Channel 4’s Dispatches missed out important factors on class and institutional racism in its brief exploration of maternity care experienced by Black women.
As both a woman of colour who has received maternity care from the NHS, and as a midwife who advocates for justice and dignity for marginalised women, I have always been keen on investigative documentaries that expose institutional injustices. I therefore anticipated watching The Black Maternity Scandal by Channel 4 Dispatches to see the metaphorical glass ceiling being broken by words and actions of truth. Keen public interest in maternity care has always been present due to the vivid experience the majority of women face when giving birth, tying all mothers together through a sense of shared humanity regardless of race. After all, birth is possibly the most intensely emotional, spiritual and physical experience of a woman’s and birthing person’s life.
The comfort of having access to the NHS in a high income country means we often take live births for granted; any deviations from this expectation appear to be relegated to a long lost pre-anaesthesia past, or across some far away border in a country seemingly too poor and undeveloped to help itself. But negative birth experiences, even traumatic ones, are very much present in modern, high income countries too. Although maternal mortality rates are significantly lower in the UK than in countries still suffering the ischaemic insults of colonialism, a report by MBRRACE UK published in 2019 that collected data on all reported maternity incidents between 2015 and 2017 in the UK, exposed a shocking statistic: that Black women were five times more likely than white women to die as a consequence of pregnancy and childbirth. This statistic raised many eyebrows in the UK as such an indication of inequality was not thought possible in a society that considers itself post-racial.
More recently, The Lancet released a systematic review of nine studies analysing miscarriage in Europe and Northern America, and concluded in their key findings that Black women were more likely to experience miscarriage in comparison to white women. The study did not expand on why this has arisen, but added that risk factors included stress from night shift work and environmental factors such as ingesting pesticides. These are more likely to affect impoverished communities which largely include people of colour. The study thereby reflects social neglect of Black women in relation to their wellbeing and reproductive health.
Though the UK’s maternal mortality inequality was known in 2019, and many were advocating for change around race in maternity and healthcare, it was only after the murder of George Floyd, the most viewed public lynching in history, and the subsequent anti-racism campaign, that institutions were shocked into holding conversations about the racial disparities they housed. A consequence of this activism led to Channel 4’s The Black Maternity Scandal, a 30-minute documentary, which bravely delves into this racial disparity.
Presented by Rochelle Humes, a singer and TV presenter of mixed white and Afro-Caribbean heritage, the documentary did well in bringing to the forefront the bitter inequality of Black women suffering higher maternal mortality than every other ethnic group, but unfortunately, it did little to address the true source of these disparities.
The documentary did include well-known professionals in the maternity world such as Mars Lord (Activist and Doula) and Professor Marian Knight whose name is first on the authors list of the MBRRACE UK report. The inclusion of these voices added credibility to the investigation, and well-complimented the anecdotes of other women interviewed about their respective harrowing experiences in facing maternal mortality and morbidity, which worked to solidly humanise the people behind the statistics. This was a much-needed element in the discourse around this unjust topic.
As a midwife, I understand the instinct we sometimes have to defend our work and colleagues when confronted by media that calls into question our practices and clinical outcomes, but this confrontation is vital in building partnerships with the women we serve, to develop care for all, and to tackle inequality. The documentary did well to highlight the NHS’ responsibility to Black mothers, one that it is evidently not upholding, but it did not even scratch the surface of institutional racism, the effect of colonial history, or actually even mention the word ‘racism’, which insinuates a hesitancy in the editing, and belies the urgency of its opening message.
Though The Black Maternity Scandal did mention that ‘the system’ is biased against women with social complexities, and fleetingly touched upon class, there was very little discussion that unpacked these multi-layered components which lead to the shocking and important disparities in maternal mortality in terms of race. It can be argued that 30 minutes was not enough time to enter such a thickly complex topic, but this proved to be the documentary’s most potent handicap. The need for more time meant that discussions around unconscious/racial bias, the role of poverty, migrant experiences, mental health complexities, difficulty accessing healthcare and austerity were left wanting. These conversations, had they happened, could have been contrasted to the experiences of affluent white women to reflect inequality not just in healthcare but in all fabrics of society.
This silence on institutional racism runs in parallel to the recently released Sewell report by the UK government’s ‘independent’ committee on race and ethnic disparities. The document gallingly declared that there was categorically no systemic racism in the UK, that minorities experience poorer outcomes derived from their cultural ‘attitudes’ rather than any misdemeanour the British may have imbued in their systems, and that remarkably, the UK is a beacon example for racial equality which European countries should endeavour to replicate. Not only is this negated by the findings of the MBBRACE report, but it is also a concrete insult to women of colour who face very real threats by our current healthcare systems.
On the subject of class in particular, I was expecting more commentary, as the UK is persistently classist and class is profoundly predictive on a child’s prospects, but unfortunately the issue of class seemed to be blanketed over by the notion that it didn’t matter all that much – that a Black middle class woman would be just as affected by racial disparities as a Black woman from a working class background. I strenuously disagree because, from my experience, the impact of institutional racism is more severe and insidious for working class Black women. This is reflected in my own work in healthcare, where Black working class women are more likely assumed to be ‘difficult’ or uneducated, and is explored further in an article by Maya Goodfellow that describes the extra burden working class women of colour face through austerity. By neglecting to address the extra burdens of Black working class women and their maternal health outcomes, the narrative of the documentary held a very middle class gaze.
Though I appreciated the documentary attempting to conclude with remedial actions to correct the racial disparities, such as ‘Continuity of Carer’ also known as case-loading, I was frustrated by the brevity with which it was mentioned. Continuity of Carer is a model of work which ensures that a pregnant woman or birthing person receives the majority of their care through one midwife. This enables good relationship-building, less room for inconsistencies, and is a proven method to protect health and promote dignity. However, it is a model of work that is not feasible for all midwives and is often employed by staff without children of their own, as the work requires high availability and commitment to many on-call shifts through the night and day. Of course, having children is not needed to be a good midwife, but considering the forcefully female dominion of midwifery, many of the workforce continue to have children of their own (such as myself) making work as a continuity of carer midwife incompatible with having a family, and calling into question the longevity of the plan. The documentary visited Newham Hospital and briefly interviewed a continuity midwife and her client, who both expressed positivity, and though this was encouraging to the viewer, lacked much needed fibre to fully understand the benefits and difficulties of the continuity model in our current healthcare system.
Midwifery professionals of colour also face disparities in the workplace, which was just jointly reported on by the Association of South Asian Midwives and the Society of African & Caribbean Midwives. The report displays the shocking treatment these staff face, and if staff are not well supported in the NHS, then women and birthing people will undoubtedly be inhibited from accessing the best care the NHS could give.
Overall, the documentary is a decent watch for advocates against racial disparities in health, as it does bring to the forefront of societal awareness the appalling racial inequality and indignity faced by Black women in the UK, which is certainly needed in order to bring about change. The documentary was not long enough to do justice to the ‘whys and hows’ of this racial disparity, which was unfortunate and frustrating, but it inspired hope that change, or at least awareness, is on the horizon. What is now needed is for institutions, organisations and government to take heed of these warnings, commit to further research into the effects of institutional racism, and step up to the responsibility they hold, in protecting the lives and wellbeing of the most vulnerable women in our society. This they can do by critiquing their own established systems which metastasise institutional racism, and holding the people within those systems to account.