Introduction
The sphere of healthcare has always been closely correlated with various socio-cultural aspects due to the fact that these notions are interdependent in terms of the potential complications for the patients. The aspect of maternity care in the context of racial and ethnic disparities has now become one of the most challenging social issues in the UK. Indeed, according to the latest research in the field, an average of 9,8 women per 100,000 died during pregnancy or up to six weeks in postnatal care (MBRRACE-UK, 2018). However, when isolating this indicator to the death rate among Black women, the number goes as high as 40 deaths per 100,000 (MBRRACE-UK, 2018). Thus, it becomes evident that the issue of the experience of Black women in the context of maternal care is to be studied closely in order to find the possible reasons for such a drastic tendency.
The primary goal of the following research paper is to explore Black women’s experiences of racial disparities in UK maternity care and the impact of COVID-19 on the current situation. In terms of the major research question, the following objectives are to be met:
- The general experiences of racial disparities Black women undergo in the context of maternity care and how this perception is affected by an ongoing pandemic;
- Exploring the ways in which national organizations such as NHS support Black women in maternity care;
- The identification of the barriers existing in today’s model of maternity care access for Black women in the UK;
- The identification of differences, if any, existing within Black ethnic ‘groups’ and their needs in terms of maternity care.
The structure of the research will include a theoretical overview, methodology analysis, and discussion of the findings. The theoretical overview will encompass the analysis of intersectionality theory as a major conceptual framework, including the notions of race, gender, and social class. The methodology section will describe the means of data collection, which contains semi-structured interviews aimed at discovering the conditions of maternal care in the UK during the COVID-19 outbreak when compared to the care patterns from approximately two years ago.
Conceptual Framework
The Notion of Intersectionality
Maternal care among Black women remains one of the most widespread yet mysterious aspects of healthcare, as there is no particular answer to the question of the major factors taking a toll on women’s reproductive health. Since the 20th century, the issues of ethnic disparities have been discussed at a relatively high rate, but no consensus is reached. This may be explained by the fact that various researchers place emphasis on one ethnic problem at a time instead of perceiving them as a unity. However, in 1989, an American sociologist Kimberlé Grenshaw coined the term ‘intersectionality theory’ as one of the means to address the issue of ethnic disparities in such socio-cultural environments as healthcare (Kapilashrami and Hankivsky, 2018). According to the scholar, the very notion of intersectionality stands for the process of the examination of various social factors in terms of their interdependence instead of studying them in isolation (Kapilashrami and Hankivsky, 2018). That is, rather than conducting sociological research based on the data concerning gender or social class solely, it would be more beneficial to put the notion in perspective and combine it with other aspects like gender, race, or sex.
Intersectionality and Healthcare
Over the past years, various approaches to explaining the notion of ethnic disparities in healthcare have been presented. However, their credibility is now considered insufficient due to the fact that most of these arguments were address the notion of gender, race, or social class solely. The issue is especially evident in the example of maternity care in the UK and in the US. For example, in the past years, when speaking of Black and minority ethnic (BME) women, major emphasis was placed on the fact that women had a poor maternity care indicator due to the fact that they were the ones who neglected proper care in the first place (Martin and Montagne, 2017). Thus, such an assumption implies a high level of interdependence between the social status of a woman and her income.
However, in the very same article published by ProPublica, a story of Shalon Irving, a CDC epidemiologist, is narrated, claiming that thinking of the high mortality rate of Black mothers as a purely social status issue is, by all means, biased and requires reconsideration (Martin and Montagne, 2017). Other scholarly articles claim the existence of a similar problem in the context of sex and reproductive health education in the context of the COVID-19 pandemic (Lokot and Avakyan, 2020). Hence, the conceptual framework of intersectionality was chosen to conduct the following research for a number of reasons.
According to Kapilashrami and Hankivsky (2018), there are various fundamental questions that have to be considered prior to incorporating an intersectionality analysis, including:
- The concept of the research: what are the basic assumptions underlying the issue, and what are the major aspects required to be considered in terms of interdependence?
- The study design: identification of the adequacy and relevance of the available data and the establishment of the data time limits in order to design the diachronic boundaries of the research.
- Impact and interpretation: estimating the ways in which the data collected will be interpreted to the broad audience (e.g., what social factors have to be outlined in order to prove the intersectionality of the research) and defining the potential implications of the research, including its practical value to the realm of global health.
Thus, considering the research question stated in the following research, the aforementioned aspects may be addressed. To begin with, the concept of the research tackles the issue of implicit racial bias that creates disparities in healthcare being implicitly correlated with sex and social status. According to the latest studies, the UK healthcare representatives are likely to implicitly modify their attitude regarding the patient’s gender even when the issues concern physical disability (Sakellariou and Rotarou, 2017). Thus, it becomes evident that both notions of racism and sexism have to considered when addressing the challenges of maternal care for Black women in the UK. Secondly, there are enough data concerning the notions of racial disparity, sex, and social status to conduct qualitative research on the topic. Finally, the implications of the following study will create a major impact on the justification of a hypothesis concerning implicit racial bias in maternal care.
Methodology
In order to collect sufficient empirical data, a semi-structured interview will be conducted. A semi-structured interview is considered as the most appropriate in the given context, as it allows the researchers to move beyond the rigorous question set once an interviewee presents a topic worth further discussion (Mannan, n.d.). The optimal number of questions in the questionnaire is twelve open questions, as in such a way, the interviewees would feel comfortable and not tired of responding, whereas the discussion might develop in another direction regarding the answers.
The questionnaire itself will be divide into four categories according to the objectives outlined in the introduction to the research. Thus, the first block of questions will be dedicated to the identification of personal information of the interviewee, including the notions of social status, ethnic affiliation (Black African, Black Caribbean, or Black other, as indicated by the UK Census), and age. Another question segment would concern the aspects of the role maternity care plays in the interviewee’s life (prenatal care, postpartum/maternity leave). The follow-up questions will then address whether the interviewees have ever faced the manifestation of either explicit or implicit racism in the context of maternity care. The subsequent block will be dealing with whether the interviewees are aware of the maternity care support provided by the NHS, such as the NHS Long Term Plan and its initiatives in terms of racial disparities (NHS, 2020). Finally, the last question block will concern the peculiarities of maternal care provision under the COVID-19 circumstances.
In order to address the aforementioned problems properly, it is of crucial importance to carefully choose the study sample. Thus, for this research, the term ‘sample’ will be used to address Black females from the UK in perinatal care. The best-case scenario for the sample size would be to encompass more than 100 females who were either in maternity care over the past two years or were enrolled in the maternity care program during the pandemic outbreak. The age range of the sample is not limited, yet it would be important to work with size-balanced age groups, meaning that the representatives of each age group should constitute approximately equal quantity. Moreover, in order to comply with the fundamentals of the intersectionality approach, it would be beneficial to include the representatives of various social groups. However, as far as ethical considerations in terms of the primary research are concerned, it is of crucial importance to take into account the fact that some Black women in the UK are unlikely to share sensitive information due to the privacy risks and fear of explicit racism manifestation (Bracken-Roche et al., 2017). Thus, when collecting primary data, the option of encoding personal names for the sake of privacy will be adopted.
When dealing with such notions as race and equity in the social paradigm, it is of paramount importance to understand that the qualitative research conducted in terms of intersectional approach will never be entirely objective. Thus, while regarding race, sex, and social class as purely social constructs, the best way to analyze the data obtained is not to isolate it from the personal perception of the environment. In order to do so, interpretivism and hermeneutics, in particular, will be applied to analyze the responses. According to the researchers, hermeneutics may be defined as the ability to look into the context of any ‘text’ or communicative situation (Ryan, 2018). The very idea of the interpretivist approach is considered beneficial by various researchers as far as social research is concerned.
Thus, according to Crotty (2004), researchers willing to obtain a better perspective on the individuals’ perception of various evidence-based concepts are likely to benefit more from looking into the deep structure of the text. This implies respecting the fundamentals of hermeneutics. In such a way, a researcher is able to read into the message provided by the interviewees to identify the foundation for implicit bias and racial disparities in the maternity care paradigm.
Conclusion
The following research paper outline was aimed at defining some of the major steps towards analyzing the empirical data concerning the experiences of Black women in the UK maternity care. In the introduction, the major research question and objectives of the research were identified. The conceptual framework of the potential research contained the definition of intersectionality and its primary constituents, including sex, race, and social class. Moreover, the following framework was analyzed on the matter of appropriateness for future research. The methodology section identified the empirical ways of obtaining data for qualitative research.
References
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Crotty, M. (2004) The foundations of social research. Thousand Oaks, CA: SAGE Publications.
Kapilashrami, A. and Hankivsky, O. (2018) ‘Intersectionality and why it matters to global health,’ The Lancet, 391(10140), pp.2589-2591. Web.
Lokot, M. and Avakyan, Y. (2020) ‘Intersectionality as a lens to the COVID-19 pandemic: implications for sexual and reproductive health in development and humanitarian contexts’,Sexual and Reproductive Health Matters, 28(1), p.1764748. Web.
Mannan, C.S. (n.d.) Best practices of Semi-structured interview method. Web.
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