Kemi Badenoch addresses pre-eclampsia experts - black mothers x5 likely to die **title edited by MNHQ**

[OhHolyJesus]

Full release here

www.gov.uk/government/news/minister-for-equalities-speaks-to-pre-eclampsia-experts-at-global-event

"But evidence shows that black British mothers are five times more likely to die in pregnancy or six weeks after childbirth, than white women. Women of mixed ethnicity have three times the risk, and Asian women almost twice the risk. Ethnic minority women are also at an increased risk of having a pre-term birth, stillbirth, neonatal death or a baby born with low birth weight."

I'm a bit of a fan of Kemi's since her speech on critical race theory in the HoP and this just makes me love her more. I don't care that she's a Tory, she knows what a woman is and is doing something.

[endofthelinefinally]

The hospital where I did my research has a very high number of BAME senior staff as well as a large number of BAME patients. However, there are a very high number of refugees, economic migrants of multiple ethnicities.
From what I learned, the issues concerned were a mix of genetic pre disposition to certain complications, lack of antenatal care related to culture/ religion/language/ late presentation, sometimes in obstructed labour, poor nutrition, the list is long. Racism was probably in there somewhere, but I wouldn't put it at the top of the list.

[wholelottaworry]

And I should say that I can quite see how: 1) the pathway designed for the majority might disadvantage women from a BAME background, who might have particular physiological profiles not factored in; and 2) if path doesn't suit, some BAME women will face particular barriers in advocating for themselves - language may be one, but also poverty and structural power (I managed to get notice taken of me when me and baby were struggling because I was assertive and not intimidated in arguing my case in front of medical professionals - some women may struggle with this and I note also that there are studies that show that black women are treated as aggressive and dismissed when they assert themselves).

[wholelottaworry]

I'd echo the view about maternity care getting worse.

I also think that because it is so underfunded, there is a pathway that most mothers (unless specific evidence of a medical issue that needs medical care or is high risk) get put on that suits a majority of people - let's call it the "uncomplicated vaginal delivery pathway". From experience though, if you do not suit this pathway but are not considered high risk, you are generally picked up late on after you have been put down this path (and you may be gaslighted if you raise concerns, given you are a first timer and medical professionals know what is best for you).

It's sad, but this is basically the best way of delivering the cheapest possible medical care to the majority, who are not having complicated births. Getting tailored and specialist advice that looks as you as a woman rather than as a statistical probability is almost impossible in the U.K. system if you are otherwise not high risk enough to be on a consultant led path. I don't blame midwives (though the ones who attempted to force me to deliver my first vaginally despite my protestations that she was stuck and just not descending and then to strong arm me into forceps so I didn't have a CS were pretty terrible) - I think that they are spread very thin.

[Gwynfluff]

The more like ourselves someone is, the better we're inclined and able to empathise, because in some subconscious sense the in-group is more 'real' than the outgroup. Which results in white doctors being a bit more on the ball with white patients.

There's structural inequality for sure. But this is too simplistic in the UK as the ethnic diversity of healthcare professionals tracks that that of the UK population. So it won't necessarily be due to not encountering BAME healthcare professionals.

[Mollscroll]

There was an interesting comment on one of the webchats to the effect that black women often needed to give birth earlier than an equivalent white woman. So earlier induction than for a white woman might be wise. No clear idea why but it seemed possibly physiological. But very hard to do research on this sort of race basis because of the fear of how this might be interpreted.

I’m sure that’s only a tiny part of the story but interesting nonetheless.

[ErrolTheDragon]

Thanks Rowan!

It certainly makes sense to get behind existing campaigns, I'm sure lots of women on this thread will be very interested in that.

[RowanMumsnet]

@ErrolTheDragon

Good for her for raising the issue, and seeking to do something about it. And I wonder if this could be an issue *@MNHQ* could do something with, in campaigning terms, too?

Sounds like it should be on their list. I'm not sure *@MNHQ* alerts anyone, I'll report this post and ask.

Hello

Thanks for raising this with us. We've been supporting the efforts of the group 5X on this issue (we try not to re-invent the wheel when it comes to new campaigns and in this case 5X were already getting lots of coverage for their campaigning). You can see a Guest Post about this issue and some links to actions to take here.

We've also run a big survey recently collecting women's experiences of pregnancy and childbirth care (among other things) since COVID struck and we're aiming to break the results down by ethnicity, so keep your eyes peeled for that data which we should be announcing in the next couple of weeks. Contacting Kemi Badenoch about this whole area is definitely on our to-do list.

If you have specific ideas for things you think we should do, do shout.

Thanks

MNHQ

[334bu]

Thank you I didn't know that. What a choice to have to make!

[LukewarmCustard]

In the USA with their private health care system it is perhaps unsurprising that black women suffer disproportionately. However, we have a national health service where noone is denied healthcare , so why is it happening here too.

Women are charged for maternity care in the NHS, 334bu. These are women who were not able to renew their visa or whose asylum claim was refused. They face bills of £7,000 or more and the NHS reports them to the Home Office if they can’t pay. It’s a really nasty policy. There is good evidence to show that these women are avoiding maternity care and some of these women are dying in pregnancy.

[334bu]

OMG if that can happen to Serena god help someone from the projects.

[OhHolyJesus]

I'm not sure if the public vs private systems are the problem, here or in the States, though I'm sure that's part of it. I say this because Serena Williams has spoken about how she raised her breathing issue with doctors but was ignored. I saw this on The View and there's more in her post-birth complications here.

www.self.com/story/serena-williams-labor-being-serena

I use Williams as an example as she is obviously a black, wealthy woman who had a history of pulmonary embolism and she wasn't listened to.

"But Williams, who had previously dealt with a pulmonary embolism in 2011, told the team that she needed a CT scan with dye. "I'm not someone who takes their health for granted," Williams says. "With as many issues and scares as I've had, I think I've learned pretty well how to listen to my body."

[334bu]

" I'm sure the (in)ability to fully empathise with patients is playing a part, because an American study found that having a black doctor improved the chances of survival for black babies."


I wonder if the outcome of these groups varies depending on where in the UK they reside ? Is it better where they are more likely to share their ethnicity with their HCP?
Obviously much more research is needed to find out why this is happening but in the meantime it surely is not beyond the maternity care service to pay particular attention to groups who are now known to be prone to difficult pregnancies?

[PotholeParadies]

@TyroTerf

I'd hazard a guess that there's a psychological aspect to it, 334bu.

Along the same lines as women having better outcomes when seen by female doctors.

The more like ourselves someone is, the better we're inclined and able to empathise, because in some subconscious sense the in-group is more 'real' than the outgroup. Which results in white doctors being a bit more on the ball with white patients.

This is just a hunch, of course, but could be checked by comparing with stats for countries that aren't in North-west Europe.

I'm sure the (in)ability to fully empathise with patients is playing a part, because an American study found that having a black doctor improved the chances of survival for black babies.

edition.cnn.com/2020/08/18/health/black-babies-mortality-rate-doctors-study-wellness-scli-intl/index.html

Could the race of medical staff be why the maternal mortality rates differ between ethnic minorities, and why British black women and British Asian women don't share the same rate of risk?

In my experience of NHS care, including maternity care, staff are most likely to be white, or of Asian heritage. Black staff are rarest.

[endofthelinefinally]

"So is it possible that in some communities pregnant women or new mothers don't get medical attention unless their husbands give permission?"

Of course.

[FiveFootTwoEyesOfBlue]

If the reason behind the increased risk was racism, then why would there be different risks for different ethnic groups? Is the NHS more racist against black women than against Asian women? It doesn't make sense. It seems more likely that it's a combination of complex reasons including genetics, social norms, subconscious bias, etc.

As an aside, I was reading an article (BBC news website) about a local council dealing with coronavirus in a predominantly Asian neighbourhood in a northern city. When people did not answer messages or phone calls to say they needed to get tested, the council sent people knocking on doors. What shocked me was that one of the reasons it listed for why people did not comply was that some women who answered the door were not willing to get tested ^without their husband's permission'. So is it possible that in some communities pregnant women or new mothers don't get medical attention unless their husbands give permission?

[endofthelinefinally]

Anecdotally, I think maternity care generally is getting worse. Certainly, 2 of my nieces have had shockingly bad maternity care, in separate hospitals. One niece nearly died, the other nearly lost her baby.
I was sitting in my local hospital this week and the ward clerk brought me a cup of tea and showed me a photo of her new grandchild. She told me about the terrible experience her DIL had been through during labour.
Another friend phoned me this morning, worried about his daughter who had a crash section after nearly 40 hours in labour, has been home 4 days and hasn't been seen by any HCP.
I have read some horror stories on MN too.

[334bu]

In the USA with their private health care system it is perhaps unsurprising that black women suffer disproportionately. However, we have a national health service where noone is denied healthcare , so why is it happening here too. Yes , certain groups have particular health problems but if it is known that certain groups are more at risk, why are they not automatically treated as high risk pregnancies?

[endofthelinefinally]

@RoyalCorgi

I think it's worth bearing in mind that the numbers of women dying in pregnancy and in the six weeks after childbirth are relatively small, mercifully, and that you need someone to analyse the data properly to find out why black women are more likely to die. You need to take into account things like the number of refugee women coming here who may not have had any care during pregnancy, the fact that some ethnic groups are typically older having their first child, and that some ethnic groups have a greater predisposition to heart problems, which then emerge during pregnancy. All of these things should be addressed, of course, but we need to think about how we address them.

I'd also want to look at stats on maternal morbidity (ie sickness, not just mortality) and stillbirths and address those.

This is really, really important to understand.
The biggest issue in all of this is lack of funding to do the research. It is incredibly difficult to get even small amounts of money to do basic audits.
I was working in USA back in the 80s. It was well known there that African Americans were at higher risk of hypertension than white Americans. I was a very junior person then and didn't know much about research so didn't know if any work was being done in this area.
Eclampsia and post natal PE are more common in black women and less common in Chinese/South East Asian women. This has been known for at least 15 years.
Unfortunately women's health is not, and never has been, a priority. This is what needs to change and I can't see that happening any time soon.

[Goosefoot]

Last time i read up on this it seemed to be that there were multiple factors involved. Some had to do with class, some had to do with new immigrants and language, and at least for black women, some had to do with physiological issues.

[RoyalCorgi]

I think it's worth bearing in mind that the numbers of women dying in pregnancy and in the six weeks after childbirth are relatively small, mercifully, and that you need someone to analyse the data properly to find out why black women are more likely to die. You need to take into account things like the number of refugee women coming here who may not have had any care during pregnancy, the fact that some ethnic groups are typically older having their first child, and that some ethnic groups have a greater predisposition to heart problems, which then emerge during pregnancy. All of these things should be addressed, of course, but we need to think about how we address them.

I'd also want to look at stats on maternal morbidity (ie sickness, not just mortality) and stillbirths and address those.

[Al1langdownthecleghole]

While I’m pleased to read this, I’m reserving some judgement. KB is my MP & When I wrote to her around 18 months ago, I got a very disappointing C&P response misrepresenting the EA and advising me that she was committed to representing the rights of people of all genders.

On the other hand she is very ambitious, so if she has realised that it is now politically expedient to recognise female biology, I’ll take that as a good sign.

[TheCountessofFitzdotterel]

It’s such an important issue, it would be a wonderful thing for MN to campaign on.

[ErrolTheDragon]

So, here's the reply.

^ Thanks so much for your email and for your idea for a Mumsnet campaign.

We will pass your message on to our Campaigns team and they'll be in touch if they feel they can be of any help. We should make you aware, however, that they plan all our campaigns at least six months in advance, so it may well be that they aren't able to help on this one and you won't receive a reply.

In the meantime, you might be interested to know that we decide which campaigns we run with on the basis of what our members think, so you might like to start a thread on our Petitions Noticeboardd_ and see whether other Mumsnetters respond positively to the idea (please remember that we don't allow petitions to be posted anywhere else on our site).

You can find out more about Mumsnet's campaigning history and our current campaigns heree_.
^

I feel I was passing the message on and there is probably someone else here who might be better suited to pick up this ball and run with it. Perhaps someone with specific experience, either an HCP or someone who has experienced the issues discussed in pregnancy. Or a collaborative effort. Any takers?

[334bu]

Excellent idea Errol

[ErrolTheDragon]

Good for her for raising the issue, and seeking to do something about it. And I wonder if this could be an issue @MNHQ could do something with, in campaigning terms, too?

Sounds like it should be on their list. I'm not sure @MNHQ alerts anyone, I'll report this post and ask.