Black mothers are still more likely to die in childbirth – this is not a case of "bad apples"
The persistent racial disparity in maternal mortality is a national scandal. We must acknowledge that systemic racism is a root cause.
There are few moments in a woman’s life more vulnerable than when she is pregnant. As she prepares for, and then experiences, childbirth, she will likely interact with NHS services more than at any other point. Too many women are being failed by a system they have no choice but to trust wholeheartedly. For Black women, these failures occur with horrifying frequency, and that trust has been obliterated.
It is now so well-reported that Black women are more likely to die during childbirth than white women, we are at risk of becoming immune to just how unacceptable that reality is.
Black women are almost three times more likely to die in childbirth than white women. Women of mixed heritage and Asian women also face significantly higher risk of death or serious complications.
Black babies are still more than twice as likely to be stillborn than white babies. Black mothers are more likely to experience mental health problems and yet less likely to receive diagnosis or treatment for perinatal mental illness. The births of babies to Black mothers are almost twice as likely to be investigated for potential NHS safety failings.
The racial disparities are stark, unavoidable, clear as day.
A combination of things cause Black women to experience worse outcomes – socioeconomic factors, higher incidence of certain risk-raising conditions, language barriers and lack of access to services. Alongside all of these, structural racism undoubtedly plays a part. Cultural biases can lead to Black women being ignored, not taken seriously, and having their pain downplayed.
A 2024 investigation ruled that “cultural and ethnic bias” delayed the diagnosis and treatment of a pregnant Black woman before her death in a Liverpool hospital.
But despite all of the evidence, there is still a profound disconnect. Listening to a Westminster debate to mark Black Maternal Health Week on Tuesday [29 April], it was disheartening and frankly unbelievable to hear Conservative MP Dr Caroline Johnson deny the existence of structural racism within the NHS.
Dr Johnson was adamant that any mistreatment of people from ethnic minority backgrounds in maternity services was simply due to “bad apples”. When challenged by Labour MP Bell Ribeiro-Addy, who secured the parliamentary debate, she reiterated that the majority of the staff working in the NHS were not racists – a fact most people who understand how institutional racism actually works would likely agree with.
But this fundamental – possibly wilful – misunderstanding of structural racism, how it operates, manifests and impacts ethnic minority patients, is indicative of the major barrier preventing real progress in fixing racial disparities in maternity services: Black women are screaming into the void. At every level – from accessing services, to getting accurate diagnoses, to managing pain, and preventing avoidable tragedy – we are not being heard.
“What we cannot allow is a cyclical conversation in which Black women are repeatedly being asked to prove their lived experiences and structural inequality is being denied by those who can never know what it feels like.”
I felt it myself when I had my first baby in June last year. My birth, like thousands of others, ended in an emergency C-section. There were issues around staffing and bed shortages, but what shocked me was being spoken to with a lack of compassion, ignored, and made to practically beg for pain relief.
As a woman with mixed Black heritage, I can’t say for certain if my race was a factor in how my birth played out, but the reality of my experience is that I wasn’t listened to, I wasn’t believed, and I was made to feel disempowered in the most vulnerable moments of my life.
This Black Maternal Health Week, much is being made of the improvements in racial disparities. A few years ago, Black women were five times more likely to die than white women. Now they are ‘just’ three times more likely to. Despite the fact that things are moving in the right direction, it’s hard to feel grateful – particularly when senior figures with NHS experience are refusing to even acknowledge the existence of racism.
Labour have pledged to set a target to close the maternal mortality gap. But flagging the issue in parliament, Ribeiro-Addy said the current data on racial disparities “is limited and scattered” and that the “lack of comprehensive research makes it difficult to see the full picture of what is happening.”
The target set to halve maternal mortality looks increasingly out of reach. Almost half of maternity units in England are now not safe enough, according to the Care Quality Commission. But safety should be the bare minimum. Without transparency, accountability and a clear path to address the deep disparities, women – of all ethnic backgrounds – will continue to be failed.
What we cannot allow is a cyclical conversation in which Black women are repeatedly being asked to prove their lived experiences and structural inequality is being denied by those who can never know what it feels like.
The stats are there in black and white, the failings are persistent – no matter which way you look at it, Black women receive worse maternity care than white women. We must now at least agree on the starting point that structural racism in NHS maternity care is a fact, and not be gaslit by the naïve myth of ‘bad apples’.
The experiences of Black women must be at the heart of any new maternity strategies. We must no longer accept suggestions or solutions from those with no willingness to listen to people who have lived it. Black women have waited too long for their voices to be heard.
Under Secretary, Ashley Dalton MP, responded on behalf of Baroness Merron to concerns raised by MPs: “Tackling inequalities and racism in maternity services is an absolute priority for this Government… We are working hard not only to set a target, but also to ensure that we are able to meet, and the actions that will help deliver it.”
Dr Johnson MP has been approached for comment, but has yet to respond to The Lead.
Here at The Lead we have consistently reported on the growing crisis in UK maternity care, looking into the way the system is set up to fail expectant mothers, and the fallout of last year’s Birth Trauma Inquiry. We have also looked into the racial inequality of IVF success rates in UK clinics. Elsewhere, Jessica Bradley investigated the women in same-sex relationships facing discrimination in maternity care. Ammaarah Z looked into the underreported world of Black and Brown doulas working to make maternity care safer for people of colour.
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Natalie, Ed, Zoe, Luke, Sophie, and The Lead team
Dr Caroline Johnson is in deep denial. And this kind of denial and wilfully ignoring the data that systemic racism persists on healthcare- is exactly why this mortality rate persists and why women are dying from completely avoidable deaths. I am keen to see what the current government will do to address these statistics that have been in existence for decades.