A Dark Truth: Baby Loss & Black Mothers
By Anisah Abdullah
Baby Loss Awareness Week provides an opportunity for us all to mark the lives of babies lost in pregnancy or soon after birth. Running between the 9th-15th October, this campaign allows dedicated time to put a spotlight on the needs of the individuals and families whose lives are irrevocably altered by the death of their children during pregnancy, at birth, and in infancy. Research has shown that Black women experience pregnancy loss, including miscarriage, still birth, preterm birth, and infant death, more often than White women.
The reasons behind this disparity are complex and still largely unclear. We do know that Black women are reported to have higher rates of pregnancy loss risk factors including diabetes, tobacco use, obesity, and low socioeconomic status. However, some of the key causes that tell us Black women more ‘predisposed’ to these risk factors are in fact the opposite due to the very real presence of institutionalized racism and systemic inequality in healthcare.
The aftermath of pregnancy and infant loss includes grief, depression, anxiety, relationship shifts, unhealthy coping mechanisms, and Post Traumatic Stress Disorder (PTSD).
These effects are often underestimated, misunderstood, or overlooked by health care professionals, friends, and family members.
For this already devastating experience to be influenced, shaped or compounded by racism is something that needs to change quickly. For healthcare professionals like me, this month, combined with Black History Month, is a real opportunity to acknowledge the huge scale and impact of pregnancy and baby loss on Black Women.
In 2017, the World Health Organization (WHO) reported that globally there are 4.1 million deaths of infants, less than one year old. WHO estimated an annual occurrence of 2.6 million stillbirths and between 17 and 22 percent of pregnancies that result in miscarriage.
The numbers are already overwhelming, and yet Black women face a significantly higher risk of having a miscarriage than their white counterparts.
This gap is not a small percentage but a worryingly high one, as the Lancet analysis of data on 4.6 million pregnancies in seven countries suggests the risk for black women is 43% higher than for white women.
For years now, Black, and ethnic minority mothers in the U.K, have been fed statistics including that we are five times more likely to die in pregnancy or childbirth than white counterparts and that we are at greater risk of losing a baby in the womb or soon after birth, and at greater risk of severe long-term health problems.
During the Covid-19 pandemic, 55% of pregnant women admitted to hospital with coronavirus were from Black and ethnic minority backgrounds.
According to data released in November 2018, Black women are five times more likely than white women to die as a result of pregnancy complications.
These numbers tell an important story about the grossly generalised maternal health of minorities in the U.K. I must add that stillbirths are still rare, but with black women 1.5 to two times more likely to experience them, the disparity is concerning.
For those of us in the maternal health arena, it’s clear to see that the increased risk of miscarriage for black women is just the thin end of the wedge in a range of health inequalities experienced by members of minority groups.
When I hear these statistics, I feel there must be structural reasons why more black women are at risk of miscarrying, having stillbirths or dying in labour than other groups.
This glaring gap is usually blamed on evidence that Black and ethnic minority women are more likely to have pre-existing conditions that put us at greater risk, including cardiac disease, diabetes, and high blood pressure, but this is far from the full picture and does not account for the specific health needs of individuals.
With those eliminated, this is usually the point where we are told that our ‘social determinants’ work against us as mothers including poverty, poor English, less education and poor living and housing standards.
The major issue these factors highlight is that even when Black and ethnic minority women do not have pre-existing medical conditions, have English as their first language, live healthy lifestyles and come from ‘middle-class’ backgrounds, we still have worse outcomes compared with white women from a similar background. At a time when institutionalized racism is at the forefront of our conversations, we have to wonder if it is the fabric of society that puts Black and ethnic minorities at higher risk when they enter the maternity system or whether there is something happening within the maternity system itself?
To me, this is a national health crisis, particularly as professionals are overlooking the serious impact these realities are having on Black Maternal Mental Health and the statistics on Black maternal mental health already make for concerning reading, and with so much stigma and pressure, is it any wonder?
It is my belief that we need to look at the social factors in terms of the experiences black women endure of intersectionality, racism, discrimination and racialised sexism. A study in 2010 found that healthcare professionals in the UK lacked the training to identify the unique needs of black women and this lack is causing black mothers to ‘fall through the net’. Ethnicity and culture really do affect how and when women seek help for mental health problems before or after having a baby. Many are still avoiding seeking out help because they feel services are not sensitive to their beliefs, or that they will be judged, overlooked or dismissed.
“The alarming feature is the persistence of this gap, and the fact we do not know what the causes are because we’re not doing the research” Dr Jenny Douglas, Open University
In light of this, UK professors have recently called for an equivalent of the 59,000-strong Black Women’s Health Study which has been operational in the USA since 1995, I couldn’t agree more.
Advocates believe that Baby Loss Awareness Week increases public awareness and promotes understanding to support and aid survivors of baby loss and their families, enabling them to overcome their trauma and recover from their mental, emotional, physical ordeal. With this in mind, more needs to be done to understand the specific needs and maternity issues for Black women so that they can be given the support they really need after something as harrowing as a miscarriage or infant loss.
“UK law demands everyone has equal access to safe, respectful maternity care but we are failing to safeguard black and brown people’s basic rights – to survive childbirth, to be treated with dignity, to have their bodies and choices respected.” Birthrights chief executive Amy Gibbs