Many women face a long and difficult journey to become pregnant. Pregnancy itself is also a challenging time where your body is undergoing miraculous changes to create a new life inside you.
For some women, pregnancy and childbirth are made even harder by the colour of their skin. Research has found that women from black, Asian and minority ethnic (BAME) backgrounds have worse outcomes in pregnancy and childbirth.
What does the evidence show?
Maternal mortality rates
The UK Confidential Enquiry into Maternal Deaths was published in 2018. The team studied data from 2014 to 2016 and examined the number of women dying during pregnancy or childbirth.
In the UK these figures are generally low. But the figures showed that black women were five times more likely to die during pregnancy and childbirth than white women 1 Knight M, Bunch K, Tuffnell D, Jayakody H, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers” Care – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014-16. Oxford: National Perinatal Epidemiology Unit, University of Oxford. 2018.. For Asian women, the risk of dying was double the risk for white women.
Maternal morbidity rates
Another UK study investigated maternal morbidity, which is the likelihood of a woman experiencing a serious health problem as a result of pregnancy. This category includes many complications including hysterectomies and strokes.
The team found that women with black African heritage had an 83% higher chance of experiencing a severe maternal morbidity compared to white European women. The risks for other BAME women were generally higher too 2 Nair M, Kurinczuk JJ, Knight M. Ethnic Variations in Severe Maternal Morbidity in the UK– A Case Control Study. PLoS One. 2014. 9(4): e95086..
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Infant mortality rates
The differences in health outcomes not only affect BAME mothers, but babies too. The infant mortality rate is a measure of the number of babies who die under the age of one.
A 2013 report from the UK Office of National Statistics found that the babies whose heritage was black African, black Caribbean or Pakistani had the highest infant mortality rates. The infant mortality rates for these BAME babies were approximately double the mortality rates for white British babies 3 Office for National Statistics. Pregnancy and ethnic factors influencing births and infant mortality: 2013. 2015..
Why is there such a difference?
The reasons behind these stark and troubling figures are unknown. But the following factors are likely to contribute towards the problem.
Certain health conditions are more prevalent among BAME women compared to white women. One of these problems is pre-eclampsia.
Pre-eclampsia is a condition which arises in pregnant women and it can become serious if it is not treated quickly. The signs of pre-eclampsia are high blood pressure and protein in the urine. In serious cases, pre-eclampsia can cause seizures and other complications for both mother and baby.
Another condition which is more prevalent in BAME women compared to white women is anaemia. This occurs when your body does not have enough healthy red blood cells or haemoglobin to carry oxygen around your body. If anaemia is not properly treated, it can increase the risk of serious complications such as sepsis.
Social and economic reasons
Social and economic factors have a huge impact on health. Research has shown that BAME communities experience higher rates of poverty than white communities 4 Barnard H, Turner C. Poverty and ethnicity: A review of evidence. Joseph Rowntree Foundation. 2011..
This is linked to unfavourable working conditions and poorer housing. Therefore it is likely that socioeconomic factors contribute towards worse healthcare outcomes for BAME women.
Antenatal care involves having regular appointments with a doctor or midwife during pregnancy. It is an essential step in making sure that the pregnancy is progressing healthily for both mother and baby.
Mothers should generally contact their GP to arrange antenatal care as soon as they know they are pregnant. However studies have shown that there are differences in the uptake of antenatal care across different ethnicities.
A study conducted in London analysed the number of mothers who started their antenatal care late, which they specified as being beyond 12 weeks of pregnancy. The team found that BAME mothers were much more likely to start antenatal care late than white mothers 5 Cresswell JA, Yu G, Hatherall B, Morris J, Jamal F, Harden A, Renton A. Predictors of the Timing of Initiation of Antenatal Care in an Ethnically Diverse Urban Cohort in the UK. BMC Pregnancy and Childbirth. 2013. 13:103..
The authors took into account mothers who did not speak English as their first language. They found that even among black women who were born in the UK, their chances of starting antenatal care late were higher than white women.
Another report from the Healthcare Commission found some differences in antenatal services for BAME women. The report found that BAME women were less likely to have an appointment booked within 12 weeks compared to white women. BAME women were also less likely to have a scan at 20 weeks 6 Healthcare Commission. Towards better births. A review of maternity services in England. 2008..
The reasons behind these differences are unknown and they need to be investigated. It could be due to issues such as a lack of antenatal services in particular regions or differences in how BAME mothers are treated by healthcare professionals.
Racism is an uncomfortable topic to talk about. But it is important to discuss it as it can be a matter of life or death for many people from BAME communities. Racism exists in many forms whether it is direct, institutional or structural, and it can significantly affect the care BAME women receive.
There is evidence that BAME women experience differences in their antenatal care compared to white women. The Healthcare Commission report found that BAME women felt they had less choice of where they could have their baby 7 Healthcare Commission. Towards better births. A review of maternity services in England. 2008.. This is an important indicator of how a BAME mother may feel that her concerns and needs are taken less seriously than a white mother.
Giving birth is an important milestone for any mother, and it is important that mothers feel as comfortable as possible during the process. But the Healthcare Commission report highlighted that BAME women felt they had less confidence in the staff involved in their labour and baby”s birth. BAME women were also more likely to be left alone without support from staff 8 Healthcare Commission. Towards better births. A review of maternity services in England. 2008..
Being left alone during such a crucial time is not only worrying, but potentially dangerous. Mothers need to be closely monitored for any signs of complications such as bleeding, in the case of postpartum haemorrhage. When BAME mothers receive less attentive care, this can directly affect how quickly problems are noticed and treated.
There is also wider evidence showing that people from BAME backgrounds are treated with less empathy from healthcare staff. A recent study conducted in an American hospital emergency department found that black patients were half as likely as white patients to be prescribed opioid painkillers, despite reporting the same level of pain 9 Singhal A, Tien YY, Hsia RY. Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse. PLoS One. 2016..
These differences in the treatment of BAME communities in healthcare settings need to be addressed. Healthcare workers need to recognise how their treatment towards different ethnicities may be biased, and they need to be supported with better training. This will help them ensure that a patient”s care is not determined by the colour of their skin.
BAME mothers experience worse outcomes in pregnancy and childbirth than white mothers. The reasons behind this require urgent investigation before they can be tackled.
The reasons for these differences in maternal outcomes are likely to be a combination of medical reasons, socioeconomic factors, differences in antenatal care and racism. Racism is the only factor which is dependent on us all doing our part to eradicate it. By being anti-racist and demanding equality we can improve our society so that the colour of a person”s skin does not affect the length or quality of their life.
If you are a BAME mother-to-be, here are some steps you can take to maximise your chances of a healthy pregnancy and delivery:
Let your GP know you are pregnant as soon as you can and be proactive in arranging antenatal care as soon as possible.
– Write down a list of any concerns you have. Be as specific as you can in terms of when you have certain symptoms and how severe they are. Take this information with you to your antenatal appointments and be vocal about your concerns to your doctor or midwife. Don”t be afraid to ask for a second opinion if you still feel worried.
– Try to find out if there are any support groups for mothers-to-be and new mums in your local area. BAME support groups in particular may be able to address many of your concerns.
– Reach out to your friends and family for help and advice.
– Make sure you are eating a healthy and balanced diet and exercising sensibly to make your body as healthy as possible for childbirth.
– Start taking a folic acid supplement before you become pregnant, ideally as soon as you decide that you want to start trying for a baby. Make sure the supplement contains at least 400 micrograms of folic acid.
Dr. Jones is an experienced consultant in assisted reproduction.
He has worked as a Fertility specialist at Kingston Hospital Assisted Conception and nearly 10 years experience of working in Obstetrics and Gynaecology across hospitals in the UK.
He completed his Masters in Assisted Reproduction Technology and then his PhD, from Imperial College London. Dr. Jones main areas of interest are Single Embryo Transfer, Endometriosis, PCOS and Implantation failure in IVF patients. He is a member of the British Fertility Society and an associate member of the Royal College of Obstetrics and Gynaecology.
- 1Knight M, Bunch K, Tuffnell D, Jayakody H, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers” Care – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014-16. Oxford: National Perinatal Epidemiology Unit, University of Oxford. 2018.
- 2Nair M, Kurinczuk JJ, Knight M. Ethnic Variations in Severe Maternal Morbidity in the UK– A Case Control Study. PLoS One. 2014. 9(4): e95086.
- 3Office for National Statistics. Pregnancy and ethnic factors influencing births and infant mortality: 2013. 2015.
- 4Barnard H, Turner C. Poverty and ethnicity: A review of evidence. Joseph Rowntree Foundation. 2011.
- 5Cresswell JA, Yu G, Hatherall B, Morris J, Jamal F, Harden A, Renton A. Predictors of the Timing of Initiation of Antenatal Care in an Ethnically Diverse Urban Cohort in the UK. BMC Pregnancy and Childbirth. 2013. 13:103.
- 9Singhal A, Tien YY, Hsia RY. Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse. PLoS One. 2016.