Why Black Lives Matter in reproductive healthcare
12th June 2020
It’s impossible to ignore the ‘Black Lives Matter’ movement right now. As a possibly new (and often uncomfortable) concept for many non-black people, it just goes to show how normal black death, brutality and pain are in our society. But what does this mean when it comes to black people, racial disparities and reproductive healthcare?
Where are we at?
Black women in the UK are five times more likely to die during pregnancy and childbirth than white women according to the 2018 and 2019 MBRRACE reports. Let that sink in for a minute. Unfortunately, it doesn’t stop there. When it comes to reproductive health, Black women face racial inequalities across all areas of obstetrics and gynaecology. Considering that only 3% of the UK population identify as black (13% of the UK identify as being part fo the BAME community), these facts and figures are hard to ignore. Studies show that Black women:
- have a higher risk of miscarriage with both spontaneous and IVF pregnancy (Dhillon et al 2015).
- are twice as likely to have a stillborn baby than white women (Muglu et al 2019).
- experience longer delays and misdiagnosis for various issues including endometriosis (Bougie et al 2019).
- are twice as likely to suffer from infertility (Wellons et al 2008), but 50% less likely to seek treatment than their white counterparts (Chandra et al 2014).
- are 3 times more likely to have fibroids than white women (Stewart et al 2017).
- have higher rates (between 44-71%) of non-attendance for cervical screenings along with Asian women than white women at 11% (Marlow et al 2017).
- are underrepresented in UK medical research studies and clinical studies along with Asian women (Harrison & Smart 2016).
The cause of racial disparities in reproductive healthcare
Although the reason behind some of these figures is unknown and require further studies, such as the higher incidence of fibroids, for others, the disparity is glaringly obvious. And no, it’s not the conveniently overused socio-economic differences which many if not all of the studies above, reported had little to no impact on the results. We live in this reality because of implicit bias, systemic racism and the silencing of black voices.
The 2013 study on Experiencing maternity care: the care received and perceptions of women from different ethnic groups (Henderson et al 2013) produced a variety of concerning results. Compared to white women, black and Asian women were: ‘less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to have confidence and trust in the staff.’. In addition to this, researchers went on to say ‘That this was still the case following the publication of a number of national policy documents and local initiatives is a cause for concern.’ That was 7 years ago and aside from more studies, what has actually changed?
What about COVID-19?
Looking at the recently published government report on the ‘Disparities in the risk and outcomes of COVID-19‘, the disproportionate black and white mortality rates are evident. The fact that a report was created in the first place is telling of where we’re at. A concurrent study from the UK Obstetric Surveillance System (UKOSS) showed that a disproportionately high number (55%) of all pregnant women admitted to hospital with COVID-19 were from BAME groups.
The impact of systemic racism
Many if not all of today’s reproductive health practices have an oppressive and colonial history and are fundamentally anti-black – especially contraception. Although centuries have passed, being black means you have a higher chance of not being seen or seeing yourself in a system that is supposedly there to help and care for you.
A common misconception is that racism only rears its ugly head as explicit physical or psychological violence. However, racial disparities in reproductive healthcare are often due to the repeated series of microaggressions and stereotypical beliefs combined with the unwillingness to change. Together, these cause the greatest harm and sustain a failing system. This results in:
1. Lack of action
Despite the amount of health/ race research that has been carried out, very little action has been taken to address the disparities that exist. Just look at the conclusion that Henderson came to in their 2013 study that we quoted above.
The British government especially, have a growing track record of launching reports and not following up. From the report on the Windrush scandal to the Lammy report which was published 3 years ago, none of the recommendations have been actioned. The pressure is currently mounting for the government to launch a public enquiry into the shocking UK BAME COVID-19 death rate. But what about the MMBRACE reports and maternal mortality rates?
So far, no plan has been outlined to help the UK half the rates of black women dying which is the supposed goal. We can only hope to see the government and NHS trusts enacting policies that address this in the near future. Solutions could include the ongoing training of staff, holding staff/ trusts accountable and creating a better reporting system for women to share their experiences and feedback about their care.
2. Lack of representation
From prenatal groups to yoga studios and the diagnosis and treatment of infertility, prejudice is Finding yourself in an already lonely and vulnerable place and then have every ad, poster, #ttcgroup and app with only the faces of white cishet women, is neither empowering nor comforting. This was very much my experience when I was looking for support for my miscarriage at 22 years old. Seeing webpages and helplines with the faces of older, happily married white women, left me – a young black woman – feeling more alone and unseen than ever. It was clear, these spaces and support were not for me.
We must also acknowledge the lack of representation of practitioners. There are a large number of Black health and wellbeing professionals, but they are rarely given as much space as their white counterparts. The importance of cultural competency of healthcare professionals cannot be denied.
Being seen, or not as is often the case, impacts both the physical and mental wellbeing of black women. Again, black women find themselves erased from a space that should and could be a welcome oasis.
3. Under-treatment of pain and other symptoms
From breaking our arms to childbirth, black pain is consistently under-treated (Reynolds et al 2020). With even the Beyonces and Serena Willams’ of our world being silenced and ignored when they’re at their most vulnerable (giving birth), is there any hope for the rest of us?
50% of white healthcare professionals still believe that black people have a higher pain threshold than white people (Hoffman et al 2016; Reynolds et al 2020). This belief stems back to slavery when white people spouted it as truth to acquiesce inhumane brutality, pain and experiments on black people.
To say that black women “die” or “suffer” is a passive truth: racist, capitalist and sexist policies can kill black women if they decide to give birth and if they decide they do not want to give birth.
Black lives matter because black death and pain
didn’t don’t. It’s 2020, and this is the current state of affairs.
What can you do?
Here are a few resources to get you started. However, please remember that they are just a small part of the work that goes into being actively anti-racist, educating yourself and changing the system.
- FivexMore Petition: Improve Maternal Mortality Rates and Health Care for Black Women in the U.K
- Pregnant then screwed petition: BME pregnant women must be shielded now
Follow & support
Here’s a list of reproductive health platforms and people addressing racial disparities in reproductive healthcare.
- Decolonising Contraception – A community-based organisation created by black & people of colour (BPOC)* working within Sexual & Reproductive Health (SRH). Instagram. Website. Donate.
- The Womb Room – This community works in collaboration with organisations and individuals to engage people of all ages to think critically about reproductive and menstrual well-being and the ways in which a lack of knowledge and understanding can contribute to inequitable outcomes for people with periods. Instagram. Website.
- Cysters Group – A Charity changing the narrative on reproductive and mental wellbeing, striving for equal healthcare for marginalised groups. Instagram. Website. Facebook.
- Kenny Ethan Jones – Wonderful black trans model, activist and writer advocating for gender equality and change within the reproductive health space (especially around periods). Instagram. Website.
- Abuela Doulas – Black-owned, founded and created UK doula course. Training doulas with cultural competency to better support people through the perinatal period. Instagram. Website. Donate.
- #FiveXMore – Campaign to raise awareness about the mortality rates of black women during pregnancy and birth. Instagram. Website.
- Birthing in Colour – A birth group for Black & Asian women to gather and explore all topics Bump, Birth & Beyond. Instagram. Website. Donate.
The Decolonising Contraception reading list is a treasure chest of articles written both by the founder Dr Annabel Sowemimo and other prominent voices in the sexual and reproductive healthcare (SRH) community.
Another one of my favourite publications is Salty. An intersectional, perfectly ‘imperfect’ feminist online publication. Here are a few articles that may be of interest to you:
- What Four People Wish They’d Done to Better Prepare for Menopause
- Bleeding While Non-Binary: My Love/Hate Relationship With Menstruation
- Luiza Prado de O. Martins is Fighting to Decolonize Reproductive Health
- Birth Control Pills Gave Me Depression. An IUD Gave Me a New Life.
- There Ain’t No Black in the Union Jack: The Cultural Politics of Race and Nation by Paul Gilroy
- Women, Race & Class by Angela Davis
- Killing the Black Body by Dorothy Roberts
- Battling Over Birth by Julie Oparah
What will we do?
A note from Adia co-founder, Lina Chan
Things need to change. We need to address the racial disparities in reproductive healthcare and services for the most vulnerable people in society. This means reducing and removing the health disparities experienced by black women, members of the LGBTQ+ community and people with disabilities.
Moving forwards, we will:
- Address our own bias and continuously hold ourselves accountable. This is a marathon, not a sprint and we’re prepared to go the distance.
- Learn more about racial disparities in the area of reproductive healthcare and use this to lead improvements in the way we support our community.
- Become better allies to the black women in our community.
- Hold space for the black women on our team and in our community to share their expertise, stories and be instrumental in guiding our strategy.
- Sign petitions and write to our MPs because these studies cannot be forgotten. We will do all we can to ensure they become a catalyst for change at a political and societal level.
- Talk more about race as a brand, on our platform, and as experts in the area of reproductive health. We can only be true experts if our work addresses the racial disparities and intersectionality within our field. It is all of our responsibility to talk about race and to take a stand against institutionalised racism. This has been going on far too long and we will not be silent anymore.