Racial Inequality in the National Health Service Maternity Care Dissertation

The purpose of this paper is to analyze the available research on the issues of racism within the National Health Service of the United Kingdom. Currently, numerous accounts indicate a high level of racial inequality in this healthcare system. Specifically, the scoping review will focus on the expecting mothers belonging to ethnic minorities. Overall, this review should accomplish two objectives, the first of which is ascertaining the impact of racial inequality on the childbirth experiences of the aforementioned women. The second is finding the ways, the NHS uses to address these racial issues.

Over the course of the review, seven academic databases will be used: Google Scholar, JSTOR, Project Muse, Science Direct, Springer, ResearchGate, and Microsoft Academic. Furthermore, sources from the non-academic literature will also be included, as the issues of racism are not often documented. The methodology for this review includes the collection and synthesis of the available evidence of racial inequality in British maternity care. As most of the data will not be numerical a qualitative research design will be used, particularly, the collection of secondary data is the primary method.

The conceptual framework is represented by a critical race theory. It is an academic approach that “emphasizes the centrality of race, racism, and White supremacy in describing educational structures and social practice” (Sablan, 2019, p. 178). The basic tenet of critical race theory is that laws and rules have been primarily written by people of white descent. Subsequently, there are few methods of monitoring the cases of discrimination, which forces the researchers to rely on stories and accounts as evidence for the fact of white supremacy. While it constitutes a fully-fledged qualitative research methodology, the sources of the evidence can be considered not credible.

The same problem applies to the area of maternity care. As most of the interaction during the delivery is not protocoled, testimonies of women serve as the major source of evidence, which compromises the capabilities of the evidence base (Betron et al, 2018, p. 4). This conflict is further exacerbated by the fact that maternity care personnel are primarily white people. Therefore, the intersection of opinions is expected to occur and lead to controversial claims. However, due to the lack of any real meaningful documentation of cases of racial injustice in maternity care, the analysis of claims and accounts is the only available method of ascertaining the truth.

The deficit of means of monitoring is also caused by the apparent ignorance of white people towards the struggles and discomfort of minorities. Whether it is a conscious decision to ignore the problems of other ethnicities or a simple lack of awareness, many people have no knowledge of the issues of inequality in many areas (J’Mag Karbeah, 2019, p. 3). This expression of indifference has two implications. First, policymakers do not initiate laws, which would help ameliorate the situation. Second, there is little feedback concerning the inequality because minorities themselves do not hold trust in the capabilities of the government or the possibility of change.

Healthcare presupposes working with people who are at risk of health deterioration. Although it may seem as judgmental, there is always a possibility of patients’ death during the delivery, prenatal care, or any other stage of childbirth. An excessive amount of potential complications creates risks for expecting mothers’ lives. Yet, it also creates a valuable excuse for the medical personnel with ethnic prejudices, who can use the complications as an excuse for negative patient care outcomes. Moreover, considering the overall restriction that women experience during prenatal care, their opportunities are limited both legally and biologically. As a consequence, expecting mothers are extremely vulnerable, especially if they belong to an ethnic minority.

As a result, maternity care is a substantial blind spot both in terms of healthcare and race equality. The mortality rate of black women in childbirth is four times higher than the same indicator for white women (More deaths, worse care: inquiry opens into NHS maternity ‘systemic racism’, 2019, p. 43). What is more, this tendency has persevered for several years, which implies the absence of any effective involvement in these affairs. Therefore, it is important to accentuate the available means of reporting inequality and maltreatment in the study of the problem of maternity care in the United Kingdom.

Over the course of the scoping review, several themes have been identified. The first one is race-based death rate inequality. There is evidence, which has been accumulated over the years about a drastic difference in complications during childbirth between white women and mothers of other ethnicities (Henderson & Redshaw, 2017, p. 38). Despite the advancement of technologies, which make the procedures related to child labor, non-white females continue to have more complications than anyone else.

The second theme is the normalization of problems during childbirth. Statistically, women belonging to ethnic minorities are more likely to experience complications, as their mortality rate is higher. Women report that many medical workers use this explanation when faced with controversies surrounding such a discrepancy in patient outcomes (Betron et al., 2018, p. 8). Even though the causes of such statistics may lie in prejudices and selective incompetence, such an excuse is a frequent one.

The third theme can be labeled as the absence of control. As has already been stated, the extent of women’s abilities during prenatal care is limited. Interactions between the personnel and patients are not documented. Based on the stories told by the mothers belonging to minorities who delivered in British hospitals, if a racially-biased nurse is assigned to an expecting mother of Asian descent, the nurse is practically free to abuse the patient or deliver insufficient quality care without any fear of sanctions (Kozhimannil, 2021, p. ). Essentially, there is no way to prove the fact of racial inequality because the conduct regarding interracial communication is not monitored.

The fourth theme is the constantly forgotten need for change. Many publications accentuate the existing problem and emphasize the necessity for greater control and larger awareness, yet there are no visible effects of such appeals. As the independent report “Saving Lives, Improving Mothers’ Care” (2019) showcases, this stalemate is not new and has been present for years. Whether it is a conscious decision to ignore this problem or indifference born of ignorance, the government does not launch any meaningful initiatives. It is no surprise that the statistics remain the same in spite of all the complaints and appeals.

Altogether, this review has identified four main themes, which are present in publications. Critical race theory was used as a theoretical framework for the qualitative research of racial inequality in the sphere of British maternal care. Research in this sphere most frequently revolves around the alarming statistics of unequal mortality rate, lack of control, social indifference, and the absence of changes. Subsequently, the major problem behind this issue is that the base of evidence consists of reports of women who experienced maltreatment during childbirth, yet these accounts cannot be objectively verified.

Reference List

Betron, M. L. et al. (2018) ‘Expanding the agenda for addressing mistreatment in maternity care: a mapping review and gender analysis’, Reproductive Health, 15(1), pp.1-13.

J’Mag Karbeah, M. P. H. (2019). ‘Applying a critical race lens to relationship‐centered care in pregnancy and childbirth: An antidote to structural racism’, Birth, pp.1-5.

Henderson, J. and Redshaw, M. (2017) Change over time in women’s views and experiences of maternity care in England, 1995–2014: A comparison using survey data. Midwifery, 44, pp.35-40.

Kozhimannil, K. B. et al. (2021). Racial and ethnic diversity in the nursing workforce: a focus on maternity care. Policy, Politics, & Nursing Practice.

More deaths, worse care: inquiry opens into NHS maternity ‘systemic racism’ (2021). Web.

Sablan, J. R. (2019) ‘Can you really measure that? Combining critical race theory and quantitative methods’, American Educational Research Journal, 56(1), pp.178-203.

Saving lives, improving mothers’ care (2019). Web.