Research shows that black women have a 40% higher risk of pregnancy loss than white women.
It is an urgent issue that the Royal College of Obstetricians and Gynecologists says deserves more attention as there are many complex reasons behind this higher risk.
These include a lack of quality research that includes all ethnicities – but RCOG leader Dr. Edward Morris says implicit racial bias also affects some women’s caregiving experience.
Isabel Gomes Obasi and her husband Paulson, from Coventry, are expecting a boy in March.
You are excited but very scared. Almost a year ago, their young son Andre died in the fourth month of Isabel’s pregnancy.
She also had stillborn twins in 2012.
Andre’s birth was extremely traumatic, Isabel says, but how she was treated when she was in severe pain and bleeding in the days leading up to her loss made the experience even worse.
“We knew something was wrong, so we went to the hospital and waited five hours to see a doctor,” she says. “I remember being laughed at by one of the nurses who said, ‘Just go home. Why do you keep coming in?’”
Isabel was checked and said the baby is fine, but says her intuition and pain were belittled and ignored.
“It got to the point where I started questioning myself,” she says. “‘Am I going crazy? Am I making these symptoms up?'”
Within 48 hours of going home, Isabel began bleeding profusely.
At this relatively early stage of pregnancy, there is little doctors can do to save a baby’s life. But the feeling of not being heard has accompanied Isabel ever since.
“I just switched off,” she says. “The experience made me anxious and depressed, if not suicidal.”
When asked why she wasn’t listened to, her trembling voice becomes steely.
“The color of my skin,” she says — the attitude of some of the staff was, “‘You have black skin – you’re not from here – you can wait.'”
About every fifth pregnancy ends in a miscarriage. It is believed that around half of all losses are linked to severe chromosomal problems affecting a baby’s genetic code, meaning the baby would never have survived.
Conditions like high blood pressure, some infections, and gynecologic conditions like endometriosis can contribute to higher risks.
But other possible causes remain unclear.
And while all ethnicities can have difficult experiences with pregnancy and caregiving, black women are four times more likely than white women to die in childbirth and are more likely to experience stillbirth and miscarriage.
Natasha Necati, trustee of the Essex Miscarriage Association, who has had eight miscarriages, says there was no “blatant racism” in her care – but like Isabel, there were times she wasn’t listened to.
“I didn’t always feel like I was being taken seriously,” she says. “I’ve complained about a lot of miscarriage pain on a couple of occasions, and it was kind of poof-pooh.”
One of Natasha’s main concerns is that little research is being funded into why black women are at greater risk.
“If it were deemed important, tens of thousands of pounds would certainly be spent trying to get answers,” she says. “One wonders if it’s considered important — and if it’s not important, why not?”
dr Morris says it’s “unacceptable” that minority ethnic women suffer worse outcomes than white women — particularly in midwifery.
“Implicit racial bias on the part of medical staff can hinder consultations and adversely affect treatment options,” he says.
And this can discourage some women from getting involved in health care.
dr Christine Ekechi, who is co-leading an RCOG taskforce launched in 2020 to address these inequalities, says more needs to be done to include black women’s experiences in miscarriage conversations and research, and to raise awareness among ethnic minorities.
However, she warns against attributing the reasons for higher miscarriage rates to ethnicity alone.
“What needs more attention is the understanding that every woman, regardless of ethnicity or race, has value,” says Dr. Ekechi. “I’m really fighting against the homogenization or grouping of all black women as one, that their thoughts and their beliefs and experiences are all the same — they’re not.
“So the problem really arises when we don’t see black women as equal to other women.
“We want all women to feel heard and valued and treated with kindness — but by better understanding the causes of miscarriage in all women, we can come closer to understanding why we see this stark difference in black women.”
Lead researcher Prof Siobhan Quenby, who heads the Tommy’s National Center for Miscarriage Research at Coventry University Hospital, says there’s a lot to study – black and Asian women, for example, are more likely to have gestational diabetes and potentially have higher blood sugar levels in early pregnancy.
Studies also show that the balance of bacteria in the vagina can differ between ethnic groups.
“We have not yet found out whether, for example, black and Asian women react differently to the hormone progesterone,” says Prof. Quenby.
- The National Institute for Health and Care Excellence has issued guidance for the NHS on recurrent miscarriage
- The BBC Action Line has details of organizations offering support
- Organizations like Five X More campaign and work with Black women to support them
Prof Quenby’s team is working on an app where people add details like ethnicity, weight and whether they’ve had a history of miscarriage, and then get evidence-based advice on how to reduce risks – like taking certain medications or maintaining a healthy one weight.
Some find the problem so complex, involving so many factors, that it’s unsolvable, she says, but solutions exist — and many women will one day receive the right treatment and care for what is currently unknown.
follow @Tulip Mazumdar on twitter.
Add Comment