The way inequalities in maternity and neonatal services are addressed must change

Historically, women from Black, Asian and minority ethnic communities who use maternity services have been viewed as being more tolerant of pain. This is a myth!

Such myths, mainly based on racial misconceptions, have delayed women in childbirth from receiving adequate pain relief or urgent treatment. This leaves them feeling unheard, frustrated or dismissed. According to the Birthright report: Systemic Racism, not Broken Bodies, some of these misconceptions have led to women feeling unsafe during maternity care, sometimes even developing a blood clot leading to pulmonary embolism and sepsis because the patient’s concerns had been dismissed during the birth. 

We must stop, listen and take seriously all of the concerns voiced by women who are receiving maternity care and their families. We must utilise all available resources, be attentive to their needs and start treatment early. Every woman who uses the NHS is someone’s daughter, sister, mother or friend – not just a number. Some of the resources now available in maternity and neonatal settings are helpful: for example, pain scales and early warning scores such as MEWS (Maternal Early Warning Score) and NEWTT2 (Newborn Early Warning Track and Trigger). These tools are meant to aid health professionals to ensure there is a standardised approach of capturing people’s pain and tracking any concerns or deterioration regardless of a person’s ethnicity or protected characteristics. 

Take another myth: that Black, Asian and minority ethnic nurses and midwives are underqualified. This has led to the belief that Black and Minority Ethinc staff are not worthy of certain job positions. In 2014, the NHS Equality and Diversity Council announced action to ensure that employees from Black and minority ethnic backgrounds have equal access to career opportunities and receive fair treatment in the workplace. And a Workforce Race Equality Standard (WRES) was mandated in 2015/16 in England through the NHS standard contract. However, all reports published since then have highlighted the imbalance of representation of Black and other minority ethnic groups at Band 7 and above. According to the 2023 NHS WRES report, over a quarter of the workforce across NHS Trusts in England came from Black and minority ethnic backgrounds (380,108 people). 

The 2023 report also highlights that, in 76% of English NHS Trusts, white applicants were significantly more likely than Black and minority ethnic applicants to be appointed from shortlisting, rising from 71%  the previous year. Sadly, only 39% of all staff from a Black and minority ethnic background believed that their Trust provides equal opportunities for career progression or promotion.

Although there has been some improvement in some of the WRES indicators, it has been very slow and it is challenging to ensure sustainability when there is minimal support to do so in some Trusts (for example, funding for key roles and pastoral care, coaching, mentoring or sponsorship).

It is not all negative. There are some positives to highlight. In 2023, NHS England published an equality, diversity and inclusion (EDI) improvement plan. This has been part of a range of targeted actions to address prejudice and discrimination, both direct and indirect. There are charities, activists and diaspora groups who are doing their best to highlight these issues to the public. And the NHS and government are undertaking various activities to help improve outcomes. 

I am proud to be making my contribution in leading some programmes, for example, the Maternity & Neonatal Ethnic Minority Band 5-7 Leadership development programme (2023) and the Nurses, AHP and Social Care Ethnic Minority Band 5-7 Leadership Development Programme. However, one cannot do it alone. As the African proverb says, ‘If you want to go fast, go alone. If you want to go far, go together.’

You can follow Tendai on X: @tendai_nzirawa or find her at nzirawatendai@gmail.com