Systemic racism in UK healthcare deepens disparities in Black maternal health and mental wellbeing

by Christelle Wealth-Mukendi

Systemic racism within the UK healthcare system leads to demonstrably negative experiences for Black women and the wider Black community, contributing to higher maternal mortality rates and hindering access to mental health support. This reflects a systemic crisis in Black maternal health.

According to the Guardian, as of 2024, black women were six times more likely than white women to have birth complications. 

Various factors contribute to the reason why the black experience differs during pregnancy and childbirth.

Socioeconomic disparities are a significant contributing factor. Black families, along with other ethnic minorities, experience higher rates of poverty compared to white families. In 2024, the Social Metrics Commission found that two in five, or 41 per cent, of black households were impoverished in comparison to one in five or 20 per cent, of white households. People who are in poverty are disproportionately affected by health, as those with lower incomes tend to have higher rates of health issues such as diabetes and chronic diseases due to having a poor diet and not being able to access healthier foods, which are more expensive. Pre-existing health conditions can act as a catalyst for further complications and increase the risk of death, particularly during or after pregnancy, highlighting a critical issue in Black maternal health.

Racial discrimination plays a part in why black women have their concerns dismissed during pregnancy and childbirth, leading to how black women tend to be viewed as strong and in need of less help, which is why their concerns during pregnancy and after childbirth tend to be dismissed. Due to racial stereotyping, black women are deemed as being able to tolerate pain more, which is why their cries for help often go ignored. Over time, this has built up a system of distrust when black women interact with the healthcare system. A  2022 study by Fiv XMore showed that 43 per cent of women felt that they were being discriminated against during pregnancy, with 54 per cent of the discrimination being based on race.

I spoke to Jesy Williams, 32, who told me about her experiences interacting with the healthcare system. Jesy told me how she was treated differently as a black woman when going to the hospital, though it wasn’t explicit – for the first person the staff tended to, they were very friendly and nice, but with her, they had a very sombre attitude. Jesy believes this was due to the built-in prejudices healthcare professionals may have, which impact their work. This encounter is just one of many examples of how the black experience in the healthcare system differs from the white experience. 

Maude, 51, a sister nurse, provided insight into efforts within the NHS to address racial inequalities among patients. Maude said that she has witnessed firsthand racism in the workplace from relatives to medical staff. However, in her experiences, the day-to-day care of the patients was not affected; the matter was reported to the matrons, and the appropriate documentation was made. In addition to this, Maude revealed that there’s mandatory training on Equality, Diversity and Human Rights. According to Maude, the trust she works for has a five-year strategy in place, which started in 2023, which focuses on improving patient services, supporting and developing NHS workers, and continuing excellent research and education. 

The government and NHS established the Maternity Disparities Taskforce to address the disproportionate challenges faced by Black and ethnic minority women during pregnancy and motherhood. They aim to reduce maternal mortality by 50 per cent by 2025. However, the task force has faced criticism for its meeting frequency. Despite a stated goal of meeting twice monthly, they only convened twice in 2023. Following criticism, they met six times by May 2024, falling short of their intended schedule. Frequent meetings must be prioritised as they are crucial in addressing issues and reducing maternal mortality rates.

The concerningly high rates of black mothers who suffer health issues or death after childbirth are reflective in another pressing issue that also needs attention – black mental health. 

According to Mind UK, Black women have the highest possibility of suffering from a common mental disorder (29 per cent) compared to white women. The intersection of racism and sexism creates a unique and significant burden on Black women’s mental health. 

However, mental health within the Black community is often stigmatised due to cultural beliefs that may downplay the reality of mental health struggles, leading to a reluctance to seek professional help.

Research by Devonport, analysing thirty-six quantitative studies and six focusing specifically on Black experiences, indicates that Black populations in the UK are less likely to access mental health support. This reluctance is often attributed to stigmas surrounding the treatment of ethnic minorities within the healthcare system and a pervasive sense of mistrust. Mind UK reported that black people have the lowest mental health treatment rate of any other ethnic group at only 6 per cent.

Katherine Lloyd, 43, a systemic psychotherapist specialising in family and couples counselling, shared a striking observation: her clientele is overwhelmingly white, with a noticeable absence of Black or ethnic minority (BAME) couples and families. While research specifically on the underrepresentation of Black individuals in therapy is limited, government reports indicate a stark disparity: Black people are four to five times more likely to be detained under the Mental Health Act compared to their white counterparts. Despite this, they are least likely to seek mental health support voluntarily.

When asked about training for equitable patient treatment, Katherine noted positive initiatives in her current London-based workplace, including Black and ethnic minority meetings and workshops for mutual empowerment and discussions about experiences of racism and discrimination. She contrasted this with her previous experience outside of London, where she faced direct racism from patients, being called the n-word and told to return to her home country. This highlights how discrimination within the system extends beyond patients to the staff attempting to provide care.

There has been action taken to help address the issues black women face during motherhood and regarding their mental health. Organisations such as FiveXMore, run by black women who have faced discrimination within the healthcare system, bring light to black maternal health by offering advice to other black women and reporting on the experiences faced by mothers.

Black Minds Matter is an organisation that focuses on improving black mental health by offering free mental health services for black families. This creates a safe space for black women and households when they are typically reluctant to discuss their issues.

The NHS launched the Patient and Carer Race Equality Framework in 2023, a model that demonstrates ways to improve patient experiences by preventing racism in mental health trusts. All plans that derive from this framework must be done together with ethnically diverse communities, allowing for a foundation of trust to be built between the NHS and ethnic minorities. 

The emergence of organisations like FiveXMore and Black Minds Matter, founded by Black individuals to support their community, highlights a critical gap. While these grassroots efforts are vital, the primary responsibility lies with UK policymakers to urgently address these disparities. Active steps are needed to protect Black women during and after motherhood, alongside their mental health.

The silent cries of Black mothers-to-be and Black women suffering mental health issues cannot be pushed aside any longer; the government and the NHS must take sincere action now to break down the racial barriers in the healthcare system.