Black History Month – a personal view

October brings the start of a focus on the important contribution that Black people have made, and are making, across society. In this article midwife Jennifer Ekwebelem shares her views on the need for greater equality in maternity services.

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In 1948, the National Health Service (NHS) was born which Bevan described as “great and novel undertaking” as it revolutionised healthcare access nationally.  However unfortunately the NHS was soon met with a staffing crisis as many women left the service to be reunited with their family post-war. The 1948 British Nationality Act encouraged migration from the common wealth and former British colonies. Many midwives migrated from the Caribbean and Africa and were employed to help with the staffing shortage within the NHS across the United Kingdom. This was also to help with the post-war baby boom within the United Kingdom.

 

Black-British Midwives knowledge and compassion have had a positive influence on family’s quality of life throughout history.  Professor Jacqueline Dunkley-Bent OBE, chief midwifery officer said: “The contribution that midwives make to the physical and psychological health outcomes and experiences of women and babies in our multicultural nation ripples through generations”. The sacrifice, compassion, and selflessness of Black-British Midwives deserves recognition. Recognition should not only be during black history month and then quickly forgotten once October comes to an end. Black-British Midwives continually promote public health and wellness for women, birthing people, and their babies, and this should not only be remembered during October.  If the awareness of prejudice, systemic racism and privilege ends once November starts, can we really claim we have made progress in terms of equality?

 

Although Black midwives and nurses only make up 9% of the midwives and nurses on the register, there are several midwives that have influenced maternity standards and guidelines nationally. This includes striving for change of practice within the NHS in the past and present: Dame Karlene Davis, former General Secretary of the Royal College of Midwives, Professor Jacqueline Dunkley-Bent OBE, the first Chief Midwifery Officer and Professor of Midwifery at King’s College London and London South Bank University, Wendy Olayiwola National Maternity Lead for Equality, recipient of British Empire Medal (BEM) and the founder of National BAME Health and Care Awards and Society of African and Caribbean Midwives (SoAC) UK.

 

Lack of representation

This is Black History Month, and it is time to celebrate and reflect on the journey made on equality and diversity. However, there are several current events that remind us we still have a long way to go. As a black midwife I have personally seen and have heard various accounts from Black colleagues that work within the NHS regarding discrimination and lack of representation in leadership. NHS Workforce Race Equality Standard published this year suggests that the numbers of Black and minority ethnic (BME) in leadership roles has increased from 153 to 298 between 2020 – 2021. In spite of this, the data collected by Workforce race equality suggests BME midwifery leaders are underrepresented in senior positions when compared to their white counterparts. Statistics show and the RCM has highlighted that those from BME background are disproportionately referred into the NMC fitness to practice procedures by employers when compared to their white European background counterparts. More needs to be done within the NMC and NHS trusts to safeguard BME midwives and nurses. I cannot help but question if we had more BME in leadership will this be the case?

 

Racial abuse, systemic racism within maternity and medical racism

Systemic racism is a form of racism that is deeply embedded in systems or institutions or law. Being a black woman and knowing I am four times more likely to die in childbirth when compared to my white counterparts is terrifying, especially in a diverse, multicultural first would country. Being a black women and a midwife I cannot put into words how disturbed I felt when reading the MBRRACE: Saving lives, Improving Mothers’ Care report. Further reports such as Systemic Racism, not broken bodies inquiry by Birthrights sponsored by Leigh Day points out that the safety of BME mothers and birthing people are put at risk due to systemic racism within UK maternity care. BME women and birthing people reported microaggression, stereotyping, coercion, incidents of physical and psychological harm. When concerns about themselves or their baby’s health were raised, they were dismissed or ignored. This includes missed diagnosis due to skin complexion such as jaundice due to the fact medical textbooks centre white bodies and how symptoms are displayed on white skin.

 

Olive Lewin, member of the Birth rights inquiry panel said:

“All women should have the right to proper care, at any time. The fact that Black women are four times more likely to die during what should be a joyous period is disgraceful and completely unacceptable. After working in the medical negligence sector for over 25 years, helping women and their families who have suffered avoidable injuries during their maternity care, I have lost count of the times I have said that lessons need to be learned. But I will keep saying it until we see meaningful change and the inequality behind this heart-breaking statistic is resolved.”

 

Birthrights said:

“The starting point for our year-long inquiry was that systemic racism exists in the UK and in public services, including the NHS. We set out to understand how it manifests within maternity care and to drive action to end it. The qualitative evidence presented in this report uncovers the stories behind the statistics and demonstrates that it is racism, not broken bodies, at the root of many inequities in maternity outcomes and experiences. This is an urgent human rights issue, and urgent action must be taken to address it – starting with the five calls to action set out in the inquiry’s report.”

 

Black midwives continue to advocate for themselves and their community with movements such as http://fivexmore.com/ with the aim to highlight health inequalities and changing maternal outcomes for black women and birthing people.  Reflecting on the last two years since the global pandemic, it is time to appreciate the remarkable contributions Black-British midwives have made to the healthcare system and the vital role they have played in keeping mothers, birthing people, and their babies safe.

 

I am determined and so should every health care professional to break down every barrier possible to reduce the inequalities within maternity care for black women and birthing people.

 

“Life is a never ending cycle of change, it keeps changing every minute of every day although not always “ Vitaly Etienne Herbert.

 

My personal view on what needs to be done to insight change?

Dismantling and changing how curriculum is taught in midwifery training and medical school to move away from white centred teaching, increasing representation of black people in leadership roles, encouraging more people from BME to train to be midwives and safeguarding these midwives from racial abuse and unnecessary disciplinary referrals. Before maternity care can be inclusive it must be equal!