Maternity care for Black and Asian women deemed "appalling" by MPs

The difference in health outcomes during pregnancy and following childbirth based on ethnicity is well documented in medical journals and parliamentary inquiries.

Since 1995, it has been government policy for hospitals in England and Wales to collect patient’s ethnicity data with the view that information will help identify health differences in the population. The first confidential enquiry report into maternal deaths in the UK was in 2000, and the reports have been conducted periodically ever since. 

Between 2000 and 2002, the enquiry found ​‘Black African women were almost seven times more likely to die’ and ​‘Black Caribbean women and Asian Bangladeshi women were twice as likely to die than White women’. Between 2018 – 2020, ​‘Black women are 3.7 times more likely and Asian women 1.8 times more likely to die in pregnancy than White women’. 

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There has been little change in the past eighteen years when it comes to the rate of deaths for Black and Asian women during or post pregnancy. This is a dereliction of care within the health service, that should shock the government into action, and also wake up Christians to the suffering and health challenges many women and families are experiencing within the church.

Since the pandemic there have been several parliamentary inquiries exploring differences in health outcomes based on ethnicity and maternal health disparities. The unique contribution of this report is how it brings together 20 years of medical study with an evidence session with medical practitioners working in different specialist areas to review current practices in maternal health care.

The committee in its introduction makes clear that the purpose of the report is to address the ​‘stark disparity between Black and White women’ whilst making recommendations that encourage ​‘effective and coherent across-government strategy’ to respond to ethnic disparities more generally.

At a glance the key findings in the report are as follows:

• Black women were almost four times more likely to die than White women during childbirth.

• Asian women were almost twice as likely to die than White women during childbirth.

• There is a need to provide culturally sensitive and personalised maternity care for women, but the standard of care varies across the country.

• Further medical training is needed for health practitioners to better understand Black and Asian women’s bodies and better diagnose and treat underlining health conditions.

• £200 – 300 million should be invested in maternity care. Current funding is at £95 million.

• There is a strong correlation between social deprivation and maternal health outcomes. Specifically, there is an ​‘overlap between high socio-economic deprivation and ethnic minority background’.

It is important that church leaders and congregants together create a culture where talking about health and wellness becomes the norm within church services, discipleship groups or pastoral care teams. 

Jesus healing the women with the issue of blood (Matthew 9, Mark 5 and Luke 8) is a story often taught in Sunday services and youth groups. The message preached is about the healing touch of Jesus and the role of faith to change circumstances. But I want to draw out other themes we speak less about and their relevance to maternal health. 

For twelve years, the women lived on the margins of society, destitute and with little financial security. A social outcast to her family, ethnic and religious peers. She lived alone, ate alone and endured the shame of her illness alone. Several times she sought out the help from physicians but none were able to find a cure for her condition. 

Additional research shows that when Black and Asian women express concerns regarding their pregnancy and general health they are overlooked. This report showed that from 2018 – 2020 ​‘60% of women who died during or up to six weeks after pregnancy had pre-existing medical problems’. Black and Asian women are overrepresented in this figure (my emphasis).

Pregnancy can be traumatic for some women and is made complicated when there are pre-existing medical conditions such as fibroids, endometriosis, hypertension, diabetes, all prevalent in Black and Asian women, that are neither diagnosed nor treated correctly. The NHS and government must improve its standards of care for Black and Asian women, but Christians can play an important role too. 

Talking about health and fertility is not easy but it as an important issue churches should engage with and seek to do so in a holistic way. For example, inviting Christian medical professionals within the church or externally, to talk on women’s health. 

Churches must become places where stigma surrounding health is put aside and women are seen and valued; where the journey towards mental and physical wellness is done in and with the church’s support. The work of Christian medics like Dr Jacky Mcleod and Dr Chi-Chi Ekhator can help church leaders and Christians to better engage in the conversation and provide helpful support in the community. 

Following the publication of the report I wanted to speak with Christian medical professionals bridging the gap between health and the church.

I reached out to Rev Les Isaac OBE, the founder and president of Ascension Trust, to ask if he knew of anyone and he was gracious in his reply, organising a zoom call with Dr Jacky McLeod and Dr Chi-Chi Ekhator. 

Dr McLeod is a GP and clinical director for Lewisham Clinical Commissioning Group with over 30-years’ experience improving the quality and effectiveness of primary care in the community. Jacky is also an ordained minister in her local church and works extensively to improve health literacy and understanding amongst ethnic communities. 

Dr Ekhator is a GP in London and GP appraiser for NHS England. She is also a vice-chair of Ascension Trust for the AT Beacon project — supporting individuals, community organisations and local businesses to address health inequalities together.

The call left me inspired by the incredible work both women are doing to end maternal and health inequalities. They are both in senior positions where they can positively influence healthcare practice and policy, whilst also pioneering pathways to equip churches to improve health outcomes within the ethnic community. 

To help you continue the conversation and know where to signpost others for support, why not watch Dr Chi-Chi Ekhator speak about Brixton’s health and wellbeing hubs on ​‘The Doctor’s Kitchen podcast’ or connect with the AT Beacon project for resources and webinars for churches.