Black mothers’ lives matter
Black pregnant women are five times more likely, and Asian women twice as likely, to die during pregnancy and childbirth than white women. For those of us who have dedicated our careers to supporting pregnant women to give birth safely and healthily, in fact for anyone, these statistics, published in last year’s MBRRACE report, are chilling. Yet, despite these disparities in maternal and newborn health being highlighted over a number of years, still so little is understood about the reason why.
The RCM is determined to change this. As part of our Race Matters campaign, launched in June, we committed to support research and champion positive change in outcomes for pregnant black, Asian and minority ethnic (BAME) women. We recognise that we cannot do this alone, that we will need to work alongside others and secure the support from policymakers and commissioners, but we will not allow that to be a barrier to delivering positive change.
The COVID-19 pandemic has magnified the entrenched health disparities in health. The UK Obstetric Surveillance System (UKOSS) study found that 55% of pregnant women admitted to hospital with coronavirus were from a black or Asian background. In context, black pregnant women are eight times more likely to be admitted to hospital with COVID-19, while Asian women are four times as likely. The RCM responded quickly to the growing evidence, publishing guidance on caring for black, Asian and minority ethnic women during the pandemic.
These inequalities in health continue to widen, and although the MBRRACE and UKOSS reports do provide a lot of useful information and themes, there are still too many things we don’t know or understand:
- While the leading direct causes of maternal deaths overall were thrombosis and haemorrhage and suicide, we do not have the causes broken down by ethnicity.
- The report doesn’t address possible correlations between the deaths and deprivation.
- It isn’t possible to see from the report whether a higher percentage of the BAME women who died had substandard care.
It is vital we start to unpick each layer of complexity and recognise why maternal morbidity and mortality rates are greater for BAME women than those for white women.
A key element of the role of the midwife is to be an advocate for the women in our care. Midwives have a long and proud tradition of providing care that addresses health inequalities. We have focussed on addressing the higher rates of smoking and drug and alcohol use among the most deprived in our society; providing additional support to young teenage parents and women with mental health challenges and setting up services tailored to supporting overweight and obese women to make positive lifestyle changes. The time has come to focus our efforts on addressing the health inequities faced by the BAME women in our care.
- Women’s Health article about the disproportionate impact of COVID on BAME people
- Report by RCM Fellow and Mary Seacole award winner Sarah Chitongo on midwives’ experiences of caring for high risk BAME women.
- Why are Black mothers more at risk of dying? BBC report, April 2019
- 'Diverse, not defective' AIMS Journal, 2019, Vol 31, No 2
- Harvard School of Public Health, articles from 2019 on the situation in the USA