The pandemic exposed what BAME women have long known: poor pregnancy outcomes are a too common a reality for mothers from minority groups. Non-medical reasons play a part in the overall picture: in a country where BAME communities live in poverty and women’s pain is often dismissed, we need a systemic change to the way healthcare is approached.

In May, research from the British Medical Journal found that BAME women account for over half (56%) of pregnant women in UK hospitals with Covid-19. Specifically, of the 427 pregnant women admitted to hospital with Covid-19 between 1^st March and 14^th April 2020, the vast majority were from Asian and Black communities.

Acknowledgement of these findings led NHS England to urge doctors and midwives to take specific action to support pregnant women from Black, Asian and minority ethnic backgrounds during Covid-19.

The additional support is, of course, welcome. But women from BAME backgrounds had poor pregnancy outcomes even before the coronavirus outbreak. The 2019 MBRRACE-UK report found that the maternal mortality rate was higher among BAME communities, with Black women being five times more likely to die from pregnancy than their white counterparts, and Asian women being twice as likely.

The fact that this is happening in a country where the maternal mortality rate fell from 11 deaths per 100,000 live births in 1998 to 7 in 2017, raises serious concerns about health inequalities in the UK.

What are the factors contributing to poor pregnancy outcomes for BAME women?

The NHS is currently investigating the causes that lead to a significantly higher maternal mortality rate for black women.

While waiting for the findings from this research, we want to give a partial answer to this question by looking into non-strictly-medical reasons that affect the health of BAME groups.

Maternal health problems do not exist in isolation from the wider social context. Without oversimplifying, we can say that complications from childbirth are a result of lifelong health inequalities.

Our health is shaped by many factors, including the environment in which we are born, live, work and age. These socio-economic conditions are a core reason for disparities in the health status of different social groups.

In the UK, people from BAME communities are over twice as likely to live in poverty than white people. This in turn leads to systematic differences in health outcomes: a 2012 UCL study revealed a stark 21-year difference in life expectancy between newborns in central London and those born in the most deprived and diverse areas in the East of the city.

In this context, BAME women are no exception.

Among the social determinants of health, gender and ethnicity are particularly relevant to the analysis of pregnant BAME women’s conditions:

• Gender bias in the medical industry means that women’s pain often gets dismissed. According to Endometriosis UK, it takes 7.5 years to get a diagnosis for endometriosis. Findings from a 2016 study from University College London pointed out that women with dementia receive worse medical treatment than men. Recently, a government ordered review into vaginal mesh, hormonal pregnancy tests and sodium valproate epilepsy treatment used in pregnancy confirmed that “those who have been affected have been dismissed, overlooked, and ignored for far too long.”
• At the same time, racial bias impacts on pain assessment and treatment. Researchers in the US found that false beliefs about biological differences between blacks and whites inform medical judgments. Another study, published in 2016, gave evidence that black patients are half as likely to receive pain medication as white patients. Ethnic inequalities in the UK health system are under-researched, but patients have raised their voices to call out the racial bias within the NHS: among them there are also black women, living testimonies of how they are treated differently from expectant white mothers and of how their life-threatening conditions are dismissed due to pregnancy.

Going forward

Considering the bigger picture, changes to the model of care for this group of women cannot and must not be limited to emergency circumstances.

At JAN Trust we believe that complex social problems need complex solutions: for this reason, the core of our work is to support women and BAMER communities using a holistic approach. If we want to improve pregnant BAME women’s pregnancy experience, we should be adopting a similar way forward in the medical field.

In the Long-Term Plan, the NHS acknowledges the impact of both social and economic environment on our health. The official position is one that points at a stronger NHS action on health inequalities. When it comes to maternity and neonatal care, the objectives set out in the 2019 NHS strategy aim to “accelerate action to achieve 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025”.

Until then, there is one thing we are sure of: commitments to tackle health inequalities would only work with a real holistic approach to healthcare, both during and after Covid-19.