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Tracey Bignall: Reflecting on racial justice in maternity services

The disparities in maternal outcomes for Black, Asian and minority ethnic women have been known for some time.

For around 10 years, the MBRRACE confidential inquiry into maternal deaths regularly highlights the poorer outcomes in maternal deaths and stillbirths for these women. Other research has also identified the racism, discrimination and poor levels of care that Black, Asian and minority ethnic women have experienced from maternity care.

The 2015 National Maternity Review led to the maternity transformation programme following the publication of Better Births in 2016.  But there was no direct focus on maternal disparities for minoritised women.

These poor outcomes have remained in the public eye and we saw the House of Commons hold a debate and produce a briefing for Black Maternal Health Week in September 2021. Research studies and articles about these maternal disparities, again and again raise the need for more research to ‘understand why Black women are five times more likely and Asian women twice as likely to die compared to White women’ (MBRRACE 2018); and to find out the specific causes of the deaths of Black, Asian and minority ethnic women.

Given these health inequalities, there is the need to not only explore the evidence but also look at what can be done in practice to improve the situation for these groups of women. There is action outlined in the NHS Long Term plan and more action recently, following the impact of Covid-19 on these women, as well as the CORE20 Plus 5 agenda targeting continuity of care in maternity for 75% of Black, Asian and minority ethnic women from the most deprived groups. But the level of urgency to address poor maternal outcomes does not seem to be reflected in the slow pace of change for these women using maternity services. 

I was therefore honoured in 2020 to be asked to be a member of the Expert Panel for the Inquiry into Racial Justice in Maternity Care supported by Birthrights. The panel is made up of those with practical experience of providing maternity care, legal services and who, like myself, have an interest in racial inequality in maternity care.

I also had the opportunity in March 2021 to highlight at a Public Policy Projects International Women’s Day event the health inequalities that Black, Asian and minority ethnic women face in maternity services. But involvement in the Expert Panel enabled a better exploration of the system, processes, and practices – and of course the impact on the women themselves.

The oral evidence sessions provided an opportunity to hear first-hand experiences of women’s negative and often distressing experiences. We were also able to question the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, and National Institute for Health and Clinical Excellence about their guidance, practices and what they themselves are doing (or intend to do) to address racial inequalities and improve experiences and outcomes for Black, Asian and minority ethnic women.

What I found most disturbing was hearing from women who had experienced racism, stereotyping and poor practice about the devastating impact it had on them, at a time when they were in a vulnerable position and should be supported.

Something must be done to improve the situation urgently.

The call to action in the Inquiry report covers all those involved in maternity care. I hope the relevant organisations take proactive action in response to the Inquiry report, to ultimately reduce the disparity gap. More importantly, we must see that the human rights of Black, Asian and minority ethnic women in maternity care going forward are upheld.

Tracey Bignall is a Senior Policy and Practice Officer at the Race Equality Foundation.