Black Maternal Health Week

Debate between Nickie Aiken and Bell Ribeiro-Addy

Tuesday 14th September 2021 Westminster Hall

[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.

[Nickie Aiken (Cities of London and Westminster) (Con)]

A constituent of mine, Jade Sullivan, has been in touch with me to share her own experiences of disparities in maternity care and outcomes for black women. Her testimony was incredibly powerful, and I hope to be able to meet with the Minster soon to discuss that in more detail. Does my hon. Friend—I am sorry, I should say the hon. Member, although I hope that she is also my friend—agree with me that we need a clear plan with targets to reduce disparities in maternal health outcomes that actually outline the specific actions needed to improve safety for black mothers and their babies?

[Bell Ribeiro-Addy]

I thank the hon. Member because I absolutely agree that that is what we need, but we also need to make sure that these plans are well thought-out and well resourced. As the whistleblower from Worcester pointed out, with the new plan, the ward could often end up being short of five or six midwives per shift. Meanwhile, those with a continuity midwife who are, according to the whistleblower, actually lower risk, are jumping ahead and delivering their babies because the midwife is available straight away.

A system that is supposed to help reduce the rate of stillbirths and maternal mortality has, through its poor implementation, resulted in a two-tier system whereby higher-risk pregnancies are made to wait for deliveries. For example, a woman in need of an urgent caesarean section may have to wait while women with a planned or elective caesarean section are seen first.

Recently, the Health and Social Care Committee’s evaluation of the Government’s progress against their policy commitments in the area of maternity services in England rated the Government’s continuity care commitment as inadequate and in need of improvement. That is simply not good enough. While figures also suggest that the number of women from disadvantaged backgrounds who are likely to experience a high-risk pregnancy are now receiving continuity care, and those numbers are increasing, it is clear that the Government are not on track to meet the target of rolling out their continuity of carer service model to 75% of the most vulnerable groups by March 2024. Without adequate funding and staffing, the two-tier system that has played out in Worcester will continue.

Other measures introduced by the Government to improve maternity healthcare seem to ignore the racial disparities altogether. On 4 July this year, the Department of Health and Social Care announced that it was committing £2.45 million to improve childbirth care. Of that, £2 million was to be allocated to test the best way to spot early warning signs of babies in distress, and the remaining money was allocated to developing a new workforce planning tool for maternity medics, including helping trusts to tackle other inequalities, taking into account local factors such as birth rates, the age of the population, the socioeconomic status of the area, and geographical factors. Those are all important, but at no point in this announcement was there any reference to tackling ethnic disparities in maternal healthcare, despite all of the information we have heard over the past few years in particular.

I ask the Minister why the decision was made to omit a reference to ethnic disparities when research clearly highlights ethnicity as a factor in maternal health outcomes, so much so that a series of papers released in The Lancet regarded black ethnicity as a risk factor for miscarriage. In fact, the only other intervention I have heard has come from the National Institute for Health and Care Excellence, which was to recommend inducing black women at 39 weeks—another tone-deaf response. There have been loads of responses from throughout the sector that really drilled down on what the problem was with this. Christine Ekechi, the co-chair of the Royal College of Obstetricians and Gynaecologists’ race equality taskforce, said that

“Stratifying risk by race alone is a blunt tool to use, and although highlighting higher risk is important, it does not move our understanding further as to why this group of women are at greater risk…Women should always be able to make informed decisions about their own health and care based on real evidence.”

This suggestion was not based on real evidence.

The Royal College of Midwives warned against “blanket approach recommendations” and argued in favour of “personalised care”, saying that

“Black, Asian, mixed, and ethnic minority women face a constellation of biases when accessing maternity services, often experiencing poorer quality of care and lower satisfaction. Introducing an intervention that is singling out women on ethnicity alone, when there are likely to be large differences in health status and values within the group could itself be considered discriminatory.”

Mars Lord, who is a doula and birth activist and started the Not So NICE campaign with her colleague Leah Lewin, said that the recommendations were already affecting black people’s mental health. She said that she had been in contact with

“dozens of black and brown pregnant women and birthing people who are fearful about their birth because they are not seeing any choices”.

Thousands have signed a petition urging the Government to reject the guidance from NICE.

It is clear that without a proper plan to end racial maternity health disparities, the Government are telling black, Asian and ethnic minority women and birthing people right across this country that they do not care: that our pregnancies, our children and our experiences do not matter. If the Government want to show that this is not true—if they want to prove that they care about the experience of every pregnant woman—they have to start, first and foremost, by setting a target to end these maternal health disparities.

When the Minister responds, I want to hear that the Government have set a target to end racial maternal health inequalities. I want to hear that they have a timeframe for when they would like to see these gaps closed and reduced, and exactly how they plan to do this, and I want to hear that the Government have heard what black women have been saying about our experiences of maternal healthcare and how they have often resulted in negative outcomes and traumatic experiences. I also want the Government to say that they will engage with black women to improve our experiences of maternal health services, and that they will be implementing the Joint Committee on Human Rights’ recommendations on black maternal health, as well as those included in the Health and Social Care Committee’s report, “Safety of maternity services in England.”

Finally, when the Minister responds, I hope to hear that the Government intend to launch an inquiry into institutional racism and racial bias within the NHS, as well as within the medical education field. Stereotypes about the pain tolerance of black people, our cultural beliefs and practices, and our perceived understanding of the medical system all contribute to the negative experiences black women have had in maternal services, and they definitely contributed to mine. It is certainly an uncomfortable view to take that medicine, or our fantastic NHS, may operate within a framework that has institutional racist bias, but if we are going to improve the maternal experiences and outcomes of black women, we have to address the racial stereotypes that cause them. We are not going to get there by burying our head in the sand and pretending that these racial injustices do not exist, or that they are not so bad. The colour of a woman or a birthing person’s skin should not impact the experience that they have of maternal healthcare services, their chances of a successful outcome or, in fact, whether they live or die. It is a sad fact that this happens in our country—in the sixth largest economy in the world, in one of the safest places to have a child—so we are calling on the Government to help improve those maternal experiences for all women.