The black maternal mortality crisis: it’s her problem, it’s your problem, it’s our problem
Content warning: This article explores themes of racism, trauma, and death
Black women are four times more likely to die in childbirth or pregnancy when compared to their white counterparts in the United Kingdom (UK). Last year, that number was five.
As a black woman, I can’t help but feel sickened and exasperated when I see these figures. Why are the odds against us? Is anyone ever going to treat these deaths like the epidemic it is? Is anyone truly willing to address the root cause of this issue? These statistics are not just an unfortunate thing that is happening to people; they are the result of repeated and grave injustice against black mothers, black futures, and black families. Are we going to keep being comfortable with this atrocity?
“These statistics are not just an unfortunate thing that is happening to people; they are the result of repeated and grave injustice against black mothers, black futures, and black families.”
Image credit: Unsplash
Every story I read of traumatising birth experiences, and in severe cases, death, echoes a sentiment that is known all too well by black women: covert dismissiveness, blatant accounts of stereotyping, and a sense of invisibility to others. Behaviours like these have names that, unless spoken of, are perpetuated by ignorance: microaggressions and systemic and cultural racism. Microaggression is “a term used for commonplace daily verbal, behavioural, or environmental slights, whether intentional or unintentional, that communicate hostile, derogatory, or negative attitudes toward stigmatised or culturally marginalised groups.”
Microaggressions often manifest as backhanded compliments and subtle insults. For instance, black women are often referred to as ‘strong’. Whilst this can be regarded as a compliment to some extent, it is frequently used in a way that denies expression of pain or concern. FixeXMore is a grassroots organisation committed to positively changing the birthing experiences of black women and birthing people in the United Kingdom. Annabelle’s story is one featured on FiveXMore’s blog, and illustrates the harm that these types of microaggression cause. After having a Caesarean section, Annabelle expressed concern about how well her scar was healing, to which midwives responded that it was “fine”, and they were “amazed by how well it had healed”. She discovered that her scar was in fact infected after taking herself to hospital. Whilst these midwives may have had very little experience with black skin, as Annabelle acknowledges in her blog post, their dismissal of her concern and appraisal of her skin highlights the unconscious racial bias they may have been displaying. Other stories on the FiveXMore’s blog detail the ways in which microaggressions undermine the care and the needs of the people in question. These aggressions often leave individuals traumatised and tired; tired of advocating endlessly for things that should be a basic right. There is a perception that microaggressions are just people being too sensitive, but I believe these microaggressions matter and that they are a big deal.
“Cultural differences and racial biases act as barriers for black people to access health care and to be seen, heard, and understood by healthcare professionals.”
Accounts like these are not limited to black women’s birthing experiences. Microaggressions are seen in differential treatment of members of the black community in the workplace and healthcare settings. Cultural differences and racial biases act as barriers for black people to access health care and to be seen, heard, and understood by healthcare professionals. These biases explain why black people are four times more likely to be detained under the Mental Health Act, but less likely to receive support and adequate treatment. Sickle cell disorders, which affect approximately 15,000 people in the UK, are predominant in black African, African Caribbean, Mediterranean, and populations of Asian origin. Despite their prevalence, these disorders receive 30 times less funding than cystic fibrosis—a disease which affects around 10,000 people in the UK. The racial disparities in medical research can be attributed to systemic racism which, contingently, negatively impacts the quality of care sickle patients receive. Several factors contribute to the disparities listed above. However, figures repeatedly show that systemic racism is at the centre of the issue. Avoidance of the subject, lack of action, and persistent failure to acknowledge the ways in which people who benefit from the system do so at the expense of others, are all reasons why being a sick black person or pregnant black woman is a dangerous state to be in.
Image credit: Unsplash
Unfortunately, this is not a problem that is unique to the UK. In the United States, black women are three times more likely to die from pregnancy and childbirth related complications. Cystic fibrosis affects less Americans than sickle cell disease but receives seven to eleven times more research funding per patient—findings which mirror those in the UK.
It breaks my heart to say that there is an insufficient amount of research on this topic and that there are no policies in the UK that protect and support black mothers. Maternal care is available locally for women across the UK, and there are mainstream initiatives, such as Better Births, which seek to improve birthing experiences and support women. However, there are few initiatives tailored to black women. In the wake of the COVID-19 pandemic, the Care Quality Commission conducted an analysis which resulted in the launch of a programme that aimed to reduce the risk of Black, Asian, and Minority Ethnic (BAME) mothers contracting COVID-19 and suffering further adverse health complications. A continuity of care plan, which is targeted at women from BAME groups and women living in deprived areas, has also been set up by the National Health Service (NHS) as part of their long-term plan in effort to improve quality of care and reduce preterm births and perinatal mortality. Additionally, a petition launched by FiveXMore’s co-founders, Tinuke Awe and Clotilde Rebecca Abe, has invoked a series of governmental action points. The proposed government action and programmes are steps in the right direction, but must be taken forward to provide support black mothers.
I do hope for one thing in the fight for better maternity care for black women: a culture shift. Systemic and cultural racism has been highlighted as the overarching contributor to multiple racial disparities in healthcare and in wider society. Laws, processes, and cultural norms in the UK that benefit white people have damaging implications for members of the BAME community. I personally believe that new policies and programmes will not address the full picture unless they embody an active effort to dismantle and remove the conscious and unconscious biases that have given room for issues like this to exist. We must address the risk factors and contributing factors that lead to the death of black mothers, and we must make every effort to fund research to improve this. But it is imperative that we look at ourselves first. We cannot continue to make presumptions that black women and black people are more likely to be front line workers and come from overcrowded households without acknowledging that societal constructs have routinely placed BAME members at a disadvantage. We cannot conclude that black women are more likely to suffer from pregnancy related complications, and assume that this is enough to explain these statistics. We must think why, and consider why we have not thought about the why before. We must try to understand black women, let them be seen and heard, and admit when we don’t understand so their care can be better informed and refined. It is not enough to put policies in place when they have often marginalised black people; cultural reform is needed.
“For the sake of black babies, the black futures that blossom as these children grow, the black women and futures that we have lost at the hands of this: we must protect black women.”
The generation of women after me must not cry the same cry of injustice. The generation of women after me should not have to endure the fear of being invisible, misunderstood, and ignored. They should never have to subject the trauma of a preventable negative birthing experience. These figures will continue to add to the racial biases that black women face if we do nothing. For the sake of black babies, the black futures that blossom as these children grow, the black women and futures that we have lost at the hands of this: we must protect black women. We must design systems that support and benefit them, and, as a society, we must uproot all barriers opposing this. This epidemic has to end with our generation. We need to treat the current status of black maternal mortality like the crisis it is—childbirth should never be this dangerous.
The author recognises that not all black birthing people identify as women and mothers. Along with Oluwaseun’s reflections as a black cis woman, more research and voices are needed on the experiences and injustices of black trans people and folks across the gender binary, too.
The following websites offer resources to support black mothers and mothers-to-be, and BAME members with their mental health:
Black Mums Matter Too: A community for black mums and mums to be.
Black Minds Matter: Free mental health services for black individuals by black professional therapists.
Therapy for black girls: Wellness, resources, and therapists for black women.
