Thread by @docrussjackson

Black women are four times more likely to die while pregnant or just after childbirth than white women.

Although this report only includes data from 2019-2021, previous reports show maternal mortality rates have been largely unchanged for a decade.

theconversation.com/black-women-ar…

The reason for this racial disparity still isn’t fully understood. It’s likely due to a combination of many factors, including socioeconomic status and pre-existing health conditions.
committees.parliament.uk/publications/3…

Numerous reports have also shown that black women receive poorer maternity care compared with women from other ethnic backgrounds, which may further contribute to poorer health outcomes.

ncbi.nlm.nih.gov/pmc/articles/P…

But in order to improve maternal outcomes for black women, work will need to be done at every level of the #NHS to fix a root cause of these racial disparities in care – a concept philosophers call epistemic injustice.

academic.oup.com/book/32817?log…

Epistemic injustice is unfairly preventing someone from properly communicating their ideas or making sense of their experiences. This can happen when someone is biased against a person – eg, due to their race or social class, leads to them to downplay the other’s credibility.

By denying someone credibility, it may make them feel less able to request care & raise worries eg patients' concerns about their health dismissed as trivial, being perceived as “dramatic”, questions being brushed aside or not taken seriously, not taking patients’ pain seriously.

Numerous studies have highlighted the ways that epistemic injustice is present in real-world healthcare settings. Often, racial prejudice is a root cause.

pnas.org/doi/10.1073/pn…

For example, research shows that white health workers are more likely to disbelieve reports of pain by black patients and less likely to provide them with proper pain relief, compared with white patients.
ncbi.nlm.nih.gov/pmc/articles/P…

Reports have also found that when black women raise health concerns, they’re often dismissed – even in severe cases, such as instances where c-section stitches are bleeding and infected.

birthrights.org.uk/wp-content/upl…

A 2022 report by the Black Equity Organisation, which works to dismantle systemic racism in the UK, found that more than 65% of respondents reported they’d been discriminated against because of their ethnicity by healthcare professionals.

blackequityorg.com/state-of-black…

The #NHS Race and Health Observatory has made similar conclusions, showing many black patients experience patronising and judgemental attitudes from healthcare staff.

nhsrho.org/wp-content/upl…

Knowledge gaps in healthcare research are another example of epistemic injustice. Black people have historically been underrepresented in research studies and continue to be so. mayadusenbery.com/book

One reason for this may be their experiences of racism from doctors, which fosters distrust and discourages black people from participating in research studies. journals.plos.org/plosone/articl…

But researchers are also slow to engage with black participants and close these knowledge gaps. Many justify this lack of engagement on feeble grounds – for instance, by insisting black women are hard to recruit. ncbi.nlm.nih.gov/pmc/articles/P…

This lack of representation can lead to knowledge gaps at every level – including in the medical guidelines used to identify and diagnose certain diseases.

tandfonline.com/doi/full/10.10…

Recently, a black infant was not diagnosed & treated for jaundice as quickly as she should have been. Although blood tests showed symptoms of jaundice, healthcare staff were still relying on visual signs to detect jaundice, not typically as evident in darker-skinned patients.

While the negative impacts of epistemic injustice on the maternal healthcare that black women receive is clear, addressing these problems within the #NHS will require change at nearly every level - which the right-wing press would inevitably dismiss as 'woke' and/or 'wasteful'.

A report on black maternal health by the House of Commons’ Women & Equalities Committee, published in March 2023, suggests some measures are already being taken by Health Education England to improve cultural competence & address racism in maternal care.

committees.parliament.uk/publications/3…

But training #NHS staff to improve “cultures of kindness” & to “listen and make sure women are heard” will not be enough to fully address the complex causes of these disparities in black maternal health.

Current #NHS strategies such as hiring more diverse staff & rethinking research priorities are a step in the right direction. By having staff from more diverse backgrounds, there’s a greater likelihood they will be able to sympathise with patients & understand their experiences.

Moreover, having more research which has included black patients will help healthcare staff better respond to the specific health needs of these patients. onlinelibrary.wiley.com/doi/10.1111/14…

Such strategies risk falling short if they don't explicitly aim at targeting systemic racism & prejudice in the #NHS.

Midwifery training needs to challenge racist stereotypes that drive some healthcare staff to deny the credibility of others’ testimonies. weahsn.net/news/black-mat…

Gynaecology & obstetric researchers must proactively include black women in their studies to ensure their distinctive needs & concerns are met. This may in turn improve medical care for women from all backgrounds.

By Ian James Kidd, Assistant Prof Philosophy, Uni of Nottingham.