Black women in the UK 5 times more likely to die in childbirth or after pregnancy

[OneEpisode]

I decided to sign the petition, on the parliament site.
On 14th June Nancy Kelley retweeted this, with the message “Please sign! #BlackLivesMatter.” She added an emoji ? (But remember I’m well intentioned but technologically inept)
Can someone who can twitter ask Daniel Radcliffe if she needs to be cancelled? The w word was mentioned a lot, and there was a maternity which might be banned too.

So edwards what do you want to discuss? The risks involved in pregnancy and childbirth, and now these risks are borne differently by different potential mothers? And how as (mostly) UK citizens we can support those mothers? Or do you want to discuss something else?

I will try again, Edwardson.

What is feminism?

And for that matter, what is racism, since you bring up the definition of blackness?

I'll stop now, just wanted to respond to the points made and wanted to say my piece about the unexpected nature of the thread given the title. I do think it's horrendous that black women are so much more likely to die in childbirth, and less likely to be believed by doctors about their pain (as are all women)

I also recognise that I have hypocritically hijacked the issue to say my piece about what it made me feel about feminism so stopping now!

www.washingtonpost.com/health/is-bias-keeping-female-minority-patients-from-getting-proper-care-for-their-pain/2019/07/26/9d1b3a78-a810-11e9-9214-246e594de5d5_story.html

It isn't just pregnancy. It is also important to look at mortality and morbidity around contraception, surgery, heart disease, diabetes, for example. Ethnicity is significant in all these areas.
One of the interesting/important things is that the ethnicity question only came up initially in the course of looking at these conditions in all women. (The biological kind).
I was doing research in women's health 20 years ago in a very diverse part of London. Realising that ethnicity was so significant was a turning point.
It just takes a long time to get anywhere with research into women's health.
I am glad this petition is doing well, but it has been such a long time coming.

Hypercoagulability is a significant risk in BAME populations.
It is also an issue in COVID. (And pregnancy)
I am long retired now, but I feel sure this is an area that needs more attention, and it is being taken seriously.

There are 3 clotting disorders that account for roughtly 30-40% of all hypercoagulation disorders amongst black, asian, and middle eastern populations. They aren’t recognised by the NHS.

grumpy I know this is FWR where I learn so much but OMG! 40% and not recognised in NHS protocols!

It isn't just pregnancy. It is also important to look at mortality and morbidity around contraception, surgery, heart disease, diabetes, for example. Ethnicity is significant in all these areas.

Ethnicity and class. My black family in the US has always had access to private health care - no issues.

On the other hand, a black friend of mine in the US (on disability and Medicaid) found out she has Stage 2 kidney disease only by looking at her own medical records online. She was never told! I've tried to prod her from afar to address this with her social worker and her health care provider to no avail.

That seems criminally negligent to me but she just seems to accept it. How much of this kind of negligence is going on?

‘Woman’ wasn’t defined because up until now everyone knew what a woman (Adult human female) was and data was recorded that related to women. There was not considered any need to define women. But certainly there is a need to define ‘black’ in this context - the main one being are we actually just referring to African descent or, as is often the case, BAME? Racism affects both groups but levels and causes of maternal mortality may differ.

Grumpy, which ones? I am really interested in this.
Also, having worked in the US, albeit back in the 80s, I think the issues are far worse there than here. I was also pretty unimpressed by the standard of obstetric care, even in posh, private hospitals. The fact that it was male dominated had much to do with it. And, of course, no midwives.
But it is extremely complex and multifactorial.

Aesopfable
Yes they do. Different risks in different BAME groups.

forsucksfake I think we need to be very careful about including any American examples when talking about the UK. We might look like very similar cultures but we are actually very different. Health care and attitudes to health care are particularly strikingly different. I forget the numbers but a large percentage of Americans think that someone without healthcare insurance (or means to pay) should just be left to die. Health care is a product that benefits those who can afford it (and many can’t - half of all personal bankruptcies in America are due to medical bills). This way healthcare is structured also means there is far less preventative health care. Plus of course their abortion laws. America sits behind Russia and just in front of Ukraine in terms of matter all mortality.

Having said that, black women in America are twice as likely to die as white women, not 5 times. Which suggests the risk of death of white women in the states is higher too.

Aesopfable. I completely agree.

Aesop Having experienced life in both the US and the UK, I know you are correct. I was just bringing some (now I see, perhaps irrelevant) personal experience to the discussion.

forsucksfake that is madness, and not at all normal in any country certainly not in the states. I would certainly say it was negligent, the only thing I could imagine is that there was a mix up in notes and the person who tested didn't realise she was not already diagnosed. Quite often doctors will do their own tests so they can individually bill the insurance medicare/Medicaid. I've never heard of anything like that.

There are 3 clotting disorders that account for roughtly 30-40% of all hypercoagulation disorders amongst black, asian, and middle eastern populations. They aren’t recognised by the NHS.

Sorry I'm being thick here, what do you mean by not recognised? They don't test for it or claim they aren't illnesses?

I don't think you can compare health care in the US with UK, as we know that the US have a differently funded model. (See earlier post).
So, do the same outcomes apply in the UK? As we have a National Health Service, I would like to know, why that is. It is unlikely to be prejudice, as many of the medical staff are BAME. So I would like to know why they have worse outcomes.

Could some of the reason be the fear of seeking help or thinking i can’t afford care? I was informed at my first appointment with ds2 no passport no booking in. From standing and waiting at an open front desk I was only one told this - but I have a foreign sounding last name. H’s friends wife is legal but she was not entitled to free healthcare (HO visa requirements) - it was 9k for standard appointments and a vaginal delivery. The finance department made sure payment had been sorted before admittance. These are London hospitals btw.

Also the way some doctors talk to my foreign husband I’m not surprised either. Medical staff can be just as racist as the general public.

It’s amazing how the white native population are suddenly waking up to the fact that we are not much better than the US.

mrs I don’t think many of what you call the “native” population know the NHS annual surcharge amounts payable with visas are so very high. I don’t know if immigration status is an issue. I think they have to investigate and look at the detail.

I know as a (white, middle class) expectant mother I felt belittled in my first pregnancy which meant I was less keen to engage. I can believe that someone with less advantages might not attend if mistreated/feels this likely, and thus would not receive treatment/advice.
I did feel my midwife in my second pregnancy was a genuine ally.

As we have a National Health Service, I would like to know, why that is. It is unlikely to be prejudice, as many of the medical staff are BAME. So I would like to know why they have worse outcomes.

Lots of BAME medical staff, but not all and BAME covers lots of different ethnicities. (Pretty much anyone not white British I think?) .

Also black people don't just deal with prejudice from white communities so could face prejudice form other BAME groups. I've seen lots of Asian doctors for example but not many black doctors, in fact I'm honestly trying to think when I last saw a black HCP and don't remember any, but surely that can't be right? So they may very rarely see any actual black HCPS.

It is really important that this area gets pushed. Women’s health is woefully under funded in research. I spent over a decade research maternal health from a genetic perspective and wanted to add a couple of things that I think contribute to the shocking statistic in the OP.

Some risk factors will be in common across women of African heritage. These include increased risk of gestational diabetes, preeclampsia (about double in black women vs white women), clotting disorders etc. One of the issues we faced in the research I was involved in was that a lot of the genetic research was done in European and American populations so our understanding of the genes at play was all based on a not totally relevant background.

This is also reflected in obstetrics more broadly, working with an African consultant obstetrician she wanted to write a textbook specific to African obstetrics. This obstetrician believed that African women had shorter gestation (38-39 weeks). That due to pelvis physiology the baby’s head didn’t engage till active labour. This is anecdotal (but coming from a consultant obstetrician with 20 years experience in a hospital with 32000 deliveries a year in sub Saharan Africa). My point is the factors may or may not be true but without research specific to pregnancy in other ethnic groups we will always be treating black women based on knowledge based on white women.

Then there are cultural risk factors such as FGM which increases risk of obstruction and haemorrhage. Less engagement with antinatal care etc.

There will be a socioeconomic component, diet, obesity, access and engagement with health care.

There almost certainly is racism component in treatment received such as the example given above of not believing black women with regard to their level of pain.

I guess my point is that it is complex and without research we will never unpick it. It is massively important that this issue is raised. According to the WHO 830 women die a day due to childbirth and associated complications. The more sunlight the better. And the more discussion the less taboo it becomes to acknowledge that there are differences that almost certainly contribute to the horrifying statistic in the OP.

It is also important that this doesn’t become weaponised for the wrong reasons.

There is a lot of prejudice between BAME groups.
Try being black in SE Asia for example.

Or Burmese in Thailand. Or Rohynga in Burma. ( I might have got my spelling a bit wrong there, so sorry in advance).

@endofthelinefinally - all of the examples you provided, every single one of them, was caused by white people

We can't change history. We can work on making things better.
I think it is more complicated tbh, but that isn't the point of this thread.

In the MBRRACE report linked to upthread it states that the death rate between women born in the UK or outside the UK is not signfiicantly different but "women born in certain specific countries (my italics) had a significantly higher risk of death compared to women born in the UK". So to compare:

Women born in UK: 8.38 deaths per 100,000
Women born outside the UK: 9.4 per 100,000

Women born in India: 7.03 per 100,000
Women born in Eritrea: 92.56 per 100,000
Women born in Nigeria: 32.59
Women born in Pakistan: 14.71
Women born in Jamaica: 56.60

When we are seeing such very specific national differences, I do not feel the overall differential should be attributed primarily to some kind of systemic racism within the UK or its health system.

For one particular nationality in one UK city, the average number of babies per woman is 4 (which is still lower than in their own country of origin). Clearly that alone puts a woman at more risk of maternal mortality and morbidity. Language as a barrier to healthcare access should also not be blamed on racism. I am not dismissing racism or prejudice but it needs to be put into perspective relative to other factors.