Whilst the majority of outcomes for pregnant women and their babies are positive, the stark truth is that Black, Asian and minority ethnic (BAME) women have a greater chance of suffering a poorer experience or health outcome when compared to white women.
Findings from the MBRRACE-UK 2015-17 report (published in 2019) shocked the nation. This study found that Black women have more than five times the risk of dying in pregnancy or up to six weeks postpartum compared with white women. Furthermore, women of mixed ethnicity have three times the mortality risk and Asian women have almost twice the risk compared to white women.
Addressing health inequalities is a key priority for the Royal College of Obstetricians and Gynaecologists (RCOG) and, therefore, we hosted an International Women’s Day event on 6 March 2020 – entitled ‘We need to talk about race’ – to expand our understanding.
It quickly became clear that the reasons for these stark health inequalities are complex and are not yet fully understood. Reasons may include socio-economic factors, poor access to antenatal care and other women’s health services and a gender and ethnicity data gap in medical research.
A growing body of research in America also shows that disparities in health outcomes clearly exist despite socio-economic factors and other demographic variables.
Implicit racial bias, though often unconscious and unintentional, can also lead to poorer health outcomes and experiences for Black, Asian, and minority ethnic women which can hinder consultations, negatively influence treatment options and can ultimately result in Black, Asian and minority ethnic women avoiding interactions with health services.
Since then, the COVID-19 pandemic hit the world, and this has shone a light on some of the health disparities that exist in maternity care.
A higher proportion of pregnant women from BAME groups have been admitted to hospital with COVID-19 when compared to white pregnant women and current data suggests that BAME men and women have a greater risk of death from coronavirus than white people in England and Wales.
It’s important to remember that an individual woman and her family lies behind every shocking statistic; a woman who has died or suffered a poor health outcome, sometimes along with her baby, which, in some cases, could have been avoided.
This is completely unacceptable. All women, irrespective of location, age, or ethnicity, should be able to access the same high-quality care and we, as clinicians, have a duty to ensure that care is the best it can be for everyone.
Therefore, in July 2020, the College launched a Race Equality Taskforce to tackle racial disparities in women’s healthcare and racism within the obstetrics and gynaecology workforce.
As a Co-Chair of the Taskforce, I am completely committed to tackling these deplorable outcomes for Black, Asian and minority ethnic women. I believe that the solutions to preventing unnecessary harm require a committed collaborative effort between clinicians, Government and women to ensure that the gap in health outcomes is eradicated.
The FiveXMore ‘five steps’ campaign is a useful tool for Black, Asian and minority ethnic women to use in all healthcare settings, not just in maternity care. As the campaign notes, women should speak up if they feel something is not quite right, they should seek a second opinion if they feel the need to and they should always trust their own feelings and seek help if they think something is wrong.
It will not be easy to eliminate inequalities in women’s healthcare services. But the time to act is now, and the RCOG intends to do just that.
Dr Ranee Thakar will respond to some comments next week.