Birthing care without racism: five minutes with . . . Kimberly Seals AllersBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m424 (Published 11 February 2020) Cite this as: BMJ 2020;368:m424
“In New York City, where I live, black women are 12 times more likely to die during childbirth than white people. In the UK, according to the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK report,1 black women are five times more likely to die, and Asian women twice as likely to die, compared with white women. We’re very far away from where we want to be.
“We have to acknowledge the role of racism and bias. Many of the studies around the experience of women in childbirth and breastfeeding talk about pre-existing health conditions, such as obesity and socioeconomic factors, but with no social context. We can’t talk about obesity without talking about food access. When we look at these problems without the context of their lived experience, we’re really missing how we can find real solutions. What women are experiencing is bias in their care. There is nothing about a black or brown woman that makes her more likely to die after childbirth or have poor birth outcomes or not breastfeed. It’s something around the care that she’s receiving.
“In my speech to the Unicef UK Baby Friendly Initiative Conference in 2019 I talked about stereotypes and how these ideas about who black and brown women are can impact the care and the options that they’re given. We looked at an academic study that showed that physicians were giving different treatment options to hypothetical white patients than they were to hypothetical black patients with the same symptoms.2 We need to question everything, including our research protocols. Evidence based research is important, but evidence based on who? What are we missing if the ‘evidence’ is based on one type of woman and one type of socioeconomic status and we’re using that to make universal policy that affects all women?
“I’ve completed several research projects in about five US cities, on the ground talking to community members, trying to learn about the lived experience of black and minority ethnic women and women of colour. We know that black and brown women are dying more, so we have to do more. It’s not enough to say, ‘we’re going to put that breastfeeding support group in that neighbourhood, I don’t know why they don’t come.’ Well, what more did you do? You have to think about engaging that community on a different level.
“We hear a lot from black and brown women that they are not being given basic medical information about breastfeeding and their birthing options. I think there are assumptions that some women aren’t going to breastfeed. Stereotyping and bias comes into play around who gets breastfeeding support and advice or who’s talked to about more birthing options, and physicians who may feel ‘I’m not going to talk to her about this because I know best and she’s not in a position to make an informed choice.’ I also think there’s an assumption that because someone is a doctor, their medical experience and credentials have made them bias free. That’s not true, we all have biases, it’s just the nature of being human, and getting a medical degree does not negate that. We can’t tackle anything if we don’t acknowledge it, and that includes on the physician side.”
Kimberly Seals Allers is the founder and executive director of Narrative Nation, a non-profit organisation that campaigns to tackle racial disparities in health. She recently created and launched a new app called Irth (birth, with the “B” for bias removed) to publicly collect and share experiences of bias in maternity and infant care.