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The Struggle of Black Women in Healthcare

Updated: Dec 5, 2023

Manhaaza Ashfaq highlights risks for black pregnant women due to healthcare access inequalities and representation gaps.

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Photo by Stacy Ropati


Historical Western perspectives on minorities have contributed to discriminatory behaviours in healthcare. It can often stem from unconscious biases that people unknowingly acquire throughout their lives, but nonetheless this Western bias poses a danger to the lives of women who deviate from the norms and values.


Prejudice is deeply ingrained within the system, exceeding personal racial beliefs and policies and as a result institutional racism plays a significant role in the mortality rates of Black mothers and infants, as well as health complications pre- and post-birth.


Racial Disparities in Maternal Healthcare


A report published by MBRRACE-UK revealed that between 2019 and 2021, 241 women died during or up to six weeks after pregnancy, among 2,066,997 births, and a further 495 died during or one year later. According to the research, Black women are four times more likely, and Asian women are twice as likely to experience pregnancy-related deaths in comparison to white women in the UK.

However, this disparity among racial groups is not limited to the UK. Research shows that every year, approximately 700 women die in the US due to complications related to pregnancy, and that 84% of these deaths are preventable.

Between 2018 and 2021, the maternal mortality rate for Black women during pregnancy or within 42 days of giving birth was significantly higher than for White women. Although these statistics reflect the COVID pandemic, the notable disparity between the treatment of ethnic minorities compared to White individuals by the healthcare system predated this time, and has since been exacerbated.

The gap in the maternal mortality rates is also relevant to the infant mortality rates - the number of babies who die within the first year. Babies born to Black women are over twice as likely to die in comparison to those born to White women (10.6 vs. 4.4 per 1,000).

The inadequate healthcare system creates a ripple effect as the consequences of ethnic minority pregnant women being treated insufficiently increase the risks of health complications for newborns. The Office for National Statistics found that in 2021, the death rate of Black babies before and during delivery was higher (6.9 stillbirths per 1,000 births) compared to babies of other ethnicities. Such statistics indicate that social, economic, and racial factors have adverse effects on Black women’s pregnancies, ultimately subjecting their babies to risks as well.



Discrimination In Access To Care


One possible reason pregnant Black women face challenges within maternal healthcare is due to social barriers limiting their access to care. There has been identified a correlation between a high maternal mortality rate amongst women of all races, and residence in deprived areas.

The 2022 MBRRACE-UK’s report revealed that, one in nine women who died during or after pregnancy had "severe and multiple disadvantages." These disadvantages include limited access to healthcare, health risks, educational barriers, low employment, financial instability, and limited access to information.

Enduring systematic racism and xenophobia means ethnic minorities can have potentially limited opportunities compared to their White counterparts. Such socioeconomic factors play a significant role in the lives of pregnant women, placing both their well-being and that of their babies at risk.

The US's lack of universal healthcare makes easy-access healthcare a privilege that financially deprived individuals cannot afford. Consequently, Black women receive inadequate levels of prenatal care in their first trimester and most healthcare plans restrict postnatal care to just one appointment six weeks after birth. This places women and their babies at an elevated risk of developing life-threatening complications, as well as heightening the possibility of stillbirth and premature births.

Crear-Perry, the Founder of the National Birth Equity Collaborative stated that "We don’t have an environment that protects moms. The same racism, classism and gender oppression that causes Black mamas and Indigenous mamas to die too early also causes them to have babies too early."

High mortality rates of Black pregnant women and their infants primarily result from the absence of supportive environments and systematic inequities. Marginalised communities typically face an endless cycle of racism, classism and gender oppression because these injustices reinforce one another, making it harder for Black pregnant women to access social and medical support.


Did You Know? Pregnancy related mortality rates for Black American women are over three times higher compared to the rate for white women (41.4 vs. 13.7 women per 100,000) - KFF

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Racial Bias In Healthcare

The inequitable care of pregnant women from different racial backgrounds also stems from the divide that exists between White health workers and ethnic minority patients. The UK based Black Equity Organisation’s 2022 report shows that 65% of Black people said they had faced discrimination by healthcare professionals due to their ethnicity.

There is a growing consensus amongst scholars and scientists that "the black body is biologically and fundamentally different from the white body" specifically that they are "stronger, faster, and more agile", therefore, they have a higher pain tolerance. This can mean Black patients are less likely to be medicated because their pain is either left unidentified, or it is recognised and ignored.

Embodying such beliefs leads to a lack of empathy for Black patients, which is especially detrimental to pregnant women given their existing emotional and physical vulnerability.

A 2022 report by Birthrights found that UK healthcare professionals were dismissive of mothers experiencing pain and expressing concerns about their babies’ health. Many also failed to identify health issues in infants who displayed clear signs of illnesses or complications because medical staff could not discern any physical symptoms on different skin tones. This led to babies having health conditions such as jaundice, brain injuries, and other developmental issues. Likewise, inadequate care of mothers caused medical conditions such as a "life-threatening blood clot", sepsis, and inflicted emotional damage when cultural needs and autonomy were disrespected.


“It’s outrageous that these inequalities have been allowed to exist. Groups like ours and activists have been raising the alarm for over 30 years. Things should be dramatically improving with the advances in technology, but these disparities have remained.” - Tinuke Awe, Fivexmore Co-founder

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What Can Be Done?


Although discrimination can be unintentional, healthcare workers’ unconscious biases jeopardize the well-being of pregnant women and newborns. Creating a safe environment for Black pregnant women to minimise their trauma is crucial, and the following considerations are important:


1. Enhance accessibility by implementing affordable medical support through government policies for low-income individuals.


2. educate healthcare staff on diverse cultural needs and promote empathy to prevent traumatic patient interactions, particularly considering concerns of ethnic minority pregnant women.


3. Foster an inclusive healthcare staff through research on diverse skin tones and medical conditions. Diverse backgrounds among healthcare workers aid in symptom identification, enhancing patient trust and understanding.


To improve healthcare access for disadvantaged Black pregnant women, addressing the ingrained Western bias within the healthcare system is essential. By combating oppressive social attitudes towards marginalised groups and providing healthcare staff with empathy and communication training, we can provide every women a safer pregnancy.

 

Researched by Robyn Donovan / Editor: Ziryan Aziz / Online Editor: Harry Hetherington

 

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