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The FiveXMore and Birthrights reports: individual and systemic racism

By Dr Jenny Hall

This week two key reports on the experiences of Black and Brown women and staff in maternity services has gathered much attention in the UK press this week. Dr Jenny Hall presents the content and considers the implications.



Racism strongly exists in UK maternity services.

The clarity of this statement has been brought front and centre by the launch this week of reports from two charities; Five X more, a campaign organisation created to improve maternal mortality and health care outcomes for Black women, and Birthrights, the human rights in pregnancy and childbirth charity. The reports will be another blow for UK maternity services, yet they must not be ignored.

It is four years since the MBRRACE-UK Confidential Enquiry into maternal death of 2018 pointed to the reality of racial disparity. It was shocking to realise that Black women were five times more likely and Asian women two times more likely, to die in childbirth than those of white ethnicity. Evidence is also pointing to a higher chance of pregnancy loss of stillbirth for Black and Asian women.

Five X More came into existence because of the 2018 MBRRACE-UK enquiry and have been working hard alongside others, despite the Covid-19 pandemic, to keep the truth of racial disparity in the forefront of policy makers minds. The current report, The Black Maternity experiences survey: a nationwide study of Black women’s experiences of maternity services in the United Kingdom, aims to amplify the voices of women who have, so far, been hidden in research.  The online survey captured quantitative information from 1340 Black and Black mixed women’s personal experiences, with a further report to explore qualitatively in more depth with a smaller group.

Highlights from the findings of the report are:

  • In the antenatal period engagement with care was mainly high
  • 61% who had a miscarriage or early pregnancy loss were not offered additional support to cope with the outcome
  • During labour just over a third (36%) reported feeling dissatisfied with how concerns were addressed.
  • 43% percent reported their pain relief options were not explained to them and 52% of women who did not receive their choice of pain relief said there was no explanation as to why it was not given to them.
  • A third of respondents (31%) were concerned care they received from their midwife during the birth recovery period.
  • However, 69% of respondents said they were somewhat or very satisfied with the postnatal health check-up performed by the health visitor.
  • While 78% had health concerns after birth, those with concerns said they raised them with a Health Care Professional, but 36% of respondents said that they were not confident to ask for help on the postnatal ward.

The statistics are not comfortable reading. Even less so are the quotes that pepper the report indicating that respondents, many of whom were highly educated, in high level employment, experienced discriminatory behaviour and remarks. For example:

“I’d turn up in a tracksuit and be spoken to in a certain (dismissive) way until they learnt I was a lawyer…and they would be more respectful overall in my experience.”

“One midwife when doing the sweep said that the reason for dilation taking so long for me was “probably due to an African pelvis” – even though I was on pain relief I was mortified that she actually believed there was such a thing as an African pelvis.”

The Birthrights report, Systemic racism, not broken bodies: An inquiry into racial injustice and human rights in UK maternity care, presents findings from a year-long study into systemic racism in services. Led by a panel of experts, the inquiry explored the lived and professional experience of racism of over 300 people via written evidence, focus groups and interviews. A further online survey was carried out with over 1000 women who had recently given birth, and oral evidence was obtained from groups of policy makers and professional organisations.

The findings pulled out themes related to:

  • individual experiences of racism through feeling unsafe, being ignored or disbelieved, verbal attitudes or behaviours from caregivers, dehumanisation and pain relief withheld.
  • Coercion and lack of informed consent.
  • Structural barriers to services, including lack of access and failing to provide interpretation services, and charging for NHS services.
  • Racism and discrimination within the maternity services workforce.
  • Points of good practice, such as good communication, person-centred and culturally sensitive care.

Both reports show, over a similar time period that the needs of Black, Black Mixed and Asian women are still not being met. The Birthrights study further indicates how staff are also experiencing discrimination, which will significantly affect their ability to give appropriate care. This is not about poor staffing, or the pandemic, but individual and systemic racist behaviours that must be addressed.

The reports provide action points to bring change. The Five X More study recommends:

  • An annual maternity survey targeted specifically at Black women
  • Improve the quality of Ethnic coding in health records
  • More community-based approaches must be used to improve maternal outcomes
  • An improved system for women to submit their feedback and/ or complaints specifically for maternity
  • Ensure that individuals involved in training health care professionals are aware and have an appreciation of the disparities in maternity outcomes.

Birthrights calls for maternity systems to:

  • Commit to be an anti-racist organisation
  • Decolonise maternity curriculums and guidance
  • Make Black and Brown women and birthing people decision-makers in their care and the wider maternity system
  • Create safe, inclusive workforce cultures
  • Dismantle structural barriers to racial equity through national policy change

Similar and complimentary action points. There is no excuse for services or education to turn a blind eye to staff behaviours or discriminatory practices. Bullying and racism must be stamped out. Services must now be transformed, and lives of women and babies are saved. The focus must be turned to services where women are central to their care, care is individualised and culturally appropriate, and there is good communication.

It is all sounding very familiar to what has been said for a very long time. This time are we going to listen and change?

Dr Jenny Hall

May 2022


Find links to the reports below:

Inquiry into racial injustice in maternity care



Watch Tinuke and Clotilde’s (Founders, FiveXmore Campaign) video presentation premiering this week on Tackling Unequal Ethnic Outcomes below:


Temitope Alaka 25 May 2022 at 17:21

I am so grateful and proud to see two remarkable young women taking such an active positive drive to see change happen following one of their traumatic birth experience and an awareness of the MBRRACE 2018 report. It is indeed frightening to hear or read as a black women that your maternal death risk is 5 times more than the Caucasian population in the same category and this is in this century within a developed country.

There is still so much room for improvement of care delivery and appropriate communication to be had between the affected communities and maternity service providers.

Jenny Hall 30 May 2022 at 11:43

Thank you for taking the time to comment. It is of deep concern this is happening here. There is so much more to be done across all services

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