Five X More report - The black maternity experiences survey: A nationwide study of black women's experiences of maternity services in the United Kingdom (24 May 2022)

Summary

Maternal outcomes for Black women are significantly worse than for white women - Black women are four times more likely to die during pregnancy, labour, or postpartum and are twice as likely to have their baby die in the womb or soon after birth. They are also at an increased risk of readmission to hospital in the six weeks after giving birth.

This report by the organisation Five X More presents the findings of a survey into black women's experiences of maternity services in the UK. The survey aimed to understand how maternity care is delivered from the perspective of women from the Black community, and 1,340 Black and Black mixed women responded, sharing their experiences. It seeks to highlight the real life encounters behind the known disparities in maternal care.

Women reported far more negative experiences than positive, and most of these experiences centred around interactions with healthcare professionals. The authors highlight three factors related to healthcare professionals that contribute to damaging interactions, to do with their attitudes, knowledge and assumptions. The report includes many quotes from Black women about their experiences of NHS care and the damaging long-term consequences of this, such as fear of having another baby, reluctance to engage with health services and mental health issues.

Content

Key findings

Antenatal care

• Engagement with antenatal care was high with 96% engaging with maternity services in the first trimester of pregnancy and 95% of women engaging fully with midwifery, doctor and sonography appointments.
• However, for women who experienced miscarriage or pregnancy loss, 61% report that they were not offered any additional support to deal with the outcome of the pregnancy.

Labour and birth

• Just over a third (36%) of respondents reported feeling dissatisfied with how concerns were addressed during labour.
• 43% percent reported their pain relief options were not explained to them and 52% of women who did not receive their choice of pain relief said there was no explanation as to why it was not given to them.

Postnatal care

• A third of respondents (31%) were concerned about the healthcare they received from their midwife during the birth recovery period.
• However, 69% of respondents said they were somewhat or very satisfied with the postnatal health check-up performed by the health visitor.
• While 78% with health concerns after birth those with concerns said they raised their concerns with a Health Care Professional, 36% of respondents said that they were not confident to ask for help on the postnatal ward.

Recommendations

The report makes the following recommendations to NHS England and NHS Improvement, the Healthcare Safety Investigation Branch, The Department for Health and Social Care and Integrated Care System leaders:

1. An annual maternity survey targeted specifically at Black women
2. Increased knowledge on identifying and diagnosing conditions that are specific to and
3. Improve the quality of Ethnic coding in health records
4. More community-based approaches must be used to improve maternal outcomes
5. An improved system for women to submit their feedback and/or complaints specifically for maternity
6. Ensure that individuals involved in training health care professionals are aware and have an appreciation of the disparities in maternity outcomes