MBRRACE: Why More BME women and babies die. A BME woman responds.

Access Denied image

Guest Blog by Beth (an AIMS member)

I remember questioning a few midwife friends about how Black and Minority Ethnic (BME) women are treated in the maternity system. The consensus is we are treated differently but not in a good way. I wish I had known earlier. Outcomes and experiences are worse even when you take away the obvious social economic factors.

BME women like me are more subjected to interventions because of arbitrary criteria such as BMI, our baby’s growth is measured against a population which is not similar to ours, and I noticed that the gestational diabetes criteria negatively affects a lot of Asian women. Our options of where and and how to birth are therefore significantly, and I’d say unfairly, limited. The constant narrative that we’re not optimal for birth because of our body size, this and that. All of my friends who are of oriental descend have been treated horribly when giving birth. None of us fall into the stereotypical vulnerable groups (non English speaking, low income, uneducated, domestic violence, substance abuse etc). None of us are over 40 years old, either.

The truth remains that the NHS maternity risk assessment is racist, non evidence based and arbitrary. The midwives and obstetric staff feel that they have a right to carry out protocols against us because they’re written in hospital guidelines. We’re considered not just as a sub class of people but our bodies are less superior and non optimal for birth because we’re not white, not a certain body size and not significant enough in number. It’s the high intervention rates, abusive practices and attitudes that make accessing maternity services more dangerous for BME women. I say the lack of acknowledgement of the issue means it’s not addressed.

When someone doesn’t think BME women deserve human rights (life) and doesn’t really care about them, they are less likely to take their concerns seriously, less likely to take care with their bodies, nor, I suppose, do they want to save them in an emergency. The NHS is unlikely to acknowledge that or the fact that higher intervention rates can cause higher mortality rates because they can cause complications and complexities.

If more interventions really mean better safety, over 40 years olds and BMEs are subjected to more interventions so you’d expect mortality to come down and not go up significantly. Something’s not adding up. I don’t think the real issue is age nor race nor ethnicity. We’re very much designed to survive whatever the colour of our skin.

I think the problem is the poor attitude towards women – the power imbalance in the care model exacerbated by institutional racism. I don’t think it’s just the obvious issue with differences in colours of skin. There’s tribalism between different groups of similar skin colour. Having institutional protocols mean that poor treatments of particular groups go undetected. All these factors are what makes pregnancies and births more dangerous for many BME women, all else being equal.

Britain, our home, is multicultural. Now is the time for our healthcare system to move on with the times and provide a maternity care model that understands and responds to women’s needs with fair and evidence based assessments. Treat every woman with respect and care. Give us all continuity of carer (in pregnancy, birth and postnatal recovery), a relationship-based model, which has been proven to improve outcome, experience and importantly reduce errors (i.e. reduce mortality). The disproportionately high maternal mortality rates for BME women have been highlighted in the latest MBRRACE report. The structural inequality and poor attitudes in the healthcare system needs to be addressed urgently. (https://www.npeu.ox.ac.uk/mbrrace-uk/reports).

The quality of healthcare we get and our chance at survival shouldn’t be determined by the colour of our skin. We are the same with the same human needs underneath it all. It’s time for us to all stand together to demand the NHS to prioritise maternity services and stop denying us care, damaging our health (harming women and babies) when we need care the most. We have worked hard to pay for our health system. It is not right for our needs to go unmet. The NHS must respond to women’s healthcare needs for our country to thrive.

Note from admin: If you would like to support or join in campaigns for quality and equality in maternity services, please contact AIMS at www.aims.org.uk.

Why Brett Kavanaugh Matters to Birthing Women in the UK

Photo of Brett Kavanaugh looking angry.

Guest Post by Emma Ashworth

Permission has been freely given by “Sarah” to include her experience in this article.

For those who are not following politics in the USA, there’s one of those slow car-crash moments happening which could have a huge and profound effect on the culture and law around women’s bodies not only across the pond, but here also in the UK and Europe.

Brett Kavanaugh is an American judge who President Trump wants to promote to fill one of only 9 positions on the US Supreme Court. These positions are life long, and filling a Supreme Court position is how Presidents leave a legacy which could last for many decades. Bizarrely, although judges are expected to be impartial, these judges are chosen very much on their partisan opinions, and Kavanaugh has shown over the years that he does not support women’s reproductive rights.

The process to finalise Kavanaugh’s escalation to the highest court in the United States hit a last minute bump in what had previously been a very smooth road when a woman called Christine Blasey Ford made an accusation that when she and Kavanaugh were both teenagers – he 17, she 15 – he attempted to rape her and held his hand over her mouth in such a way that she feared that he would kill her. Subsequently two more women have come forward to accuse Kavanaugh of serious charges of sexual abuse. In a climate where the US President has been accused of sexual assault and rape by at least 22 women (whom he has called liars), and has himself boasted that he can “grab them by the pussy”, the climate for women who confront those who assault them is unrelentingly hostile. The Republican senators have almost unanimously closed ranks around their frat boy, protecting their own and perhaps also themselves… if one of them can be accused, why not all?

While Dr Blasey Ford goes through a partisan process where she is systematically ripped apart (who helps to put her back together again?), where Trump mocks her testimony to a crowd of cheering men AND women and the media is undertaking a trial-by-opinion, underneath it all is the same relentless, persistent, ruthless misogyny which underlines the way that women are treated following all forms of assault, including obstetric assaults.

While watching and reading about Kavanaugh I was reminded of a senior midwife who once berated me for supporting a woman who was, in her opinion, “just out to get” the midwife that she was making a complaint about. The birthing woman, let’s call her Sarah, had never met the midwife before she came to her in labour. Sarah had no personal reason to be “out to get” this midwife outside of the assault that Sarah explains happened to her during her birth. Sarah went through the complaints process with the hospital and, like most women who complain, was told all the reasons why she was wrong about what happened to her. Like the Republican senators, the Trust closed ranks and rejected Sarah’s complaint with a combination of rebuffs right out of the rape defence textbook, including lack of evidence, arguing that she must be wrong or have misunderstood, and attacking Sarah herself as being aggressive and abusive, as though trying to escape from what Sarah experienced as a desperately dangerous situation was unreasonable behaviour.

Sarah’s experience is not at all unusual. Like Kavanaugh’s snarling, angry attacks on those who were trying to untangle the complexity of a sexual assault allegation, the shocking concept that a woman could deign to raise her head to say “you hurt me” to those who are actually supposed to care leads to aggressive denials from both trusts and health care providers who fight back with arguments about “policy” or “guidelines” but who actually mean “we know better than you, how dare you question our power”.

The satirical news site “News Thump” put it brilliantly with their headline, “Man ridiculing victim of sexual abuse on world stage asks ‘why didn’t she come forward sooner?’ We could just as easily say “HCPs telling women they’re wrong about their birth experiences ask why women don’t make complaints about obstetric violence”.

I do see a light, though, and it’s a light made up of flames. I see women who are no longer willing to stay silent, and for every woman who speaks out either to her peers or in a complaint she lights a flame. AIMS reminds us that “It is better to light a single candle than to curse the darkness” and every flame that is lit shows the way for another, and another, and another. We will not be silenced and we will no longer be forced to be in the dark. Our flames are growing and our flames are joining. We are all the granddaughters of the witches that they did not burn, we are not going away and we are SHOUTING.



If you have experienced obstetric violence, or a birth which included an assault and would like help or support, you can contact the AIMS Helpline here.