The lack of Black midwifery leadership at board level in the NHS in England –why aren’t we represented?
This is Black History Month, and it is a time of celebration of Black history and progress. As we reflect on how far we have come in the journey of equality and diversity, we are reminded by current events that we still have some way to go. As a senior midwifery leader who worked in the NHS for 32 years, I have anecdotal knowledge that Black colleagues in the NHS regularly raise concerns about discrimination and the lack of opportunities for Black midwives in midwifery leadership.
Moreover, there are specific issues regarding how colleagues view black leaders as ‘special’ in a condescending way, especially at the Trust board level. A reason might be that racial diversity is uncommon at the strategic level where decisions that shape cultures in the NHS take place. This begs the question of what factors might influence ethnic diversity at the senior leadership level in midwifery? Is it your ethnicity and network? Or do years of experience, dedication, education, and training, count for anything. I will seek to find the answers to these questions through the research I will be conducting. I will examine the barriers and facilitators in leadership for Black midwives.
What do we know about the state of Black leadership in midwifery today?
Contested findings of the UK Government report on race disparities suggest that many ethnic minority groups have better outcomes than the white population (Commission on Race and Ethnic Disparities 2021). However, research indicates that race discrimination in the NHS has continued to increase over the last five years, with London performing the worst in the country (Rhead, et al., 2020). Furthermore, research suggests that midwives from ethnic minority backgrounds have raised concerns about the lack of diversity within senior midwifery leadership roles (Saifeldeen, 2020).
In contrast, NHS Digital (2020) data suggest that BME midwifery leaders from band 8a and above are proportionate to their White European-heritage counterparts. On closed analysis, the data indicates that no midwifery leaders were reported at band 8d and above in any NHS Trusts in England. The lack of diversity at this level is significant because it is at this level that leaders will usually have access to the Trust boards and be able to influence strategy. Clearly, the lack of diversity at the senior leadership level of band 8d and above raises serious questions about structural inequality in the NHS (Razia, et al., 2021). Therefore, it is essential and urgent to conduct primary research to understand these phenomena and their effects.
It has been shown that discrimination negatively impacts the health and well-being of members of ethnic minority groups in the NHS (Rhead, et al., 2020). The under-representation of ethnic minorities at strategic levels affects patient care (Rhead, et al., 2020). The Confidential Enquiry report into maternal deaths has consistently shown over the last decade that Black mothers are more likely to die during childbirth (MBRRACE-UK 2020).
Given this, my research study aims to understand the complexities of Black midwives’ careers in the NHS and to learn more about how the participants came into midwifery, their leadership journey and experiences of organisational processes concerning leadership. The study also seeks to explore the institutional challenges and the enablers and the impact that these have had on Black Midwives’ careers and the service. I hope findings from this study will promote equality in NHS midwifery leadership to represent the diverse population we serve.
As we celebrate diversity during this time, I will be creating a space for midwifery leaders to reflect on their lived experiences by taking part in my national study. ‘Watch the space’.
Commission on Race and Ethnic Disparities (2021). The report of the Commission on Race and Ethnic Disparities. [on-line] Available at: <https://www.gov.uk/government/publications/the-report-of-the-commission-on-race-and-ethnic-disparities> [Accessed: 30 Aug, 2021].
MBRRACE-UK (2020). Saving lives, improving mothers’ care: Lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2016-18. MBRRACE-UK https://www.npeu.ox.ac.uk/mbrrace-uk/reports [Accessed: 30 Sept 2021]
NHS Digital., 2020. NHS Hospital and Community Health Services (HCHS): Midwives by Ethnicity and Agenda for Change (AfC) band, in NHS Trusts and CCGs in England, as of 31 December 2020, headcount. (Freedom of Information through Royal College of Midwives, December 2020), England.
Razia, M., Majeed, A. and Esmail, A., 2021. Structural racism is a fundamental cause and driver of ethnic disparities in health. [on-line] Available at: <https://blogs.bmj.com/bmj/2021/03/31/structural-racism-is-a-fundamental-cause-and-driver-of-ethnic-disparities-in-health/> [Accessed: 30 Aug, 2021].
Rhead, R.D., Chui, Z., Bakolis, I., Gazard, B., Harwood, H., MacCrimmon, S., Woodhead, C. and Hatch, S.L., 2021. Impact of workplace discrimination and harassment among National Health Service staff working in London trusts: results from the TIDES study. BJPsych Open, [e-journal] 7 (1), pp.0. https://doi.org/10.1192/bjo.2020.137[Opens in a new window]. Available through: google <https://www.cambridge.org/core/journals/bjpsych-open/article/impact-of-workplace-discrimination-and-harassment-among-national-health-service-staff-working-in-london-trusts-results-from-the-tides-study/609C67DB9ABF46179D5B079325880BC7> [Accessed 24 June 2021].
Saifeldeen Laila, 2020. Recognising White Privilege: Moving Towards Anti-Racism as a Student Midwife | All4Maternity. https://www.all4maternity.com/, [e-journal] 3 (4), pp.0. 0. Available through: google <https://www.all4maternity.com/recognising-white-privilege-moving-towards-anti-racism-as-a-student-midwife/> [Accessed 12 July, 2021].