“Historic racism” impacts the experiences of pregnancy and contraception health services for black and south Asian women, a leading expert on reproductive health has warned.
Dr Rebecca French, Associate Professor of Sexual and Reproductive Health Research at the London School of Hygiene & Tropical Medicine, said the issue is partly due to “mistrust in and exclusion from health services” for some ethic minority groups.
It means reproductive health services “need to be culturally aware without making assumptions”, she added, as some ethnic communities are underrepresented not only in the health service workforce but also in policy-making.
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A report released last year by MBRRACE-UK found that black women are four times more likely to die during pregnancy or childbirth than white women, while Asian women are twice as likely. Another UK study by the Royal College of Obstetricians and Gynaecologists (RCOG) found that 55 per cent of pregnant women admitted to hospital with Covid-19 were from a black, Asian, or minority ethnic backgrounds.
The recent Commission on Race and Ethnic Disparities report said that “historic experience of racism still haunts the present”, hindering people from ethnic minority backgrounds from engaging in government services, including healthcare.
Dr French is leading a Public Health England (PHE) survey to better understand inequalities in women’s reproductive health. It will expand on PHE research from 2018 that was found to not be representative of the population. Of the 7,500 women surveyed in 2018, white participants were over-sampled, but South Asian and black respondents were undersampled. Women from the most deprived areas of England and women over the age of 45 were also under-sampled.
Black women have a 40 per cent increased risk of miscarriage compared to white women, and infant outcomes are similarly bleak according to research by pregnancy charity Tommy’s. Stillbirth, neonatal death and premature birth are more common among ethnic minorities, older mothers, and women living in deprived areas.
Dr Jo Mountfield, Vice President at RCOG, said more research into why health disparities exist for women from Black, Asian and minority ethnic backgrounds, and those from disadvantaged backgrounds, is “vital”.
“It has the potential to improve patient experience and quality of care, as well as diagnostic rates for women, which in the long term can lead to a more efficient and effective healthcare system,” she said.
“Who you are or where you live shouldn’t matter; every mother and every baby are entitled to the best care,” said Kate Davies, director of research, policy and information at Tommy’s.
“While pregnancy and childbirth in the UK is usually a safe experience, a wealth of data shows persistent and significant variation across geographic regions and between societal groups – disparities which the Government and the NHS have acknowledged, but not set targets to end.
“We need to understand these unacceptable statistics if we’re going to change them, so the PHE survey is an important step on that road,” Ms Davies said.
The British Pregnancy Advisory Service (BPAS) also welcomes the reopening of the PHE survey. A spokesperson said: “It’s vital to engage with women who were under-represented in the initial survey in order to fully understand and meet their needs.”
A recent British Pregnant Advisory Service (BPAS) report into the provision of long-acting reversible contraception found that particular groups, including black women and women of colour, felt pressure to use coils, implants and injections.
A spokesperson from BPAS said: “The report found that racial bias meant black and women of colour were expected to have a higher pain tolerance, meaning serious concerns could be dismissed with suggestions to simply ‘take some ibuprofen’.
“It’s important that we understand both the history of sexual and reproductive health, and the ways its legacy can still impact provision of services and patient experiences today.
“Choice and autonomy must be central in our approach to all aspects of reproductive healthcare. There is still much work to do to deliver a genuinely woman-centred contraceptive framework.”
The PHE survey will collect data from women and people with female reproductive needs.
Dr Sue Mann, Medical Expert in Reproductive Health at Public Health England, said: “It’s important we find the right solutions to address why some women are treated differently in how their reproductive health needs are met.
“We want to help ensure that everyone has equal access to good reproductive health services, and identify people who may need extra support.”
The survey is open until 29 July and can be filled in online here.