Conceiving a child, carrying a pregnancy and then giving birth is a life altering process, no matter how many times you do it. Often the cause of either giddy excitement or intense nerves (up to 1 in 4 pregnant women experience anxiety), at times it can feel like there’s as much to celebrate as there is to worry about.
It’s estimated that around 30% of women experience adverse pregnancy outcomes which can depend on everything from maternal age and education, to marital status and socioeconomic background. Unsurprisingly, race plays a considerable role in all of this, with women from ethnic minorities — and Black women especially — having poorer outcomes than white women across the globe.
Today in the UK, Black women are nearly three times more likely to die during or in the first year after pregnancy than white women. This figure has gradually decreased since we learned in 2018 that there was a five-fold difference in Black women’s maternal mortality rates. Black babies are also almost three times more likely to die than white babies and are more likely to be born preterm.
Racial discrimination and bias have been cited as root causes for these disparities, which is something that Obstetric and Gynaecology Consultant, Dr Elizabeth Egbase, concurs is a problem among healthcare professionals. “Traditionally there has not been a lot of emphasis in training healthcare professionals to consider implicit bias, racial discrimination or the racial tropes that [are associated] with different ethnic minorities,” she explains.
“There’s the strong Black woman trope — the idea that Black women don't necessarily feel as much pain. All these very antiquated racist concepts get perpetuated in what we call the hidden curriculum, so you pass on or pick up these messages based on clinical conversations. And unless we're being trained in an environment that actively debunks it, people end up subconsciously carrying some of these thoughts, which can definitely impact the care that Black women are receiving.”
For Black women hoping to have children, awareness of maternal health inequalities is undoubtedly necessary, but it can also stoke up a hotbed of intrusive thoughts which make an already daunting circumstance seem even more frightening.
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Zainab is mum to a five-year-old, a two-year-old and a one-month-old. Her youngest child was born preterm, and she’s previously had two miscarriages. “After those experiences I got thrown into this world of thinking you don't just get pregnant, have a baby and have great medical care — there are obstacles you have to go through. You may need extra appointments, you might have to advocate for yourself. So when it came to my third pregnancy I would always take any extra appointments or scans my hospital was offering.”
At one point she was admitted to hospital due to complications with her placenta and was confronted by a doctor who seemed disgruntled by her choice to remain under observation.
“He said ‘Why are you in hospital? Are you worried about your baby dying?’. And I said ‘Yes, because I’ve been through it before’. His response was ‘Just go home, because even if you're here, we won't be able to save your baby's life’. If I hadn't experienced my previous miscarriages I would have just gone with what he said and I might have had a very different outcome.”
Zainab had befriended another woman on the ward who didn’t speak English as a first language, and who subsequently had a miscarriage after being discharged. “That same medical professional who had spoken quite aggressively to me also spoke to this person and told them to go home. When they came back, their baby had no heartbeat.” Looking back, she suspects her race has something to do with the way she was treated. “I just thought you don’t speak to people like that, it didn't make sense.”
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When we spoke to mum-of-one, Funmi*, she was 33 weeks pregnant with twins. “I was a bit ignorant when I had my first baby, but as the years have gone on I’ve read all these different stories about Black mothers dying, c-sections going wrong and stillbirths. It got me to start researching those things more, especially now that I’m having twins.
“I'm constantly reminded that every risk is possible and every complication can happen so it's made me more aware of the risks. Now I’m anxious about what happens post-birth as I’ve read about women bleeding out and haemorrhaging.
“I also have a friend who had a baby where I’ll be giving birth. She was very clear that once you’re on the ward after the baby comes out, they're not listening to anything you have to say if you’re Black, and that scares me. She felt like compared to the other ladies on the ward she was ignored the most.”
In order to help settle her fears, Funmi has spoken candidly to her doctors about her concerns. “I've been very clear with my consultants about my anxiety around my race. They're aware of how I feel and they’re with me through to my delivery so I hope it’s something that they'll express to the rest of the team when the babies come.”
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Tosin moved to the UK from Nigeria three years ago. She gave birth to her first child in 2024 following a miscarriage the year prior. “As an immigrant, falling pregnant and then trying to navigate the NHS system is a big deal. I thought that when you get pregnant you go to the hospital and you're supposed to get checked. But I didn't get any checks, I didn't get a call.
“I miscarried my first baby and I could almost pinpoint the fact that it was due to negligence. When I fortunately got pregnant again I had to advocate for myself, which is what I preach these days as a Black woman. I wasn’t just concerned, I felt scared. If I had experienced any complications, was there enough care for me? What interventions were available? Would the professionals listen? Would they understand what was happening to me? It meant that I was hyper alert, more than another person would be, because I know there are dangers during pregnancy for Black women.”
Since giving birth, she’s conscious that the vigilance she adopted throughout her pregnancy still lingers subconsciously. “Once you get into the habit of learning things, reading and looking at science, it's not a very good place to be, especially as a new mum when you are worried about every single symptom.”
Black women remain most at risk of experiencing adverse pregnancy outcomes, but despite the depressing statistics, Dr Egbase doesn’t want us to lose faith in the healthcare system.
“I want to make sure that Black women understand the space that they're coming into, but not be afraid to enter the space”, she says.
“Motherhood isn't something that should be taken away from you, and you shouldn’t have a poor experience just because you're a Black. There are people working really hard to try and inform the environment, the colleagues, the team, the system, in a way that can give Black women the experience they deserve when it comes to their maternity.”
