Ethnic inequalities in access to, experiences of, and outcomes of healthcare have been longstanding problems in the NHS. They have been recognised as being rooted in experiences of structural, institutional, and interpersonal racism.
During the COVID pandemic, gross racial health inequalities again came to the fore. This month, a newly released report uncovers the extent to which pregnant Muslim women suffer from “a culture of maternity abuse” (see page 8).
The research, which follows other recent reports from Birthrights and FiveXMore, found cases of unacceptable poor clinical care. In some cases, inductions were performed without reasonable medical justification, which is not always in the best or safest interest of the mother and baby, according to the Royal College of Midwives.
The findings highlight the experiences of Muslim women being poorer compared to the national average, and that women from racialised minority communities were 1.5 times less likely to be given an epidural for pain relief. Some of those interviewed also experienced care they considered to be prejudiced.
The discriminatory treatment makes for heart-breaking reading. Feeling invisible is a strong feature in this report, and no woman, whatever her ethnicity or background, should feel invisible or unheard during her maternity journey. Women being denied choice and with care not personalised to risk is unsafe and unacceptable. Many of the themes have been found in other reports.
It is particularly distressing to see that some of the prejudices experienced by the women have come from the very staff there to care for them. Yet, the RCM claims to be committed to anti-racism and supporting midwives and maternity support workers of all colours and backgrounds to do what they can to improve the care they deliver to all women.
For too many years, the health of ethnic minority people has been negatively impacted by: a lack of appropriate treatment for health problems by the NHS, such as poor quality or discriminatory treatment from healthcare staff; a lack of high-quality ethnic monitoring data recorded in the systems, lack of appropriate interpreting services for people who do not speak English fluently; and delays in, or avoidance of, seeking help for health problems due to fear of racist treatment from NHS healthcare professionals.
At times, there have been attempts to try to blame the patient, as if it is somehow the fault of their culture rather than the discrimination they face. The report makes four major calls to action: better data collection, analysis, and utilisation of equality data to hold individuals and organisations to account, and better-tailored maternity services to meet the needs of ethnically diverse local populations.
What is needed is a cultural shift in attitudes and behaviours towards racialised minority communities and improving maternal empowerment through better information provision about their risks, their rights, and complaints processes so that they are better equipped to hold maternity care providers to account.
Racism, like other issues, cannot be addressed in isolation but rather as the part of a larger prejudice endemic in society. A total of 45 recommendations have been made, including many that should already be taking place in hospital trusts. It is also the prevalent attitude towards pregnancy, though, in treating it as if it were a sickness rather than a natural process.
The findings suggest that there are significant gaps in practices, especially in the accountability mechanisms that should be monitoring the effectiveness of care and treatment. Increasing accountability can only help to improve the quality of services provided, since practitioners, professional bodies, and NHS healthcare providers will have to justify their practices.
Gaps in the midwifery workforce also must be addressed in terms of numbers, diversity competency in knowledge, communication skills, and being sensitive to personalised care according to the needs of different ethnic groups.
