Addressing Maternal Health Disparities in the UK Maternity System
The UK prides itself on a publicly funded healthcare system that provides care to all residents, yet maternal health outcomes remain deeply inequitable. Black women are nearly four times more likely to die during pregnancy or within a year postpartum than White women, while South Asian and Muslim women also experience disproportionately high maternal mortality rates. These statistics, as highlighted by MBRRACE-UK (2024), underscore the urgent need for systemic reform in maternity care.
Understanding the Disparities
The disparities in maternal health are not merely incidental; they are embedded within broader social determinants of health, including socioeconomic status, racial bias, and access to healthcare. Balde et al. (2021) emphasise that the intersection of wealth, education, and ethnicity significantly impacts access to maternal and newborn health services. Even among women with similar income levels, racial disparities persist, suggesting that structural inequalities rather than individual choices are at play.
The Role of Structural Inequality in Maternity Care
Historical and contemporary research has demonstrated how systemic racism contributes to adverse maternal health outcomes. Hoang and Wong (2022) argue that intersecting systems of oppression—such as racism, sexism, and economic marginalisation —shape women’s experiences in maternity care. This framework, known as intersectionality, helps explain why racial disparities persist despite improvements in overall maternal healthcare.
One of the key factors influencing maternal health is the medical profession’s implicit biases. Studies have shown that Black women are more likely to have their pain dismissed or their concerns ignored, leading to delayed interventions and higher rates of complications during childbirth. This aligns with the "weathering hypothesis" introduced by Geronimus (1992), which posits that chronic exposure to social and economic disadvantage leads to premature biological aging and deteriorating health outcomes.
A Call for Policy and Practice Reform
Addressing these disparities requires more than just awareness; it demands structural change. Maternity care providers must undergo training to recognise and mitigate racial bias, ensuring that Black, South Asian, and Muslim women receive equitable treatment. Additionally, policies should prioritise community-based maternity support systems that provide culturally competent care and improve access for marginalised populations.
Future research should focus on developing and evaluating interventions tailored to the specific needs of at-risk groups. Expanding midwifery-led care, increasing representation of Black and South Asian healthcare professionals, and ensuring that maternal healthcare policies are informed by the lived experiences of women from diverse backgrounds are crucial steps forward.
Conclusion
The persistence of racial and ethnic disparities in the UK maternity system highlights the need for urgent and systemic reform. By addressing structural inequalities, training healthcare providers to recognize bias, and implementing inclusive policies, the UK can move towards a maternity care system that truly serves all women equitably. It is only through such deliberate action that we can hope to close the maternal mortality gap and ensure safer, more just maternity experiences for all women.
References
Balde, M. D., et al. (2021). "Intersecting Inequalities in Maternal and Newborn Health: A Systematic Review of Social Determinants." BMC Public Health, 21(1), 1105.
Geronimus, A. T. (1992). "The Weathering Hypothesis and the Health of African-American Women and Infants: Evidence and Speculations." Ethnicity & Disease, 2(3), 207-221.
Hoang, T., & Wong, P. (2022). "Applying Intersectionality in Perinatal Health Research: A Review of Challenges and Opportunities." Journal of Racial and Ethnic Health Disparities, 9(3), 897-910.
MBRRACE-UK. (2024). "Saving Lives, Improving Mothers' Care: Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity." National Perinatal Epidemiology Unit, University of Oxford.
