Black women continue to face racism in maternity care despite initiatives

The Black Maternal Health report 2024-26, compiled by the Health and Social Care committee, says that failure to confront deep-seated inequalities within maternity care continues to cause serious human and systematic costs, including an erosion of public trust and a negative impact on maternity staff.

It also acknowledges that the crisis in care for Black women 'is happening in the context of a maternity system that is failing women more broadly, which may give the misleading impression that outcomes for Black women have improved'.  

The report cites systemic failings in leadership, training, data collection, and accountability as the causes behind the cultural racism facing black women. The committee concluded as 'indefensible' that cultural competency training for NHS staff and leaders in maternity care including midwives is still optional rather than mandatory.

It also suggests that such training, particularly for midwives, should be shaped by the actual experience of Black women with maternity care.

It has been six years since the launch of The FiveXMore campaign aimed at addressing the disparities in maternal health outcomes for Black women in the UK, following the MBRRACE studies in 2018 and 2019 that revealed that Black women were five times more likely to die during pregnancy and childbirth compared to white women.  

Last year, a FOI request by the Guardian also produced that data show that the births of babies born to black mothers are nearly twice as likely to need investigating by the maternity safety watchdog for potential failings in care by hospitals and midwives. 

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Meanwhile, since the Health and Social Care committee launched its investigation, the Government announced what it called a 'rapid' national investigation into NHS maternity care. The committee remains cynical about the impact of yet another initiative, while listing its clear recommendations for targeted results:

Culture, leadership and racism. We heard of a culture where women, particularly Black women, are not listened to and their concerns are not taken seriously. This is reinforced by bias and stereotyping underpinned, in some cases, by racist assumptions. Addressing this requires both operational change—including mandatory and meaningful cultural competency training—and effective leadership, with senior leaders being meaningfully held accountable.

Workforce. Shortages undermine the ambition to improve maternity care. Midwives and obstetricians are burnt out, unable to consistently deliver good quality, safe care, and many are considering leaving the profession. The Government must take decisive action on training, recruitment and retention, core priorities in its upcoming overhaul of the NHS Long Term Workforce Plan. 

Data. The lack of robust, real-time data, particularly on maternal morbidity and patient ethnicity, means the system remains blind to its failings. Information, like the Maternity Services Data Set, suffers from missing or incomplete entries and the Government appears to have 2 made no progress developing a maternal morbidity indicator since it was recommended by the Women and Equalities Committee over two years ago. 

Funding. The Government has cut the Maternity Service Development Fund from £95 million to £2 million, transferring the money to core Integrated Care Board (ICB) budgets. The Government must ensure that this change does not leave maternity funding deprioritised.

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