The WHO states that health equity is achieved when everyone can achieve their full potential for health and well-being (1). In the UK, 65% percent of black people reported that they had been discriminated against by health care professionals because of their ethnicity (2). As a black female General Practitioner, figures like these pull on my heartstrings.
Various thoughts raced through my head about the message I wanted to convey about Health Equity and Black Women in the UK. The area of health equity which means the most to me as a black woman living in the UK, is maternal health. I am most probably biased because I became a mother about 1.5 years ago and have a daughter. However, writing this post forced me to reflect on how I as a health care professional spent my first pregnancy ignoring the figures on the black maternal mortality figures . I distinctly remember being in hospital, days away from delivery, hurriedly turning off MP Bell Ribeiro Addy's speech, which evidenced the harrowing issues facing black women during childbirth. At that particular moment, I didn’t have the emotional bandwidth to listen to the 'statistics' relating to hopeful mothers-to-be like myself.
Dr Matilda Esan, a General Practitioner, shares her experience as black woman in the UK - as a mother and a healthcare professional.
So again, I ask myself what message would I like to convey on what feels like a heavy matter. Deep down, I want to portray a truthful picture on black maternal health in the UK with a positive slant.
The first issue to consider when exploring health equity in black women is use of the term BAME. For many years BAME has been both an unavoidable and problematic term, as it lumps together the experiences of every ethnic group you can imagine and dilutes the voice and the experiences of individual ethnic minorities. The relevance of this, is that it makes assessing the health experiences of black women in Britain difficult. Of course, amongst friends, families and professional circles we have anecdotal evidence. However, the things which prompt policy changes and cause people to listen are hard facts and research which highlight the extent of the problem.
In maternity care, you may well be familiar with the fact that the MBRRACE 2018 and 2019 reported that black women were five times more likely to die in pregnancy. In the 2020 report, this reduced to four and in the 2022 report, this reduced to 3.7 more times likely. Though change is happening and things are getting better, it is evident that more work still needs to be done. The repeated themes in speeches and articles that you read is that black mothers don’t feel that when they express health concerns such as, being in pain, that they are believed or being taken seriously.
In regard to work that is being done, there are numerous charities, organisations and MP’s who have worked tirelessly to ensure the experiences of black women are heard in the spaces which really matter like Parliament. The charity FIVE x More were responsible for founding the UK’s first awareness week dedicated to Black Maternal Health in 2020 and since then it has continued to gain traction and go from strength to strength. Furthermore, many Black Female Obstetricians and Doctors, in addition to their clinical work, have advocated in various spaces for black women to try to pave the way to ensure that things change. So whilst figures remain uncomfortable, the question those of us occupying health care spaces should be asking ourselves as individuals is , “What small steps can we take towards making a cumulative big difference?”
As a general practitioner, I give my pregnant patients space. I ask about their
previous experiences, I ask about their concerns, their anxieties. I do my best
to listen and act on clinical things which need to be actioned in a timely manner. These days, once patients are referred to the midwife, our involvement as the GP can be quite limited. So for me a black mother myself, I really try to make the interactions I have with my patients count. Many times, I don’t have control of what happens to my patients in the hospital. However, what springs to mind for me is the Maya Angelou quote “People will forget what you said. People will forget what you did. But people will never forget how you made them feel”.
At the end of the day, I am the first contact in a pregnant patient's journey. I am also one of the first contacts post delivery. My aim is to ensure my patients feel comfortable at the beginning of their beautiful journey. That way, whatever obstacles they may encounter on the way, they always know I am a telephone or face to face appointment away. They can trust and be assured that if they are worried, then I too will be worried and escalate things appropriately.
Ultimately the power to address health inequality in black women in the U.K. lies within each of us. The way we can choose to do this can vary - be that through advocacy when dealing with patients, being willing to listen emphatically and take appropriate actions or by enacting policy changes on a larger scale.
References:
1. Health Equity - Global. https://www.who.int/health-topics/health-equity#tab=tab_1 Accessed: 2023-03-23
2. State of Black Britain Report - BEO (blackequityorg.com) Accessed: 2023-03-23