The call for changing birth outcomes for black and indigenous people of colour, and what we can do to break the cycle
This article highlights the inequality birthing BIPOC women face and how we need to challenge the system to change outcomes
The reality for birthing BIPOC women is that, statistically they face a significantly higher chance of dying during or after childbirth in the UK-in comparison to Caucasian women.
The Facts
The NPEU at the university of Oxford published a report in 2018 as part of its MBRRACE-UK work, within this care report statistics showed that the risk of Asian women dying during, or in the year after childbirth was twice as high compared to Caucasian women, and Black women were a shocking five times more likely to lose their lives. Previous reports had already highlighted this issue of inequality, and the shocking injustice that the discrepancy is continuing to grow.
To acknowledge the implicit biases in UK healthcare systems that affect patient outcomes, first there has to be a willingness to engage in the debate. Awareness is key to bringing the measures necessary to change outcomes for the mothers and babies behind the numbers.
The stark fact is UK healthcare systems do not accommodate for our ethnically diverse population, and present bias, systemic racism and lack of awareness has exacerbated the inequality and inadequate treatment of BIPOC women, and disparity between BIPOC and Caucasian births. Going forward, we are being asked to step up to change what is happening and support the equal rights, dignity and respect that all women deserve, and enable them to birth their babies safely.
Why is this happening?
Stereotypical narratives of vulnerability due to lack of language skills and low socioeconomic status are key factors that contribute to the way BIPOC women are treated. These outdated assumptions show statistically In the 2018 report- of the BIPOC women that lost their lives 96% spoke English and 63% were born in the UK.
Birthworkers' observations have been that educated and articulate BIPOC women are often at risk of being treated worse because they challenge institutional protocols and stereotypes. Many first hand accounts refer to women being ignored-shut down and denied their right to be treated with respect, and instead receiving prejudice and ignorance, having concerns and fears treated disrespectfully and responded to inadequately.
Caucasian “norm”
UK healthcare systems rely on statistical base analysis from data of Caucasian women. The base rates for BMI, body types, and potential risk factors are designed to fit western women as if they are the ‘norm’. Comparing BAME women to white women is not only unacceptable standardised supremacy, but exposes the blindness and inequality of dominant ideological narratives.
The damage of using theoretical statistically average white women as a baseline assessment is not only a shameful example of racial inequality, but fails to recognise or understand the human variation of many women. This inevitably leads to many BIPOC women and babies becoming victims to the perceived white supremacy that medical and institutional protocols continue to support.
Many BIPOC Women are subjected to obstetric led interventions for their “risk factors'' measured inaccurately against, and compared to a BMI and baseline norms that do not accommodate ethnic range and diversity. By denying equality and failing to accommodate the natural and healthy range of multi racial women, healthcare systems put BIPOC women at severe risk by making assumptions made based on highly outdated Caucasian narratives.
Medical factors
The main direct medical causes that statistically affect more birthing Black women are thrombosis and haemorrhage, and statistically BIPOC women are more likely to experience preeclampsia and gestational diabetes, in comparison to caucasian women, both which are considered high risk. However the third most frequent cause of maternal death is suicide. This outcome questions support available from mental health services and also highlights a potential lack of support available for new mums within their community and wider society.
If evidence based studies prove that some pregnancy related problems are concentrated in specific ethnic groups, this provokes further questioning as to whether the conditions are caused by, or increased from lifestyle factors such as stress, diet, social and economical factors- if so then the question would need to be asked whether systemic inequality is continuing further down the line.
What happens when you don’t fit into the “norm?’
More interventions-
BMI used to calculate a woman’s health is not evidence based and varies dramatically from country to country, for example- typically some Asian women have a smaller build compared proportionally with the average Caucasian perceived “norm” Due to being measured against ratios that are not relevant or reliable determines them to be at “risk” which results in limited birthplace options (birth centres/home births and instead hospital births) and hypervigilant monitoring and interventions which are imposed because of the inaccurate norm and inconsistencies between trusts guidelines on diagnostic criteria.
The ratios determined to be “normal” from a Caucasian based perspective doesn’t determine anything about a woman’s health, body shape, or their ability to birth, yet these narrow parameters are used to determine and limit birth options.
Restricted options-
Restricted options and limited choice have a huge effect on the rights of a woman to be able to birth in a way she would choose to. The environment in which a woman gives birth determines her experience and the risks and complications introduced because of bias are the very narratives that should be being used to encourage and empower positive and safe birth for women, but instead are not only doing the opposite, but are actually causative of death during childbirth.
Intervention-coercion and non negotiable options
Women who repeatedly challenge obstetrician led decisions are often referred to increasingly senior staff who continue to back up the theory and guidelines for Caucasian women, even when it's explicitly obvious that the women in question are a healthy norm for their ethnic group.
These additional appointments and uninformed decisions made by healthcare professionals show a real lack of respect and a trend towards the coercion of intervention. The discomfort of knowing restricted birth choices decided are not only completely uninformed, but also non negotiable, are an abuse of basic human rights of birthing women. This systemic racist bias, which statistically leads to a higher chance of death, shows ineffective institutional standardisation relying on protocols that undermine decision making, ability, intellect and autonomy of BIPOC women.
How can outcomes improve?
Find this horrifying? Want to make a difference?
We make a difference by bringing this information forward into the light.
The present UK healthcare systems are oppressing women and their right to birth safely.
Together we can take responsibility by addressing this inequality through our own individual awareness, and by raising deeper awareness within our society.
NHS and private healthcare, although aware, are well overdue a reform. Within the birth world, Doulas are amplifying BIPOC women's voices, and as birthworkers, we are working to ensure necessary change can come. By tending to the ground work and raising awareness we can begin the steps to invite in equal birthing rights for all women.
Future forward thinking to change BIPOC birth;
Reformation of Incorrect care models
BIPOC women treated statistically with data from own individual ethnic groups
Accountability from trusts
Systemic restructured attitudes and practices
Education for medical professionals
Realistic standards nationwide
Care staff acting with awareness
Continuity of care- relationship between maternity staff and mothers
Ethics of diversity supported
To campaign for BIPOC birthing equality or be involved in a 2021 petition, you can sign up for information through the Newsletter.