The World Health Organisation estimates that nearly 94% of all maternal deaths occur in low and lower middle-income countries. It is therefore alarming that for Black women in an industrialised nation such as the UK, the chance of maternal death is 1 in 2500. This was according to the UK Confidential Enquiry into Maternal Deaths, which investigated the causes of maternal deaths and morbidity between 2014 to 2016. The report also found that the mortality rate for Black women was fivefold higher compared to white women. This problem isn’t just a domestic issue however; parallel statistics have been observed in the US, where Black women have a three to four times higher maternal mortality rate. This begs the question: what exactly is causing this disparity?
The issue is multi-factorial. For example, Black women are more likely to develop pre-eclampsia, a common cause of maternal death. The condition causes high blood pressure and protein to appear in the urine. When left untreated, pre-eclampsia can result in complications or death to the mother and/or the baby. The risk of developing pre-eclampsia for Black women is tripled. Additionally, Black women are also more likely to be anaemic during pregnancy and develop gestational diabetes.
The report also found that the mortality rate for Black women was fivefold higher compared to white women
However, biological factors do not paint the full picture. “Other factors such as socioeconomic status and living conditions can have a profound effect on pregnancy outcomes,” says Winslow*, a foundation year doctor working in London. “There is research to suggest that even income level doesn’t improve the racial disparity in outcomes.”
Winslow isn’t wrong. While it is generally believed that greater socioeconomic advantage and mobility leads to greater health outcomes this, unfortunately, is not the case for Black women. A study in 2017 found that middle-class Black women were still more likely to die from pregnancy-related complications compared to working-class white women. These statistics are even exemplified in the public sphere, through high profile stars such as Serena Williams and Beyoncé. Serena Williams, who had an emergency C-section to deliver her daughter, suffered from shortness of breath a day after giving birth. Due to her history of blood clots, the athlete knew that she needed a CT scan and IV heparin. However, medical staff were slow to respond and ignored her requests. Beyoncé herself suffered from pre-eclampsia during her pregnancy and had to have an emergency C-section when one of her twins showed signs of distress in the womb. These two famous cases illustrate how even greater socioeconomic status does not necessarily prevent pregnancy-related complications in Black women. Furthermore, Black women are more likely to have difficulties accessing reproductive healthcare, which further decreases positive clinical outcomes.
Middle-class Black women were still more likely to die from pregnancy-related complications compared to working-class white women
However, there is another factor that seems to not have been considered as diligently. “Bias hasn’t been looked into as closely in the UK and it needs to be because it’s a rising problem,” says Winslow. Structural racism and bias can have a profound impact on health outcomes and the experiences of patients.
Undeniably, there have been a multitude of studies that have investigated the effect of physician bias and perceptions on patient treatment. For example, a 2016 American study that surveyed 222 white medical students found that half of these students had false beliefs regarding biological differences between Black and white patients. This included the belief that Black people felt less pain compared to white people. Another 2016 study found that Black patients were half as likely to be prescribed pain medication than white patients, even if they had the same level of pain. A factor in this is the false belief that Black patients are more likely to be drug addicts.
Structural racism and bias can have a profound impact on health outcomes and the experiences of patients
These studies not only show the interplay between racial bias and clinical outcome but also how race can magnify the power imbalance that exists between patients and doctors. Furthermore, these studies provide further insight into how false perceptions around race can lead to disparities in treatment.
Sentiments of bias have been echoed by many Black women on social media platforms, detailing instances of being ignored or receiving poor treatment from doctors. “There is an obvious race disparity for a number of reasons and it needs to be looked into by the GMC and the NHS,” adds Winslow. “They need to think about what things we can do as health professionals to help improve outcomes for Black women.”
Sentiments of bias have been echoed by many Black women on social media platforms, detailing instances of being ignored or receiving poor treatment from doctors
The General Medical Council (GMC) is the regulator of individual doctors in the UK and part of its role extends to assuring the quality of education and training of doctors. In 2018, their ‘Outcomes for Graduates’, a document that sets out the attributes that graduate doctors are expected to possess, was revised to include specific references, including the requirement of doctors to be aware of issues around equality and how any bias may affect patient care and how to address this.
“All patients deserve to be treated fairly and doctors mustn’t let any personal biases interfere with the care they provide,” said a GMC spokesperson when reached for comment. “To help reduce inequalities, we’ve asked medical schools and postgraduate training organisations to ensure medical students and doctors can recognise and counteract their biases, including those which may be unconscious. We hope this will have a positive impact on doctor-patient relationships, and the health outcomes of disadvantaged groups, in the years to come.”
The General Medical Council (GMC) is the regulator of individual doctors in the UK and part of its role extends to assuring the quality of education and training of doctors
When asked how the GMC ensures that medical schools and postgraduate training programmes are highlighting these issues, a spokesperson clarified that the GMC regularly monitors and check these standards are met by carrying out visits and by receiving regular reports from medical schools and royal colleges. Feedback is then provided. The GMC also plans to roll out a new comprehensive framework for quality assurance review for medical schools this summer; Warwick Medical School was included in the pilot.
It is evident that the disparities in health care go beyond socioeconomic status, class and education level and that a racial factor to maternal mortality exists. This needs to be researched more comprehensively and a framework for change is needed so that reforms are made systemically within the healthcare system. The Royal College of Obstetricians & Gynaecologists, which sets standards for clinical practice, will be holding an event on International Women’s Day entitled ‘We need to talk about race.’ The event hopes to broaden the conversation about racial disparity within healthcare, through discussions with clinicians and hearing from women who have experienced inequalities in healthcare. When reached for comment regarding bias in healthcare, a spokesperson said that the College is currently working on a position statement.
The GMC also plans to roll out a new comprehensive framework for quality assurance review for medical schools this summer; Warwick Medical School was included in the pilot
With the hurdles that come with motherhood, Black women should not have the added concern of a biased healthcare system. “It really is a human rights emergency. Many of these deaths are preventable and we are letting down a generation of women by not investigating this more thoroughly,” Winslow emphasises.
*The name in this article has been changed for privacy and anonymity
Note: The National Health Service press team were contacted for a statement. A spokesperson stated that they do not provide comment to student publications.