Maternity safety — why race matters
We take a look at the very real ongoing issue of race in women's healthcare services; where we currently stand, and what the future holds.
On 9 September 2021, we were proud sponsors at the National Maternity Conference hosted by Baby Lifeline. Whilst the conference was insightful and uplifting, it did highlight the very real and ongoing issue of racial inequality in maternity and women’s healthcare services. The conference also offered some ideas as to how these issues could be addressed.
Why do we need to talk about race?
- Statistics show that black women are five times more likely to die in pregnancy, childbirth or in the six-month postpartum period compared with white women and the risk for Asian women is twice as high.
- During the pandemic, 55% of pregnant women admitted to hospital with Covid-19 were from a black, Asian or other minority ethnic background despite the fact that 13% of the UK population identify themselves as BAME.
- There is a significant gap in understanding the factors that result in a higher risk of morbidity and mortality for BAME women in the UK.
At the conference, Dr Christine Ekechi, Consultant Obstetrician and Gynaecologist at Imperial College Healthcare NHS Trust, talked about why racial inequality exists. The factors include BAME women being less likely to be involved in decision-making, pre-existing medical conditions, greater social deprivation and sadly, structural racism.
There is also the issue of what is referred to as “stereotype threat.” This occurs when a member of a social group worries that what they do or say may confirm some stereotype about their group. It was discussed at the conference that this has the potential to affect health outcomes in three ways: avoidance of medical interactions, impaired communications during medical interactions and poorer medical adherence. It is not difficult to see, therefore, why this will impact upon the care provided and in turn lead to increased adverse outcomes for BAME women.
Where are we now?
The extent of the issue is such that in July 2020, The Royal College of Obstetricians and Gynaecologists (RCOG) launched a Race Equality Taskforce to better understand and tackle racial disparities in women’s healthcare and racism. The taskforce is aimed at reducing adverse health outcomes experienced by BAME women and implicit racial bias experienced by healthcare professionals. Dr Edward Morris, President of the RCOG, commented that “The creation of a Taskforce is one important step towards eradicating health disparities in women’s healthcare and in the medical workforce in the UK. The Taskforce aims to highlight where health disparities exist, improve our understanding of the causes behind inequalities and collaborate with government to create meaningful solutions to improve healthcare experiences and outcomes for all ethnic minority women.”
MBRACE UK, as part of the Maternal, Newborn and Infant Clinical Review Programme, has recently published Rapid report 2021; Learning from SARS-CoV-2-related and associated maternal deaths in the UK, June 2020 – March 2021. The cases studied included those from the BAME community and mirrored previous study findings reporting that women who are members of an ethnic minority group are shown to be at a greater risk of poor outcomes. The report concluded that cultural and structural biases must be tackled to ensure pregnant and postpartum women do not continue to be subject to this unacceptable inequity.
In May 2021, the Government launched a Continuity of Carer Tool Kit for midwives and health visitors to encourage “relationship care”. The benefits are intended to include earlier identification of women in need of targeted support, better ability to share relevant information between midwives and health visitors in a timely manner and aligning service commissioning and pathways. Overall, the initiative aims to ensure that women and their partners are given the same consistent and evidence-based information throughout their maternity journey, supporting them to understand when and how their health information will be shared, and enabling care to be tailored to their needs.
The themes identified within this article were given momentum as part of the Black Maternity Scandal and Black Lives Matter protests last year. The issues are real and impact upon the quality of care that women receive. The recent reports have highlighted the issues and the impetus must now be on facilitating the changes needed. We are hopeful that the increased awareness generated and the Toolkit will enable clinicians to take a more holistic approach to assessing risk, therefore reducing adverse outcomes. It must be considered that those trusts which fail to introduce measures to reduce risks for patients from BAME backgrounds are likely to face civil claims for compensation in the future. Given that we are now seeing maternity claims valued at in excess of £30 million there is a financial imperative, but also a greater moral imperative to make patient safety improvements if it can spare one child or one mother from suffering harm or dying at birth.
17 September 2021 marks World Patient Safety Day 2021. We are committed to diversity and inclusion, and spreading and embedding patient safety whilst working alongside NHS Resolution and Trusts.