Birth Companions Ambassador Dr Annabel Sowemimo reflects on the need for collaborative approaches in the vital work to address racial disparities in reproductive health across the lifecourse.
Dr Annabel Sowemimo is a doctor, academic, activist, writer, and Ambassador for Birth Companions. She is an NHS Consultant in Sexual & Reproductive Health working in South London, and Harold Moody scholar at King’s College London whose work focuses on Reproductive Justice. To mark the seventh annual Black Maternal Health Awareness Week in the UK, Annabel has been reflecting on the need for a collaborative approach to address racial disparities in maternal health, care and outcomes.
The latest MBRRACE-UK report shows that Black women remain 2.5 times more likely to die in childbirth than their white counterparts and are twice as likely to experience neonatal death. And yet, when it comes to tackling reducing the maternal mortality and morbidity gap, the response still feels soiled. The inequities experienced by Black women in the UK start long before pregnancy, and are compounded by the vulnerabilities of pregnancy and the current state of our maternity care system. While an average pregnancy lasts nine months, the factors that feed into our pregnancies start well before - and extend well beyond - this period.
Inequities in Black women’s reproductive health start during puberty. A recent report demonstrates that, on average, it takes 3 years longer for Black women to receive an endometriosis diagnosis than our white counterparts. Other conditions such as fibroids that disproportionately impact Black women are woefully under-researched and under-funded. There are significant disparities in Black women’s attendance for cervical and breast screening checks, and in the uptake of Human Papilloma Virus (HPV) vaccine as compared to white women. And towards the end of our reproductive years, we appear to experience a longer menopausal transition while being less likely to access care. This phenomenon cannot be explained in terms of biological differences, and is more likely due to environmental stressors and lifestyle factors.
While these issues across the lifecourse can feel unrelated, they reflect the difficult material circumstances that far too many Black women find themselves in. Many Black women work within frontline professions and public service roles - 11% of all nursing and care staff are Black women. These jobs are often poorly paid, with workers afforded less autonomy. So, while providing care to others, many struggle to take care of their own health to attend both routine and screening appointments.
Too often, I see patients navigating immigration, housing, or work related stress which either leads to or is compounded by poor mental health. To address such issues, we must be able to build collaborative services that enable direct contact with a range of professionals. Too often, I find I am able to help a woman address a physical ailment, only to be confronted with no clear pathway to address the wider socioeconomic circumstances impacting her health.
Voluntary sector organisations frequently face multiple barriers to collaborating with NHS providers - contracting can be complex and challenging, and the funds granted frequently do not reflect the resource needed for a project. While innovations like social prescribing offer some hope, we need to take a much more bold and holistic approach to bringing many different specialisms under one roof, to ensure women and babies facing the sharpest forms of inequity and disadvantage are able to access all the care and support they so urgently need.
The annual report from Five X More and Khiara Bridges’ work in the United States demonstrate that wealthier Black women also face higher risks of the most dire outcomes. So what else is happening?
Last week, the Government released its renewed Women’s Health Strategy with a foreword by the Health Secretary Wes Streeting that promises to combat medical misogyny. It is vital that we bring a specific focus on racism and racial inequities into this important work, and begin talking not only of medical misogyny, but also of medical misogynoir.
In 2018, Professor Moya Bailey defined ‘misogynoir’ as a specific form of anti-Black racism and misogyny that targets Black women and frequently draws on media-driven stereotypes.
Harmful tropes, such as that of the strong Black woman who is overly resilient or too demanding, often play into how we are treated within medical settings. Serena Williams, who has been both masculinised and dehumanised in the media throughout her career, has spoken frequently on how she was gaslighted when trying to suggest she had a pulmonary embolism (a blood clot in the lung) during the post-partum period which left her on “her death bed”. Tragically, many similar accounts have also been recently shared by Black women in the Motherhood Group report.
This is medical misogynoir; the specific misogyny directed at Black women as they navigate the healthcare system and interact with healthcare providers. Our requests are more frequently ignored; I personally know this all too well, and often the consequences can be fatal. There will now be anti-racism principles for the education of midwives at universities across the UK. While this is welcome, there remains a lack of consistency on how all healthcare professionals are assessed in their equitable delivery of healthcare prior to them treating patients.
The issues that Black women contend with in pregnancy start well before we become pregnant - inequalities exist in menstrual disorders, cervical screening, abortion, miscarriage management, infertility - and, yet there’s a lack of acknowledgement on how our prior experiences deeply impact how we navigate pregnancy, birth and the postnatal period.
If we are to start addressing racial disparities that have long persisted then, we must start to think much more broadly and creatively about solutions.
We cannot keep having the same conversations, with the same people at the table. As Five X More has made clear with the theme of this year’s Black Maternal Health Awareness Week, it is time to move beyond just talking about the traumas that Black women face within and outside of the medical system; we must shift our focus to solutions, and start situating reproductive and maternal health and care within the broader context of Black women’s lives. I am passionate about making this happen within my work, and I know Birth Companions is too. I hope you will join us.
