Tinuke Awe hadn’t been long at her midwife’s appointment when her pregnancy started spinning out of her control. Despite her body swelling uncomfortably as her baby grew, it was only at that 38-week checkup that pre-eclampsia was diagnosed. The midwife’s message was stark: go straight to the hospital, your life could be in danger.
Once there she was given a vaginal pessary to induce labour, and told to expect nothing to happen for at least 24 hours. But a few hours later she was in agony. “I kept saying ‘I’m in pain, I’m in pain’, but I was completely dismissed and fobbed off – no one looked at me,” says Awe.
Rushed into a treatment room when midwives finally discovered she was on the verge of giving birth, she found she was too exhausted to push and her son was delivered with the help of forceps. “I was just left feeling like I didn’t matter, that no one really cared about me,” she says.
Her story is shocking but not uncommon. In the UK, Black women are five times more likely to die in pregnancy or childbirth than white women, according to a 2019 report published by MBRRACE-UK. Black and minority ethnic groups are at greater risk of their baby dying in the womb or soon after birth, and at greater risk of severe long-term health problems. During the Covid-19 pandemic, 55% of pregnant women admitted to hospital with coronavirus were from BAME backgrounds.
This week the government has been put under mounting pressure to introduce targets to eradicate the disparity. At prime minister’s questions on Wednesday, the Labour leader, Keir Starmer, asked Boris Johnson to commit to an inquiry into Black maternal mortality, describing the disparity as “truly shocking”.
Friday sees the first meeting of the Royal College of Obstetricians and Gynaecologists’ (RCOG) race equality taskforce, and the launch of “five steps for healthcare professionals”, devised with Fivexmore, a campaign group set up by Awe and her co-campaigner Clotilde Rebecca Abe.
“There are real people behind those statistics,” says Abe, who is also a co-chair of the St Thomas and Lambeth Maternity Voice Partnership and the creator of the social enterprise Prosperitys. “Something has to be done.”
An increasingly vocal consensus that direct action must be taken is also growing in the medical community. In July Prof Jacqueline Dunkley-Bent, England’s chief midwifery officer, explained to the parliamentary joint committee on human rights that a target had been set to provide continuity of care for 75% of BAME women. Asked if a target was needed to address mortality disparity, she said: “The short answer is absolutely, yes. One death where there is inequality because you are not on a level playing field is one death too many.”
Why does the inequality exist? According to Dr Christine Ekechi, a co-chair of RCOG’s race equality taskforce and a consultant obstetrician gynaecologist, Black women are more likely to have conditions that can put them at greater risk, including cardiac disease, diabetes and high blood pressure, but this is far from the full picture.
“The deeper question is: why are Black and Asian women more likely to have existing health conditions?” asks Ekechi. “There’s no specific gene that links all Asian people or a common gene that is found in all Black people. Many of these pre-existing conditions are non-communicable diseases which are driven by social determinants of health such as poverty, education and housing.”
Research from the US shows that when Black and Asian women do not have pre-existing medical conditions, have English as their first language and come from middle-class backgrounds, they still have worse outcomes compared with white women from a similar background, she adds. “There’s something more that’s happening there.”
A spokesperson for the Department of Health and Social Care said Dunkley-Bent was leading work to reduce health inequalities, while government-funded research at Oxford University was investigating the increased risk of women and babies of a BAME background dying.
Introducing targets would indicate that the UK is determined to consign poor maternal health outcomes for Black women to history, says Ekechi. “What we don’t want is in the next reports to see that this disparity is widening.”
Awe, an HR executive who set up the support group Mums and Tea in the wake of her own experience as well as co-founding Fivexmore, is determined to stop that happening.
“In 1991 when my mum gave birth to me she was at greater risk of dying. In 2020 when I gave birth to my daughter that risk had increased and I was five times more likely to die,” she says. “I’ll be damned if my daughter, whenever she decides to give birth, is 25 times more likely to die.”