By Ruby Jackson, Midwife, Chelsea and Westminster Hospital NHS Foundation Trust and Digital Health Innovator
Working at the intersection of healthcare innovation and maternal care, I know how structural racism and unconscious bias continues to shape the experiences of Black and Brown women in our healthcare system. The evidence is clear and undeniable: there is inherent structural racism within our public health services that desperately needs addressing.
One of the most fundamental issues lies in how our healthcare system operates through a Euro-centric lens, with white bodies and experiences as the default. This approach manifests in countless ways, from medical education to daily clinical practice, creating an environment where women receive different treatment based on their skin colour.
The impact of this systematic bias isn’t always overt. Today’s racism in healthcare settings is frequently covert, making it harder to pinpoint but no less harmful. These subtle forms of discrimination, from microaggressions to unconscious bias, have profound effects on both the physical and psychological health of women of colour during their maternity journey. This stems not only in practice but also the clinical teaching we get in training to become healthcare professionals. The lack of representation in medical textbooks (less than 5% of images in medical textbooks show conditions on Black and Brown skin) for conditions such as jaundice mean these conditions can be missed at birth.
The dual impact on mental and physical health
Research1 examining the experiences of Black and mixed-heritage women has revealed disturbing patterns. A study of 1,340 women’s experiences showed that these encounters with racism, whether overt or covert, had significant long-term effects on their mental health. This psychological impact creates a dual burden – affecting both maternal mental health and physical outcomes during pregnancy and birth.
The stress induced by experiencing bias and discrimination in healthcare settings can have serious implications for both mother and baby. These aren’t just statistics; these are real people with real experiences, whose lives are being fundamentally affected by systemic inequities in our healthcare system.
A multi-level approach to change
Addressing these disparities requires a nuanced, multi-faceted approach. We cannot rely on blanket solutions to solve these complex issues. Instead, we need to tackle the problem from multiple angles:
- Education and training
From the very beginning of healthcare professional training, we need to implement comprehensive education about caring for diverse populations. What practitioners learn in their early years shapes their entire career trajectory. If we don’t embed cultural competency and anti-racist practices from the start, we cannot expect to properly care for our diverse population of women and birthing people.
- Practical tools and solutions
While research is crucial, we need to move beyond studies to implement practical, tangible solutions. This includes developing innovative technologies and tools that can help bridge gaps in care and improve communication between healthcare providers and patients. Tools like the Melanatal App I have created and CardMedic’s innovative healthcare translation app are helping the NHS improve health equity and access.
- Policy and strategic changes
Systematic change requires policy reform at both institutional and national levels. We need clear accountability measures and targets for reducing racial disparities in maternal health outcomes.
- Community support
Organisations like Black Maternity Matters, The Motherhood Group and campaign group Five X More, play a crucial role in educating women about their birth rights and experiences, focusing on the wider context beyond clinical care. This community-based support is essential for building trust and improving outcomes.
When examining positive experiences among Black and Brown women in maternity care, two factors are crucial: continuity of care and representation. Having consistent care providers throughout the pregnancy journey, particularly those who share similar cultural backgrounds or understand cultural nuances, significantly improves outcomes and experiences. Improving representation in the healthcare workforce is essential; we need healthcare providers who mirror the communities they serve and understand what they’re going through.
Building trust through action
One of the most significant challenges we face is the deep-seated distrust many non-white women feel toward our healthcare services. This distrust isn’t unfounded – it’s built on generations of negative experiences and documented disparities in care. To rebuild this trust, we need to show concrete action and implementation of practical changes that directly address these concerns.
The path to equitable maternity care requires sustained commitment and action at every level of our healthcare system. Rather than relying on one-size-fits-all solutions, we need specialised, nuanced approaches that acknowledge the diverse needs of different communities. This must be supported by targeted education and training for healthcare professionals, ensuring they are equipped with the cultural competency and clinical skills needed to provide optimal care. Alongside this, we must develop and implement practical tools and resources that specifically address the needs of diverse populations. Greater representation in the healthcare workforce is also crucial – we need care providers who reflect the communities they serve and understand their unique experiences. Finally, we must establish robust systems for continuous monitoring and accountability of health outcomes across racial groups to ensure we’re making meaningful progress in reducing disparities.
As someone working to develop digital health solutions in this space, I’m encouraged by the increasing recognition of these issues, but we must maintain momentum. The time for research alone has passed – we need action, implementation and practical solutions that can make a real difference in women’s lives today.
