Pregnancy and maternal medical care remain disproportionately dangerous for Black women, with the maternal mortality rate two to six times higher for Black women than for white women in the US and five times higher than that of white women in the UK. These significant racial disparities have widened in the last few decades, despite most pregnancy-related deaths being preventable. “Severe morbidity poses an enormous risk to women’s health and well-being,” and it will persist if medical systems do not directly address the consistent mistreatment of Black women in healthcare settings.
The rights to dignity, autonomy, equality, and privacy all apply to pregnant women and their treatment; the failure to regard these as a priority in maternal care have led the organisation Black Mamas Matter to label maternal deaths a “human rights crisis”.
Protections for pregnant women in the UK under the Human Rights Act incorporated human rights set out by the European Convention and includes the rights to life—including life-saving and basic maternal care (article 2)—physical integrity, and bodily autonomy as well as standards of care, dignity, and privacy under the right to private life (article 8). Legislation such as the Health and Social Care Act in the UK and Improving Access to Maternity Care Act in the US are examples of bills specifically targeting inequalities with duties to provide care in disadvantaged areas. These domestic bills, however, often focus solely on economic inequalities. A more critical and intersectional initiative is needed to address the racial gap in care. A failure to provide maternal services with established standards of care, respect, and dignity undermine women’s fundamental rights and may leave patients feeling degraded and unsafe.
BIASES SHARPLY INFLUENCE MEDICAL STANDARDS OF CARE
Whilst recognising environmental and genetic contributors, recent research stresses social determinants such as attitudes and perceptions as the most significant in explaining racial disparities. Socio-economic factors contribute to a lack of access to adequate healthcare, however the disproportionate rates of poverty amongst Black Americans could not, alone, account for shorter life spans and higher rates of illness. Importantly, the research highlights how disparities in medical treatment, not just access, contribute to the persistent disadvantage Black patients face. A higher morbidity and mortality rate for Black women persists when socio-economic variables, such as health insurance and medical facility, are controlled, meaning Black women are still disadvantaged when they have the same access to care as white women.
Studies have found medical providers and systems hold a negative bias towards Black patients. Racial bias may materialise as targeted discrimination or implicit biases that affect physician decision-making or treatment, both affecting the patient-provider relationship.
Implicit biases, as opposed to explicit discrimination, are unconscious, automatic associations one makes and are therefore difficult to acknowledge and control. When medical students and residents took the Implicit Association Test (IAT) they scored similarly to the wider population, suggesting that negative biases towards Black people ultimately affect the quality of care they receive as patients. Astoundingly, many medical students believe myths—like that Black people having less sensitive nerve endings or thicker skin. These pervasive fables harm Black patients, as practitioners who believe them were more likely to inaccurately rate a Black patient’s pain as lower, fail to prescribe pain medication, and make less accurate treatment recommendations.
Negative implicit biases towards Black women directly risk the quality of care Black women receive throughout pregnancy. Racist attitudes contribute to a physician’s being more willing to learn about a white patient’s needs and concerns as well as to attend to white women’s appointments more attentively. Specific racist beliefs some physicians hold and perpetuate include that Black patients are more likely to disregard advice or not to understand detailed information. Such physicians are less likely to ask their patients open-ended questions or to tailor their care to the specific woman’s needs. This toxic relationship cycle furthermore reduces trust in practitioners by the Black community making it less likely that Black women will seek care when needed.
REFORMING MEDICAL CARE TO ACCOUNT FOR RACIAL BIAS
Anti-bias training and further, related initiatives are necessary to improve the care and treatment of Black women. It is not enough, however, to significantly close the current morbidity and mortality rate gaps. Alongside these improvements, the patient–clinician relationship, central to achieving high-quality and personalised maternity care, must be improved as well. It is essential for policymakers and medical experts to recognise the link between access and human rights in regards to pregnancy, as funding maternity care and services are integral to reducing the racial gap in pregnancy related complications. Upholding women’s rights during pregnancy depends on the freedom she has to make her own choices; these are better protected when options are available to her without economic and or access barriers. We are all, medical practitioners included, susceptible to implicit biases however, the impacts these have in maternity practice and care can be greatly reduced. Relationship-centred care, anti-racist training, together with transparent, aggregated data accounting for race and gender variables in medical care can help to ensure medical systems deliver a high standard of care to all patients. The medical profession must actively counteract the racially-biased system until the evidence proves it is committed to protecting Black women’s health and treatment at every stage of pregnancy.
Zahra is a final year LLB student at the University of Manchester. She is a vocal activist, has spoken in the council chambers of Redbridge and Waltham Forest and has published poetry on the Black Lives Matter movement. Her Pro Bono work includes supporting young offenders at Youth Justice, presenting human rights workshops in secondary schools and as a student advisor for law centres in Greater Manchester. When she is not volunteering, she can be found cycling, painting or re-tweeting.