Black Maternal Healthcare and Mortality

Anne McLaughlin Excerpts

Monday 19th April 2021 Westminster Hall

[Anne McLaughlin (Glasgow North East) (SNP) [V]]

I am happy to speak under your chairmanship today, Sir Gary, although what we are discussing is a very unhappy set of circumstances. I thank Five X More for the petition and the debate, and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for leading it. I confess—I know I am not alone in this—I knew very little about this subject until hearing from Five X More , and I am someone with a long-term interest in racial inequality, so I thank it sincerely. Many hon. Members have spoken powerfully today. I pay particular respect to the courage of the hon. Member for Streatham (Bell Ribeiro-Addy).

In the UK, almost 800,000 women give birth every year. That is 800,000 interactions with their national health service, making childbirth the No. 1 reason for engagement with the NHS. For a large proportion of women, it is their first adult contact with health services, and maternity care should be a unique opportunity to mitigate some of the factors that perpetuate health and social inequalities. I have no doubt that for many it is, regardless of ethnicity. I also have no doubt that the vast majority of healthcare workers care deeply about the people they work with. This debate is more about the system itself and the structural inbuilt inequalities.

We are hearing through heartbreaking testimony and alarming reports that these inequalities are very much there, putting black mothers and babies at a significantly higher risk of maternal and perinatal death. It is worth repeating again and again that black women are four times more likely to die during pregnancy or shortly after giving birth than white women. Women from mixed-race backgrounds are three times as likely and Asian women twice as likely. Most alarming to me is the fact that this inequality and disparity in maternal and newborn health has been highlighted for several years, yet there is still no target to end this. Why on earth not?

I want to pay tribute to MBRRACE-UK for the work that it has done in the confidential inquiry into maternal deaths. There is a coldness to research and statistics that often lets us forget what MBRRACE-UK points out: behind each number is a mother, a father, a baby, a family and a community left devastated by these events. Five X More has published a comprehensive list of suggestions for the Government to act on, as many hon. Members have noted today. I will note just one: the advice to listen to the voices and experiences of black women. Listen!

Maternity Action notes that a reason for the disparity, as the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) has noted, is that migrant women with insecure status face charges of £7,000 or more for essential NHS maternity care. That will clearly deter lots of these women from attending for care. Maternity Action has rightly called for an end to no recourse to public funds rules, as others have today. The rules exclude some migrants from access to top-up payments such as housing benefit, universal credit, child benefit and other critically important benefits. Many working people are paid so little that they require those top-ups just to survive, but many migrant women with work visas and jobs and others with limited leave to remain do not have the right to what is considered essential for everybody else.

Finally, Maternity Action and others are calling for a welfare safety net for all pregnant women. I will add to that by talking about how important universality can be. In Scotland, there is universal access to free prescriptions, but even more relevant to this debate is universal access to the baby box. It is not a poor baby’s box, but a “welcome to the world” baby box. It is free to all new parents and is based on the Finnish model, which has a proven record of decreasing infant mortality. The box includes essential items for a baby’s first weeks and months, and it provides a safe space for babies to sleep near their parents. However, one of the most important aspects of the baby box is that it brings women in touch with healthcare workers before and after the baby is born. Those workers can then support the mother and baby.

Every baby should be born with an equal start in life, and the SNP Government are exploring even more ways in which the baby box can be used to promote women’s health and support mental health. I mention the baby box not to say that Scotland does everything so much better than the rest of UK, but it is something that I would love to see the rest of the UK adopt. It is not just about health and being in touch with health services; it is about the psychological impact of the Government telling people, particularly migrants to this country, that their babies are welcome and loved. So much work was done on ensuring that it was not seen as a poor baby’s box that, in 2019, 47,000 baby boxes were delivered to new parents in Scotland—a 93% uptake. That is what happens when there is universality.

As we know, the mortality risk from covid-19 among ethnic minority groups is twice that for white patients, and that is after potential confounding factors such as age, sex, income, education, housing tenure and area deprivation have been taken into account. A recent report found that black pregnant women are eight times more likely to be admitted to hospital with coronavirus, and Asian women are four times more likely. There is simply no hiding from this issue. If we are to fully understand race and health, we have to fully understand the role of ethnicity and racism in our society—the everyday acts of discrimination, the unconscious and implicit biases, and the cultural and structural racism that we are now being told does not exist.

I do not have the time or expertise to delve deeply into this issue, so I am glad that others are speaking about it. One of those is Dr Christine Ekechi, who is the spokesperson for racial equality at the Royal College of Obstetricians and Gynaecologists. She said:

“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.”

Dr Ekechi has suggested that we need more diversity in healthcare systems and that healthcare professionals should check themselves for whatever biases they may have. I expect the vast majority would want to do that, and we should be supporting them. It is one of the things that we will be looking at on the all-party parliamentary group on unconscious bias, because it does exist. We should be finding ways to help people unravel their biased thinking, because it has a massive impact on people’s lives.

I want to add to some of what others have said about the Commission on Race and Ethnic Disparities report. Rather than focusing on structural inequalities, it attempted to explain them by talking about economics, geography and family units. Academics have accused the report of cherry-picking data to reach predetermined conclusions. They say it is littered with mistakes and selective quoting, in an attempt to tell us that

“the British discourse on race is obsessed with victimhood when it should be celebrating progress.”

That is not surprising, given that the author has already said many times in the past that he does not believe structural inequality exists, but it also chimes with a growing trend among Conservative politicians to claim that there is no such thing as structural racism in the UK. However, even the Prime Minister now seems to be distancing himself from the report, saying recently:

“I’m not going to say we agree with every word.”

For those who may not know and who may be watching, if we say the health service is structurally racist, it does not mean that it is populated by racists. It means that the way it is structured is for white people and that it takes into consideration their needs—culture, language, health trends and so forth—with very little flexibility to take account of anyone else’s. We need to change the structures and make them more flexible, which is what this debate is calling for. After all, our NHS is not a national white person’s health service; it is supposed to be for everybody equally.

This is a moral issue. As Alexandre Dumas wrote:

“Moral wounds have this peculiarity—they may be hidden, but they never close; always painful, always ready to bleed when touched, they remain fresh and open in the heart.”

I will end with the words of Amy Gibbs, the chief executive of Birthrights:

“A lot of black and brown people in the birthing world are understandably frustrated by calls for more research when what’s needed is action.”

I think she is right. We need to act now. No more endless research: let us just do something about this.