Black Maternal Health Week

Kirsten Oswald Excerpts

Tuesday 14th September 2021 Westminster Hall

[Bell Ribeiro-Addy]

The hon. Member is absolutely right. With disparities such as these and no clear way forward, that is what we are hoping to hear from the Government. With all the information that we have, it is clear that the response is not good enough.

In the USA, where there is also a glaring disparity in maternal health outcomes for black and ethnic minority women, the Government have actually begun to take steps to address the problem. In April, the White House issued its first ever proclamation on black maternal health. President Joe Biden declared a Black Maternal Health Week, to take place annually from 11 to 17 April.

[Kirsten Oswald (East Renfrewshire) (SNP)]

The hon. Lady is giving a very powerful and important speech. I wonder whether she is aware that research from the USA shows that when black and Asian women do not have pre-existing medical conditions, do have English as their first language and come from middle-class backgrounds, they still have worse outcomes than comparable white women. Does the hon. Lady agree that there is something more going on here, making it all the more pressing that this Government here understand and act?

[Bell Ribeiro-Addy]

I thank the hon. Lady for that timely intervention. She is absolutely right; that shows that this is clearly about racism. It is important that we look to what other countries that also clearly have issues with racism are doing to tackle it.

Alongside the Black Maternal Health Week proclaimed by the White House, the Biden-Harris administration has outlined several action plans specifically looking at addressing maternal health issues. Through the American Rescue Plan Act 2021, $30 million has been reserved for implicit bias training for healthcare providers, as well as a provision that will allow states to expand post-partum Medicaid coverage from 60 days to a full year.

How have our Government responded in comparison? In response to a question I asked one of our equality Ministers, I was told that there was no target because the numbers were not high enough. Our Government have responded with poorly rolled-out plans that actually exacerbate the issue by ignoring the problem altogether. The NHS long-term plan aimed at providing continuity care for women across the country seemed, on paper, like a really good starting point to improve maternal health outcomes. However, a whistleblower at Worcester Royal Hospital has said that, in reality, it has created a two-tier system for pregnant women. To create the new team of continuity carers, midwives have had to be pulled from the hospital’s core staff, leaving the hospital unit without enough specifically trained staff.

--- Later in debate ---

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

It is a pleasure, Mr Hollobone, to serve under your chairmanship today.

I start by paying tribute to the hon. Member for Streatham (Bell Ribeiro-Addy) for securing this debate in Black Maternal Health Week. Clearly, she is determined that something will be done to change this terrible situation, and rightly so. Persistence very often pays off and I am sure that she will persist until change comes. I also know that this is a very personal matter for her and nothing that happens in the future can change what happened to her and her child. The fact that she keeps fighting so that the situation changes for others says much about her and I am more than happy to offer her my support.

Just as the hon. Member and others will keep raising this issue, so should we all keep raising it again and again, as others have today, until it is no longer true that black women are four times more likely to die during pregnancy and childbirth than white women. I repeat that: four times more likely to die. Women from mixed backgrounds are three times—

[Kirsten Oswald]

To highlight what my hon. Friend is saying, it seems to me that it is inconceivable that the general public know about this issue. If people understood what a huge disparity in maternal health outcomes there is for black women and for mixed race women, I feel sure that there would be a huge outcry. It is really important that the Minister takes that point on board and takes every step possible to deal with this terrible blight.

[Anne McLaughlin]

I completely agree with my hon. Friend. It is up to the many Members of this House who are not already doing it to do it, and those of us who are doing it must keep repeating over and over again that black women are four times as likely to die during pregnancy and childbirth as white women. For women from mixed backgrounds it is three times as likely, and for Asian women it is twice as likely.

The reason we need to keep saying that is that, despite the fact that the inequality and disparity in maternal and newborn health has been highlighted for many years, we still do not fully understand why it exists, as we have heard, and we do not have the targets that we need to tackle it. The right hon. Member for Romsey and Southampton North (Caroline Nokes), the Chair of the Women and Equalities Committee, of which I recently became a member, said that the statistics are so stark that there should be immediate change. She called on the Government to meet ambitious targets rapidly, and I completely agree.

In the previous debate on this matter, I focused on some of the shocking statistics that MBRRACE-UK highlighted in its confidential inquiry into maternal deaths; I shall repeat some of them. For every 100,000 women who gave birth between 2016 and 2018, 34 black women, 25 mixed ethnicity women and 15 Asian women died, compared with eight white women. Behind those numbers are people—women and babies. Compared with babies of a white ethnicity, black babies have a 121% increased risk of stillbirth and a 50% increased risk of neonatal death, and the gap has been widening since 2013. So there are these tiny human beings—boys and girls—who never got a chance at life. There are grieving fathers and husbands. There are whole families and whole communities.

In addition to the higher mortality rates, other concerns include the number of near misses and the number of times that women have felt that their voices have not been heard because of their skin colour. The hon. Member for Vauxhall (Florence Eshalomi) described a terrifying experience, when she must have felt completely powerless. That is wrong. I was shocked to hear many stories of mothers denied pain relief or left to suffer with undiagnosed post-partum conditions. I know that these things happen to women who are not black—it is always wrong—but for someone to be treated differently because of their skin colour surely compounds the problem. Just as we would research and address any medical causes of these things, we must research and address this issue. I echo the calls of the hon. Member for Streatham for the Government to address it.

As someone who is white, it took me some time to learn that people who are black just know when someone’s behaviour towards them is because of their skin colour. It is hard to explain. It was hard for me to understand at first, and obviously it is harder for me as a white woman to explain it because I do not experience it, but I have no doubt about it. I encourage everyone who does doubt it to really listen to what black and Asian mums are saying and trust that they just know.

NHS GP Dr Adwoa Danso has pointed out that instances of medical mistreatment have impacted on black, Asian and minority ethnic communities’ faith in the health services, and we saw that when it came to getting the covid vaccine. There is a further suggestion that, as the majority of migrants are disproportionally black, Asian and mixed ethnicity, the Home Office’s hostile environment immigration policy makes public services incredibly difficult to access. The right hon. Member for Hackney North and Stoke Newington (Ms Abbott) talked about the hostile environment and has campaigned hard against it for many years.

Women seeking asylum have been blocked or refused by reception staff acting as gatekeepers, often in conjunction with expectations or experiences of prejudice and discrimination. The hostile environment also leads to decisions such as taking women seeking asylum out of supportive communities and into places such as the so-called mother and baby unit in Glasgow, where tiny babies are put in tiny rooms with not even enough room to crawl. The frustrating thing for me as an MP representing Glasgow North East, in a country where we have our own Government, is that our Government can do nothing about it because all the decisions about it are taken down here in Westminster.

--- Later in debate ---

[Anne McLaughlin]

Absolutely. The right hon. Member for Romsey and Southampton North mentioned evidence from the Women and Equalities Committee. I was not on the Committee at the time, but NHS staff gave evidence saying that they felt unable to speak up. A number of years ago when I was a Member of the Scottish Parliament, I met with a group of South African nurses, and they were astonished that they were able to meet with a parliamentarian, because they thought it was not their right to be represented. They told me the things that were happening to them in their jobs in the NHS, and they certainly needed someone to support and represent them, so, yes, I do completely agree with the right hon. Member for Hackney North and Stoke Newington.

Maternity Action research found that, just like staff who were too afraid to report, black and minority ethnic women tended not to report negative experiences, and they were less likely to be treated with kindness by health professionals or spoken to using terms they could understand. Although data has not been collected recently, a 2007 confidential inquiry into maternal and child health found that between 2003 and 2005 10% of all maternal deaths were women who could not speak English. As we heard earlier in an intervention from my hon. Friend the member for—Eastwood?

[Kirsten Oswald]

East Renfrewshire.

[Anne McLaughlin]

It is Eastwood in the Scottish Parliament. Forgive me, Mr Hollobone. As my hon. Friend said, studies in America show that even among women who come from fairly well-off backgrounds and who do speak English, black and Asian women are still disproportionately affected.

If I worked in maternity care in the NHS and heard someone like me saying these things, I would naturally feel defensive. Instead, what I ought to do is think about it, read up on it, question myself—and I do regularly—and really listen to what people are saying. I have no doubt that the vast majority of healthcare workers care deeply about the people they work with. The debate is more about the system itself and the inbuilt structural inequalities. For those who may be watching and do not know this, if we say the health service is structurally racist, it does not mean it is populated by racists: it means the way in which it is structured is for white people from certain backgrounds. It takes into consideration their needs, culture and language, with very little flexibility to take into account anyone else’s. Changing the structures makes them more flexible, and that is what the debate is calling for, in addition to addressing the very specific problems that have been talked about. After all, our NHS is not a white person’s NHS, it is an NHS for everybody.

I had decided that I was only going to speak for five minutes, and I think if I had not taken interventions then I would have done, but I think it is worth saying why I had decided that. I wanted to give the hon. Member for Streatham longer—and I know she will want to say a few words at the end—because, even though I have ended up taking 10 minutes, I do believe that part of offering support is saying less and listening more.