As we strive to create and curate more inclusive and fair communities, I wanted to draw our
attention to an incredibly important topic in perinatal health. Monday April 11th (2023) was
the start of Black Maternal Health week in the USA, and from 24th-30th April 2023, it is
Black Maternal Health week in the UK. Both initiatives aim to raise awareness of the
proportionally greater health risks facing Black mothers*. And crucially, both initiatives aim
to set the context for demanding societal and policy changes which will protect and save
Ibram X. Kendi, in his excellent How to Raise an Anti-racist, opens the book with a personal
and vivid description of his partner Sadiqa’s experiences of perinatal care in the USA. As a
pregnant Black woman, her concerns about her physical symptoms were twice dismissed by
probably well-meaning healthcare staff; as a paediatric doctor, she was able to channel her
concerns into accessing the care which ultimately saved their baby’s life. Black parental
health, both physical and mental, is a fundamentally important topic for us to know about and take action to redress the too often fatal imbalance of care.
What do we know about the experiences of pregnant Black women?
Of course, it differs from country to country, but the picture in countries in which people of colour are in the minority highlights a stark disparity. This a huge problem worldwide but in this post, I am focusing on two major English-speaking countries, the United States of America and the United Kingdom, from whom much of the research originates.
According to the US Centers for Disease Control (CDC), in the US, Black women are 3 times as likely to die from a pregnancy-related cause than white women, and between 2-5 times as likely to have “near- misses,” a situation exacerbated by the COVID-19 pandemic. The picture in the UK is similar, with Black mothers of 4 times more likely to die than their white counterparts. Brazil, another country with a history of enslavement of African individuals, reveals similarly appalling numbers, with one study showing that mothers of colour were 3.5 times more likely to die than white mothers. Nonetheless, recent research in the States indicates that over 80% of maternal deaths are preventable, another jaw-dropping statistic.
The picture in France is far less clear. One study by Philibert and colleagues found the risk
of maternal mortality in women of foreign nationality was double that of French nationals, in
particular for women of sub-Saharan African nationality. But further clarification on the
relationship between ethnicity and perinatal health is not possible, due to France’s approach
to collecting data on ethnicity. (See also Germany and Canada for example). In France, it is
illegal to collect data relating to race or ethnicity, except under limited circumstances. This is
in the context of a “colour-blind” approach to citizens.
There is also an historical legacy of abuse of data in the collaborationist Vichy regime in World War II when identity cards allowed authorities to identify Jewish people for transport to concentration camps. The absence of any data therefore makes it impossible to state quantitatively whether there are different experiences for groups with different ethnic backgrounds in France. In 2020, government spokeswoman Sibeth Ndiaye, a French woman of Senegalese origin, called publicly for the debate around ethnic data collection to be opened, but so far, there has been no political appetite for this.
Why is this disparity happening?
Authors Latoya Hill, Samantha Artiga and Usha Ranji argue that in the States at least, “health disparities are driven by social and economic inequities that are rooted in historic and ongoing racism and discrimination.” People of colour are more likely to have barriers to care in the States, and further, Black pregnant people may be more likely to have healthcare providers who do not listen to them, or were slow to listen to their concerns. This is in part due to implicit bias, as authors Bani Salujha and Zenobia Bryant argue in their review paper.
Implicit bias refers to the thoughts and feelings we have outside of our conscious awareness, but which nonetheless contribute towards our attitudes and behaviours. For example, one study in 2019 showed a racial bias in white participants towards under-recognition of pain in Black faces compared to white faces, something which has clear implications for appropriate access to healthcare, even when financial barriers such as insurance are lifted.
What can be done? What can I do?
In France, we cannot point to research indicating any disparity of outcome for Black mothers. But hearing from mothers themselves for example is a rich source of information: blogger Diariatou Kebe has published her own experiences and reflections in her book Maman Noire et Invisible (which you can buy online at FNAC for example) to help guide other Black mamans through pregnancy and beyond.
It’s also worth taking inspiration from countries which can quantify the problems faced by
people of colour. In the US, the Black Mamas Matter Alliance founded a week-long public
health campaign to raise awareness of these problems. Their theme in the 6th annual event
(2023) is “Our Bodies Belong to Us: Restoring Black Autonomy and Joy.” You can find out
more and participate right now through the hashtag #BMHW23.
In the U.K. four years ago, campaign group Five x More founded a week’s awareness campaign for Black Maternal Health, this year with the theme “Respectful Maternity Care.” It’s running from 24th -30th of April 2023 and you can find out more through #BMHAW23. Both campaigns provide plenty of resources on their websites for Black birthing people, their partners and their allies.
Political action is one key route to improving outcomes.
In 2020, Five x More successfully raised enough signatures on a petition entitled “Improve Maternal Mortality Rates and Health Care for Black Women in the U.K.” for the topic to be debated in the UK parliament two years ago, leading to a commitment from the government to fund research into the factors associated with the higher risk for Black mothers (and those from other minority ethnic backgrounds) and to provide a greater continuity of care for people throughout pregnancy and birth. The Motherhood Group, a British social enterprise designed to support and improve the Black maternal health experience, hosted the first Black Maternal Health conference in the UK in March 2023.
Increasing access to relevant information for those who are pregnant and their healthcare
providers is also a crucial component.
In the US, the CDC campaign Hear Her encourages pregnant people, their loved ones and healthcare providers to watch out for and communicate urgent maternal warning signs (see below). They encourage people to have confidence in their knowledge of their own body – to be able to say I know my body and something doesn’t feel right.
Urgent Pregancy Warning Signs
Dizziness or fainting
Changes in your vision
Severe belly pain
Severe nausea and throwing up
Thoughts about harming yourself or your baby
In the U.K., each month the Positive Birth Company offers 100 Black pregnant people free
access to their online birthing course https://www.fivexmore.com/pbc and the Motherhood
Group offers free counselling sessions to mothers in the UK.
It can be easy to feel disempowered when we are faced with injustices, frightened if we are
implicated in the statistics and helpless if we can’t see what we can do to improve a situation. If this resonates with what you have experienced reading through this blog post, I would encourage you to reflect on what actions, no matter how small, you can take which are in line with your values around this topic. For example, for me it has been engaging with the
education offered by the individuals and organisations highlighting problems and advocating for change. As small as this is, I know that the more I understand a situation, the more creatively I will be able to think about ways I can contribute positively.
About the author: Sophie Wallace-Hadrill trained as a clinical psychologist in the UK and now works in Paris offering therapy and coaching, specialising in supporting
parents. She facilitates the Monday morning Message Maternal Mental Wellbeing group.
You can find out more about her work at www.sophiepsychology.com
* This post focuses on initiatives and research which focuses on cis-female mothers, and so I
mainly use this language. However, I also refer in the post to pregnant people and birthing
people (e.g. women AND folk who are trans, non-binary etc) as part of a commitment to
make my writing more inclusive. I’ve also capitalised the B in Black to reflect the wider
historical and cultural experiences of the community. This choice of language is because I
hope this blog post will be relevant to the widest possible audience. I will make mistakes,
and when you notice them, if you would like to share, I welcome your feedback. If you would
like to know more about writing inclusively, I can highly recommend Carrie Klassen’s work
Working Together to Reduce Black Maternal Mortality
Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them
Racial Disparities in COVID-19: Key Findings from Available Data and Analysis
Saving Lives, Improving Mothers’ Care (MBRRACE-UK)
Can excess maternal mortality [in France] among women of foreign nationality be explained
by suboptimal obstetric care?
Global Disparities in Maternal Morbidity and Mortality
How Implicit Bias Contributes to Racial Disparities in Maternal Morbidity and Mortality in
the United States
Perceptual contributions to racial bias in pain recognition
Health in colour: black women, racism, and maternal health by Elizabeth Dayo, Kayonne
Christy and Ruth Habte
The opinions expressed in this article are solely those of the author and do not necessarily reflect the opinions or beliefs of Message.