In recent years, Conservative ministers have sought to debunk institutional racism, with the government-ordered Sewell report concluding that its existence in Britain is “not borne out by the evidence”. Yet the evidence is incontrovertible, particularly in health. A recent example comes from a report published by the women and equalities committee, which finds that black women are almost four times more likely to die as a result of childbirth than white women. MPs behind the report have rightly denounced the government’s failure to address this gulf.
The statistic is not news. Racial inequalities in maternal healthcare have been documented for at least two decades. Serena Williams recently drew attention to this phenomenon in the US when writing about the birth of her daughter. The tennis player, who was at risk of blood clots, was told when requesting a scan that medicine was making her “talk crazy”. Once the scan was granted, it revealed what Ms Williams had suspected. The clots had returned. The resistance she faced is not uncommon. Research from the US shows how racist assumptions that black patients can endure more pain have resulted in doctors being less likely to grant them adequate treatment. In Britain, black women report being denied pain relief, feeling unsafe and seeing their concerns ignored by midwives and doctors.
When politicians and parts of the media promote the idea that racism is a matter of bad apples rather than wider organisational failures, it should be no surprise that the role of systemic racism in health is ignored. Many of the problems faced by women of colour on maternity wards are rooted in unconscious biases. Midwives still use the Apgar score, a 1952 tool that checks the health of newborns by the colour of their skin. Textbooks and equipment are still based around white bodies: pulse oximeters are prone to inaccurate readings when gauging the oxygen levels of people with darker skin. Ethnic minority groups are underrepresented in clinical trials. An equalities minister should encourage attempts to make learning more diverse. It’s a pity that the current holder of the post – Kemi Badenoch – does not do so.
Ministers have framed attempts to address unconscious biases as symptoms of a “woke” agenda. This ugly climate diverts attention from the consequences of systemic racism. The government’s response has been feeble; the Maternity Disparities Taskforce founded in 2022 has not met for nine months, and race is omitted from its terms of reference, which concentrate largely on preventable risks such as smoking and drug use. These are important factors, but this focus risks blaming women of colour for maternal health, and ignoring how the physiological effects of racism can drive health inequalities.
The NHS founded the independent Race and Health Observatory in 2021, while local maternity services have made progress on adopting equality plans. But leadership is needed from the top. Austerity and the absence of a fully funded NHS workforce strategy have made it practically impossible for midwives to deliver continuity of care. Despite ministerial pledges to level up health, the promised health disparities white paper has disappeared. Ms Badenoch has conceded that fewer than half the measures in the government’s plan to tackle racial inequality had been delivered. So long as politicians trivialise systemic racism and pretend the journey towards equality is complete, the causes of these health disparities will go undiagnosed.
Do you have an opinion on the issues raised in this article? If you would like to submit a response of up to 300 words by email to be considered for publication in our letters section, please click here.
