Woman's Hour: Black women are 5x more likely to die in childbirth than white women

[arranbubonicplague]

Black women are five times more likely to die as a result of complications in pregnancy than white women. The risk has been increasing year on year [in the UK].

www.bbc.co.uk/programmes/m0006sg5

Related to this, an eye-opening Twitter thread that discusses why black women have a higher rate of pre-term birth in the US and (indirectly) how clinical research and epidemiology have missed some crucial perspectives of "minoritized populations":

Using white women as the reference tricks you into thinking that if black women just did everything whites women do, they’d have the same outcome.
DrSJefferson’s work shows why that is both incorrect, but also further damages Black women.

twitter.com/Epi_D_Nique/status/1151968410726739968?s=20

That is shameful. I knew the US stats were appalling, I didn't know we were seeing the same trend here.

That’s appalling

Asian women in UK are x2 as likely to die under these conditions as white women - the best that can be said about that is that the mortality has remained stable unlike the increasing rate for black women.

It's beyond wretched. It's always discussed as a complex problem but particularly after seeing the discussion involving Dr Jefferson's work I'm not at all confident that systemic issues and relevant perspectives are given enough attention and respect.

The interview with Deidre Cooper Owens explains why "racism is a public health crisis". Owens' research gives an insight into why experimentation on slave women contributes to the myths that persist in the systemic treatment of black women that underpins these statistics: Medical Bondage

The accomplishments of pioneering doctors such as John Peter Mettauer, James Marion Sims, and Nathan Bozeman are well documented. It is also no secret that these nineteenth-century gynecologists performed experimental caesarean sections, ovariotomies, and obstetric fistulae repairs primarily on poor and powerless women. Medical Bondage breaks new ground by exploring how and why physicians denied these women their full humanity yet valued them as "medical superbodies" highly suited for medical experimentation.

www.amazon.co.uk/Medical-Bondage-Origins-American-Gynecology/dp/0820354759?tag=mumsnetforu03-21

Awful and unsurprising. I was thinking about this when reading the other thread about the mother who refused a male HCP during birth and was wondering how black women fare in the US medical system. Given it is both misogynistic and racist the terrible outcomes are predictable.

That's appalling, and especially bad levels are rising in the UK.

DH had to listen to Woman's Hour for me (I have hearing loss) and he had to stop. He said that although Jenni Murray was very sensitive he found the interviews with the black women who'd had such bad experiences in the UK to be harrowing. (In particular, the young woman who developed sepsis.)

The global colonial paradigm still exists, it is just dressed up nicely with a cherry on top. Statistics like this show the true situation.

What are the medical reasons for this?

What are the medical reasons for this?

These stats are after taking into account social, economic and educational factors, so the clear implication is that it’s racism.

Black women are less likely to have their symptoms or pain taken seriously. There’s some evidence that the cumulative effect of living in a racist society causes an increase in background levels of stress which translates into a higher incidence of medical problems.

If it can happen to Serena Williams and Beyoncé, then no black woman is exempt.

thinkprogress.org/beyonce-almost-died-giving-birth-i-most-certainly-would-too-7feb1c0ed73a/

It's not just racism (although I'm sure there's a healthy dose of systemic racism at work, too). One of my colleagues works in this field and has been investigating the reasons why pre-eclampsia and eclampsia occur at a much higher rate in African mothers than in European ones, and has shown that there are biological and genetic differences that explain some of this:

medicalxpress.com/news/2017-02-explore-pre-eclampsia-common-women-african.html

Presumably many of the black mothers in the UK (and the US) will carry genes that make things like pre-eclampsia more likely to occur. The trouble is that, as one of the PP noted, medics here are trained to use a north European as "reference woman" so won't necessarily be aware of additional risk factors that should guide the care of pregnant black women (e.g. more frequent monitoring of blood pressure). Put that casual ignorance together with systemic racism and socioeconomic inequalities, and you've got a great recipe for poor outcomes among black mothers

I heard that programme and words fail me.

Has the African continent always had a problem with obstetrics?

How genetically similar are people from Rwanda to people from Sudan, as they seem to have completely different builds and the only external thing they have in common is curly hair and black skin.

From the cases referred to in the programme, I would say it is mainly racism that is the problem, but it is appalling.

pre-eclampsia and eclampsia occur at a much higher rate in African mothers than in European ones, and has shown that there are biological and genetic differences that explain some of this

But that's racist too (not you, the science). Because we know men are the 'norm' in medicine and women suffer. White women are the 'norm' and Black women suffer.

How much statistical noise does this produce? I'm wondering if the answer to the question, "why is American maternal care so shitty" is answered by this. I mean if white women in the States have the same outcomes as the rest of the developed world, does the treatment of Black women bring the care down to such parlous levels?

I'm also curious about medicine being designed for white people. I know that is the group that generally get the most advantage out of it, but isn't also shockingly true that most drug trials are carried out in third world countries?

Birth Needs A #METOO Reckoning

Jennie Joseph is an example of a practitioner who is working to address disparities in maternal health care with measurable results. Joseph’s maternity care model, known as The JJ Way, uses a trauma-informed, team-based approach that is centered on patient access, support, education, and empowerment. Research into the method showed that African-American and Black women who received care The JJ Way had not only better outcomes compared to patients of the same race in Orange County, the state of Florida, and the nation, but also had better outcomes than white women at the county, state, and national level.

The patient-provider dynamic can influence whether a person feels safe enough to access prenatal care. Peprah says that according to the BWBJ survey, some people stated that they chose to forgo prenatal care, altogether, because of their negative experiences.

www.damemagazine.com/2018/06/18/birth-needs-a-metoo-reckoning/

I was a midwife in a unit with a fairly high proportion of African women - I mean African proper, not just of descent. One if the drs once told me that our first line defence drug for hypertension was known to have little effect on Africans. She didn't know why, speculated that maybe they had increased levels of baroreceptors due to genetics & that drug just wasn't enough to have an effect. Nevertheless, that was the first drug we had to try. So again, N European women being used as the default to the detriment of others. More research is needed, no doubt to be met with cries of racism from some quarters.

The JJ Way sounds similar to a Canadian model it's either Herway or Sheway, I forget. Basically they take a harm reduction/trauma informed approach to pregnant and parenting homeless women. They don't expect sobriety or abstinence which is shocking. But they do massively reduce the amount of violence and abuse the women experience. And increase their access to supportive health care.

Interestingly, the outcomes for the children are far better. The theory is that it's not the drug use that impacts the children as badly as the constant violence and trauma homeless women experience. And lack of care. Of course the drug use is reduced in the program but not to zero in a lot of cases.

I find it really interesting because it's essentially removing the judgement, power imbalance and infantilization which is such a feature of maternal care. Caring without the wagging finger. And a lot of the women are First Nations so racism in healthcare is a constant in their lives. To the point of torture and murder historically.

It's good that the Iolanthe Midwife Trust is sponsoring a UK conference on action to reduce mortality in Black women and babies - with key notes from Jenny Joseph and Dorothy Roberts discussing US initiatives

www.iolanthe.org/latest/groundbreaking-conference-action-reduce-mortality-black-women-and-babies

As with the thread linked in the OP, it feels like there is a missing perspective that means the socioeconomic etc. factors that reduce risks for white women are not those that are necessarily relevant to black women. Beyond that, I was taken by Dr Jefferson's report of the impact of housing insecurity as the recent Women's Budget Group support identified that there is currently no region of England where housing is affordable for women. If housing insecurity increases like this then there's a risk that outcomes will deteriorate for all women and their babies but some demographics more than others.

Thank you for the thread

So upsetting to hear this sort of information but very important

I heard this yesterday as I was driving to visit my (Asian) friend who had just given birth. Was incredibly upsetting to hear the stories, particularly Candice’s story.

She’s campaigning for better maternal care for black women
petition.parliament.uk/petitions/259256

Just seen mention of Reproductive Injustice: Racism, Pregnancy, and Premature Birth

Black women have had to endure a medical structure that has historically not really viewed them as worth caring for—I mean really caring for
...
If doctors do not want to talk about race, then they are not likely to talk about, let alone try to address, racism. Circumventing such discussions helps the medical-industrial complex to avoid having to undertake an analysis of how it is complicit in medical racism.

twitter.com/astuebe/status/1157674169942892544

The thread is painful to read.