Black women are being let down by maternal healthcare – these are all the ways it could be better

The fact that Black mothers in England are almost twice as likely to have their births investigated for potential NHS safety failings is shocking and unacceptable – but for me, it’s not entirely surprising. As someone who co-founded Five X More after my own distressing birth experience, I find these statistics hit close to home. The higher rates of investigations among Black mothers reflect a grim reality: Black women and their babies in the UK face significantly greater risks during childbirth.

For every 1,000 deliveries by Black women, 2.3 are investigated compared with 1.3 for white women, the Guardian found – figures that highlight the deep-rooted systemic issues in our healthcare system. They are also four times more likely to die in pregnancy and childbirth, and they have severe complications more frequently than their white counterparts. Black babies in England are three times more likely to die than white babies and also more likely to suffer a brain injury. These are not isolated incidents but part of a broader, systemic issue that requires urgent action.

My dreadful experience giving birth to my son began with undetected pre-eclampsia, a condition that poses serious risks to mother and baby. Despite showing clear signs during my pregnancy, my condition went unnoticed until very late leading me to be induced. The birth itself was extremely challenging; everything progressed rapidly, and I was in severe pain and vomiting. When I alerted the midwives, I was dismissed and told that it takes 24 hours for the induction to start working. It was almost too late before they realised my labour had advanced significantly and I was near delivery. Throughout this ordeal, I felt unheard and unable to advocate for myself when I needed support the most.

The underlying cause of these disparities is not just individual bias but institutional failures. A 2016 study found that white medical students held false beliefs about biological differences between Black and white people, leading to significant racial biases in pain perception and treatment. These misconceptions contribute to the systematic undertreatment of pain in Black patients compared with their white counterparts. This is just one example of how ingrained biases can lead to poorer health outcomes for Black women.

More recently, our Five X More Black women’s experiences report highlighted that Black women continue to face significant disparities in maternal healthcare, with many reporting feeling unheard and dismissed by healthcare professionals. These negative experiences were found to fit within a framework of three interrelated constructs centred around healthcare professionals’ attitudes, knowledge and assumptions.

Attitudes included the use of offensive and discriminatory language, and being dismissive of concerns. Knowledge referred to a poor understanding of the anatomy and physiology of Black women, and the clinical presentation of conditions in their babies. Assumptions involved racially based beliefs about Black women’s pain tolerance, education level and relationship status.

Unfortunately, the stereotypes still exist that Black women are uneducated and come from lower socioeconomic backgrounds, which I believe leads to the disparities in their treatment. However, our Black Maternity Experiences report refutes these stereotypes. The majority of respondents who reported poor experiences were degree educated and above, earned above the national average salary and were in a relationship at the time of their pregnancy. This evidence clearly shows that education and economic status do not shield Black women from systemic bias and poor treatment in maternal healthcare. It underscores the need for comprehensive reforms to address these ingrained prejudices and ensure equitable care for all mothers, regardless of race or socioeconomic status.

For pregnant women who are concerned about these disparities, there are proactive steps you can take. First, know your rights and the standards of care you should expect. Speak up if something doesn’t feel right, and don’t hesitate to seek a second opinion. Bringing someone with you to appointments can provide additional support, and documenting your interactions with healthcare providers can be crucial if you need to escalate your concerns. Reporting instances of discrimination or inadequate care through the proper channels is also vital for bringing about change.

While we are grateful that we get to play a part in making a difference to women’s lives with our free resources and campaigns to change views in parliament, systemic change is essential. Healthcare professionals need better training to recognise and address their biases, and there must be comprehensive data collection to fully understand and tackle these disparities. Given the findings of our report, we recommend implementing an annual maternity survey targeted specifically at Black women; increasing knowledge about identifying and diagnosing conditions that disproportionately affect Black women; and improving the quality of ethnic coding in health records, as not all trusts and hospitals currently use the same codes to collect data. More community-based approaches – such as working with grassroots organisations that are closer to those who are underserved– must be used to improve maternal outcomes. Additionally, there should be an improved system in the NHS for women to submit their feedback and complaints about maternity care.

The urgency of addressing these issues cannot be overstated. We must act now to prevent more mothers and babies suffering due to systemic biases. When we implement changes that specifically address the disparities faced by Black women in maternal healthcare, we improve the system for all women. With collective effort and commitment, we can hope for a future where healthcare outcomes are equitable for all mothers, regardless of their race.

Tinuke Awe is the co-founder of Five X More, an organisation campaigning for Black maternal health outcomes in the UK. This article was co-written by her co-founder, Clotilde Abe
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