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Why are mums dying after giving birth?

CONCERN: Dr Marian Knight says that further investigation into the number of black women dying after childbirth is important

A YEAR-LONG programme of research is set to look at why a disproportionate number of black women are dying after giving birth.

The move follows the publication of a recent report, the UK Confidential Enquiry into Maternal Deaths, which found that black and minority ethnic (BAME) women were much more likely to die from health complications surrounding pregnancy than their white counterparts.

In the United States, figures have consistently shown that African American women experience much higher rates of death after giving birth compared to other ethnicities.

But until the recent report, there was relatively little attention given to how black women in the UK were affected.

CHANCE
It found that the chance of death is one in 2,500 for black women. However, the rate was five times smaller for white women between 2014 and 2016.

The report's author, Professor Marian Knight, of the National Perinatal Epidemiology Unit, described the figures as “concerning”.


RESEARCH: Profesor Marian Knight is looking into the concerning figures

She told The Voice: “The figures we have uncovered are likely to be mirrored among women with severe illnesses in pregnancy such as high blood pressure, heart disease and blood clots so the need for investigation is very important.”

Professor Knight continued: “Part of the reason for publishing our report and undertaking further research, is that we can then begin to work out why there is this big difference.

“We know from the research we’ve done, that more black women die from heart complications. And we know that in our maternity units we need to improve our care for pregnant women who have associated health problems, such as high blood pressure and diabetes. There are some new initiatives to train doctors who are expert in the care of women with other medical problems such as diabetes, heart disease and blood disorders such as sickle cell anaemia, but those expert doctors are not there yet.”

She added: “These are health problems that disproportionately affect the black population, so we need to make sure that as we develop these new services going forward, they specifically address the needs of black women.”

Speaking about the research projects she will be working on in a bid to find answers, Professor Knight said: “We have two projects that are already ongoing. We are looking specifically at women from black and minority ethnic groups who have died, to find out in more detail about the medical complications that underlie the reasons for their death.

UNDERLYING
“That will help us better design our NHS maternity services to care properly for women with these health complications. We are also examining the medical records of all of the BAME women who have died, to look at factors associated with their ethnicity which may underlie their deaths. Some of these may be straightforward issues such as language and cultural barriers to accessing care. These may lead to problems in terms of women presenting later if they have underlying health problems before and during pregnancy.


WORRYING: The health of black women after giving birth has only recently been looked at in the UK

“This type of information will give us a start in helping to detect any problems that BAME women have and help us to treat them early so we can hopefully prevent these women from dying in larger numbers.”

In the US, leading female celebrities have spoken about the difficulties faced in their own pregnancies, which has helped shine a spotlight on the issue.

Tennis star Serena Williams has written about how fortunate she felt to survive a range of health complications that followed the birth of her daughter.

In August last year, chart-topping singer Beyoncé wrote in Vogue magazine about the impact on her of preeclampsia, a condition which black women have a greater chance of developing.

According to a number of health campaigners in the US, the deaths of women after giving birth are entirely preventable.

As well as medical complications, they point to factors such as disparities in access to quality health services, not being listened to or taken seriously by medical professionals as well as anxiety and the potential impact of racial bias in the health system.


Dr Ria Clarke says that non-medical factors could lead to black women dying after giving birth

These are factors that Dr Ria Clarke, a doctor in obstetrics and gynaecology, says should be factored into any future research examining the UK picture.

She told The Voice: “Anecdotally, we know anxiety in pregnancy can be debilitating and if it isn’t recognised, women may not get the care they need.

“Our healthcare system is indeed very different to the US. However, we know that in both countries black women are more affected by morbidity and mortality than white women during and after pregnancy. The US has done more research into this area and in some parts of America a black middle class woman is more likely to die than a white lower class woman. This is even taking into account things like health conditions and wealth. That suggests that other factors may be at play, of which racial bias is high on the list.”

Dr Clarke continued: “If we’re serious about exploring why black women are dying, we have to be willing to consider that black women experience racial bias, that it has an impact on the care that they receive and that this may be reflected in the mortality figures. We must never forget the physiological and genetic processes that may disadvantage black women (such as increased risk of gestational diabetes and conditions like sickle cell, which disproportionately affect black women), but if we are too scared to confront racial bias, then we aren’t ready to change things.”

However, she said there were a number of cultural barriers preventing black women from creating dialogues on this issue.

BIASES
She said: “My experience from talking to black women is that they are very keen to address this, but some women don’t feel they will be taken seriously or that they will be considered to be the “angry or aggressive black woman”, so don’t want to complain.

“We need to move forwards with cultural competency training and talking about all aspects of women’s experiences so that we can all explore our biases and how they impact on patients.”

Professor Knight agreed: “One of the most important things about any future research will be talking to women about their experiences and those points that Dr Clarke has raised, whether women are being listened to and whether or not they are accessing services that help them need to be looked at.”

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