Five Times More: The Black Maternal Mortality Rate
British Vogue, 2020
Systemic racism today extends to the healthcare system, a battlefield in which Black women aren’t just fighting to be heard and believed – they’re fighting for their lives.
The greatest enemy in the systemic struggle for racial equality? Implicit bias, which stems from dangerous Eurocentric ideologies and allows for prejudice to persist, ultimately resulting in the mistreatment and death of Black people – something that is particularly true for Black mothers.
According to the 2019 report published by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK), Black women in the United Kingdom are five times more likely to die during pregnancy and after childbirth compared to their white counterparts, even though they account for just 4 per cent of those giving birth. For women of mixed ethnicity the risk is threefold, and for Asian women, it’s double.
The report acknowledges that this country’s maternal mortality rate is, thankfully, among the lowest in the world, but the widening gap between Black and white women within those numbers is where injustice currently thrives, revealing a shameful discrepancy that needs to be addressed, examined, and rectified. Though, in order for this to happen, the onus to enact change cannot fall exclusively on the shoulders of women already weighed down by the burdens of discrimination.
“As medics, I understand we go [into this field] with such good intentions so it’s very hard for us to believe that we may perpetuate some of the ills that exist in society, but I think that it’s important for us to acknowledge that we are still humans, and so there are lots of things that can operate at a conscious level, but there are many things that operate at a subconscious level,” says Dr Christine Ekechi, a consultant obstetrician and gynaecologist at Imperial Healthcare and spokesperson for racial equality at the Royal College of Obstetricians and Gynaecologists. Until we as a people collectively accept the imbalances of our racialised world and reckon with our individual roles within it, Dr Ekechi asserts, we won’t be able to tear down the hierarchical frameworks explicitly designed to value white lives above all others — especially as they pertain to the preventable death of Black mothers.
The inequality haunting the UK’s healthcare system has been a contentious topic as the global pandemic rages on, shining a bright and brutal light on how Black, Asian, and minority ethnic (BAME) groups are disproportionately impacted by the coronavirus. This means that the veil of politeness behind which so many of us hide to avoid talking about race has now been lifted, and there’s simply no looking away from the fact that Black men and women are four times more likely to die from Covid-19.
Yes, the figures are alarming — so much so that over 70 legal, campaigning, and civil society organisations have called for an immediate investigation into the government’s handling of the crisis — but the issue of health disparities driven by racial bias and discrimination is far from new. It is, however, getting worse.
According to The Marmot Review’s February 2020 report, over the past ten years, health in the UK has been on the decline for the population at large, making life even more difficult for anyone trapped towards the bottom of the social hierarchy. So it should come as no surprise that as health inequalities increase, so does the Black maternal mortality rate.
“It’s chilling to think that when my mum gave birth to me in 1991, she was more likely [to die during pregnancy] back then,” says Tinuke Awe, founder of the digital platform Mums and Tea which connects, supports, and celebrates new and expecting Black mothers both on and offline. “Almost 30 years later, and I’m now five times more likely. And I have a daughter, so if nothing gets done, will she be 10, 15, 20 times more likely to die?”
Awe is no stranger to the risks of being pregnant while Black. She endured a rushed and excruciating induced labour with inadequate pain relief before her son needed to be pulled with forceps from her weakened body. It was an experience that could have been easily prevented had any one of the medical professionals on Awe’s prenatal care pathway noticed early indicators of preeclampsia, a condition that causes high blood pressure during pregnancy and after labour — instead, it was something that lay undetected, even as she “swelled to the size of a house,” right up until delivery.
Many other Black women harbour similar stories of neglect from either before, during, or after childbirth. Upon identifying race as the common thread woven through each anecdote of pain being disregarded, concerns being ignored, and adequate time and space in medical settings being denied, Awe, a self-proclaimed nerd, started researching why this was happening to Black mothers specifically. She came across the harrowing statistical truth and decided, alongside Clotilde Rebecca Abe, to transform it into a rallying cry for change: together they founded FivexMore, a campaign to amplify the perils faced by Black mothers across social media while equipping women with tools and information to improve their personal health outcomes.
“Starting the FivexMore organisation was so important to me because I have a little sister, female family members, and friends, and I don’t want any of them to become a statistic. They have the right to become mothers without the fear of dying,” Abe, a mother of two herself, explains. In addition to working full-time in foetal medicine, Abe is the co-chair of the St Thomas and Lambeth Maternity Voice Partnership and the creator of Propseritys, a maternal wellbeing social enterprise.
With high-profile names such as actor Kelechi Okafor and influencer and author Candice Brathwaite forcing such injustices to the forefront of public discourse, focus on the issue is starting to gather pace. Serena Williams also gave the power of her voice to the cause when she told her personal story of almost dying after giving birth to her daughter in 2017. Despite expressing fear that her shortness of breath could be a sign of what turned out to be a pulmonary embolism, Williams’s valid concerns were initially met with the suggestion that her pain medication “might be making her confused,” she recounted in a 2018 interview with US Vogue. Her truth exposes Black maternal mortality as not only a global problem, but a multifactorial one as well. Williams’s experience proves that linking the deaths of Black women at the hands of medical professionals to surface-level factors such as education and socioeconomic status alone is a damaging oversimplification.
The numbers in America are equally disturbing. According to the Centers for Disease Control and Prevention, the risk of pregnancy-related deaths for Black women is three to four times higher than for white women, and studies show that that the way medical workers deliver care differs based on the person sitting in front of them. This evidence suggests that healthcare professionals, whether they realise it or not, tend to dedicate more time when talking and engaging with a white woman about her treatment plans than they would for a woman from a BAME background. “This means that that a [non-white] patient leaves the consultation without that same personal agency, and without feeling that they had any central role in deciding and discussing the care pathway that affects them,” Dr Ekechi explains.
As was the case with Williams, it’s clear that even when Black women feel empowered to advocate for themselves, they’re often dismissed as being angry or troublesome — a fine line to tiptoe along when trying to articulate a point without being labelled as aggressive.
Dr Ekechi offers the following example to illuminate this phenomenon: “If a white woman presents with all of her information in a binder with a laminated birth plan, we see her as being informed. We may see her as being a little bit difficult, but actually, we very much take on board what she’s saying and we work very hard to accommodate her needs, her desires, her wishes. If a Black woman presents in the same way, quite often she’s perceived not as being somebody who is enforcing her rights to insist on certain levels of care, but as somebody who’s being difficult and the same effort is not necessarily made to accommodate her wishes.”
Maria Purcell is one such binder-toting woman. As the head of commercial partnerships for Workplace by Facebook and co-founder of the part-journal, part-period guide We Are The Hood, preparedness is in her nature, and she thought she’d be taken more seriously by documenting everything that had gone wrong with her first pregnancy ahead of seeking care for her second. After being put under general anaesthetic for an emergency C-section with her first child, Purcell had to grapple with the emotional ramifications of not being awake for the birth of her daughter.
Her experience didn’t improve the next time around. In addition to the hospital staff’s gross negligence in recording and communicating her history of gestational thrombocytopenia, Purcell was told she couldn’t have morphine after undergoing surgery when her placenta ruptured during her C-section. The reason given was that the medication is “highly addictive,” pointing to a common stereotype that prevents scores of Black people from getting the medical help they need. “I was like, ok, but I’m not a drug addict, and I’ve just had abdominal surgery, so paracetamol isn’t going to cut it,” Purcell recalls. Her binder went missing not once, but twice, throughout these exchanges.
Engagement with this issue ebbs and flows with the ever-changing tides of the news cycle, but since the universal Black Lives Matter movement has sparked renewed demands for more meaningful action against racism, talk of Black maternal mortality is trending once again. When the internet got swept up in floods of ceaseless activism, so did the petition created by the FivexMore organisation earlier this year asking for improved maternal mortality rates and health care for Black women in the UK. It now has the support of over 180,000 signatures.
So far, the government has responded with the National Health Service’s long-term plan to fund more research around this topic, adding that by 2024, 75 per cent of women from BAME backgrounds “will receive continuity of care from their midwife throughout pregnancy, labour, and the postnatal period, with additional midwifery time where needed.” While this emphasis on continuity of care can help prevent the mistakes witnessed by women like Awe and Purcell, it’s also not the only solution. Plus, by sticking the convenient BAME bandaid over flagrant gaps in the healthcare system, the specific and urgent needs of its Black constituents are effectively being overlooked.
According to Dr Ekechi, to even begin tackling the issue, medical professionals need to look inwards to both recognise and dismantle the biases through which they see their patients. This requires training throughout the early stages of medical school during which students should be educated about the racist history of medicine through revised curricula. They shouldn’t have to write their own books on how clinical features like rashes appear in all types of skin rather than just that of the culturally valorised. They need additional and more widespread teachings on how advancements in fields like gynaecology were achieved violently on the bodies of Black women because, at the time, it was widely believed that they did not feel pain — incredibly, a myth that still exists today.
The rising Black maternal mortality rate may be a complex issue, but, whittle it down and healthcare inequality is not hard to understand. As Awe, Abe, Purcell, Okafor, Brathwaite, Williams, and countless others are building a safer, more promising future for generations of Black women to come, the job of ripping up the foundation upon which society has been constructed to hold them back belongs to all of us.