healthcare coverage should extend to a year following birth to prevent deaths of women of colour
If you are a woman of colour, we hope that the necessary steps being taken to tackle racial bias, as outlined in this article, can give you some comfort and that you have found the names of groups which can be of further help.
If you feel as though you need an infertility community to talk to, feel free to download our free Fertility Squad app.
