Report on Black Maternity Experiences Blames “Racism” Without Evidence

As reported in Global Health Now this week: “49% of black women in the UK who expressed concerns during labour didn’t receive adequate support” and “23% did not receive requested pain support”. Shocking figures, meant to shock, and reported in ‘The Five X More Black Maternity Experiences Report: Continuing the Conversation on Black maternal Care in the UK‘.

The Guardian lapped this up with the headline: ‘Half of black women in UK who raise concerns during labour did not receive suitable help, study finds.’ This had a subtitle which claimed, inaccurately, that the report also “found black women up to four times more likely to die in childbirth”. The report only claims that black women are 2.9 (so not even three) times more likely to die in childbirth, and, while this statistic was quoted in the report, it was already known and not a new finding.

Tragically, black women are nearly three times as likely to die in childbirth as white women. But this report does not explain why. In fact, the report is not worth the volume of cyberspace it occupies and does nothing to further the cause of the black women it purports to help.

With a foreword by Marian Knight, Professor of Maternal and Child Population Health, University of Oxford, who ought to be ashamed of herself for lending her name to the report, the study presents the expressed experiences of black women who gave birth in UK hospitals – and that’s all. The report does not include data from non-black women (e.g. white, Asian or other ethnic groups) for direct comparison with its findings on black women.

With the organisation Five X More claiming that it puts black women and ‘birthing people’ first, and with the report explicitly including people who do not identify as women but have experienced pregnancy, it is easy to work out the perspective the report is coming from. The survey on which the report is based was open to “black women and people from other marginalised genders (including trans men and non-binary people)”. It’s not clear if being of a marginalised gender alone was enough to qualify you to complete the survey.

The trend in deaths among black women giving birth has slightly, but not statistically significantly, decreased since the last report in 2020 and the trend among white women has increased. So, the gap is closing to some extent but probably for the wrong reasons; maternity care in the UK is terrible.

Of course, perish the thought that the black women who are dying in childbirth are any different from the ones who survive and may, in fact, have more in common with the white women who die in childbirth. While the gap between black and white women does persist after adjusting for potential confounding variables such as age and socioeconomic status, the report lays the blame entirely on the fact that “structural and systemic racism continue to shape the maternal health outcomes experienced by black women in the UK”.

The evidence to support this “enduring inequality” is entirely qualitative. For ‘qualitative’ read ‘subjective’. Black women were asked about their experiences, and they reported, for instance, that the white women on postnatal wards received “more empathy”, “faster help” and “better communication”.

There is no suggestion that their perspective may have been tarnished by continual propaganda telling them they are oppressed and marginalised, no hint that they may have been hypersensitised to the possibility they were receiving a bad deal, nor that they may have provided, for the purposes of Five X More, socially acceptable answers. Qualitative research does not produce ‘evidence’, according to the usual understanding of the word. There are no measurable or verifiable facts, simply opinions and subjective experience: their ‘truth’, a truth which must, of course, be believed.

That women in the UK continue to die in childbirth is scandalous and it is more scandalous that this is more common among black women. Research should continue into the phenomenon of death in childbirth generally and, including all the measurable variables that could account for the disparity, the higher levels of deaths among black women.

We cannot rule out the possibility that prejudicial attitudes may contribute to the problem referred to in the Five X More report. But the report does not prove that they do. Well conducted, objective observational research is required. Prematurely jumping to conclusions based on subjective opinions is unlikely to save lives.

Dr Roger Watson is Professor of Nursing at Saint Francis University, Hong Kong SAR, China. He has a PhD in biochemistry. He writes in a personal capacity.