Series Two: Protecting Life at the Beginning
For a Black woman in London, the journey into motherhood is a tightrope walk over a chasm of systemic failure. The path to a long, healthy life begins at birth, but for too many, it starts with a pattern of dismissal and danger. This is the first investigation in the Afro Mosaic Health Guide’s year-long series, “The Global Black Lifespan Journey,” and the inaugural piece for our sub-series, “Your Neighbourhood, Your Heart: How Structural Racism Shapes Health.” We begin in London because to understand health across the diaspora, we must first confront the life-and-death challenges faced at its very start.
1. The Problem: A Pattern of Dismissal and Danger
Black women in UK maternity care consistently face dismissal, neglect, and danger—reflecting a systemic, not isolated, issue with serious consequences.
1.1 The Alarming Statistics
Recent reports reveal a stark and unacceptable reality: Black women in the UK are four times more likely to die in pregnancy or childbirth than white women. While the overall maternal death rate in the UK was 12.82 deaths per 100,000 maternities in 2021-23, the outcomes for Black women are disproportionately worse, highlighting a deep-seated crisis in care.
1.2 “They Are Not Listening”: The Lived Experience
Behind every statistic is a human story. The overwhelming theme from women’s testimonies is a feeling of not being listened to, often with life-threatening results. One woman’s partner, for instance, “kept asking for help but was dismissed” during a 36-hour labour. This dismissal can lead to catastrophic medical events being overlooked. A Ghanaian woman who repeatedly raised concerns about chest pain and breathlessness was discharged from the postnatal ward, only to be later diagnosed with a life-threatening pulmonary embolism. In another case, a Black woman showed clear signs of sepsis, but her paleness was only recognised by a South Asian doctor who took swift action. An inquiry by the All-Party Parliamentary Group (APPG) on Birth Trauma found that a “lack of kindness or compassion” was an overwhelming theme in written submissions. One mother recounted her experience: “I was covered in blood and my own faeces, but there was no one to help.”
1.3 Mental Health: A Silent Crisis
Black women face distinct challenges accessing perinatal mental health (PMH) support, often causing serious unmet needs. Key takeaway: Mental health barriers remain hidden and dangerous for Black mothers.
- Language and Cultural Barriers: The lack of interpreters who understand specialised PMH terminology can hinder effective communication. Furthermore, in some cultures, mental health is “simply not spoken about,” making it difficult for women to disclose their struggles.
- Fear of Consequences: Women express a profound fear of speaking out. They worry their capabilities as a mother will be questioned or, in the most extreme cases, that their baby will be removed. This fear is magnified for asylum seekers, who are concerned about potential detention or dispersal if they reveal their mental health difficulties.
- Systemic Exclusion: A tragic case study from the MBRRACE-UK report illustrates the fatal consequences of systemic failure. A woman with a known history of substance use and domestic abuse had her referral to the perinatal mental health team declined. After her baby was removed from her care, she received minimal mental health support and died from an overdose four months after giving birth.
2. The Systems: Why This Is Happening
These patterns of poor care reflect broader issues: the healthcare system is failing, policies are flawed, and institutional practices are deeply entrenched. These problems stem from a lack of Social Structure & Support and a failure in Legal Realities & Protection.
2.1 From Biased Beliefs to Broken Trust
Systemic racism manifests directly in maternity care through the stereotypes held by some healthcare professionals. A report from Birth Rights highlighted the “mistaken belief that ‘Black women have a higher pain threshold than other women, ’” a dangerous misconception that directly impacts pain management and the assessment of symptoms. This stereotyping creates a vicious cycle. Black women may avoid healthcare interactions due to a fear of prejudice. If they sense they are being stereotyped, they are less likely to share crucial information with providers, further compromising their safety and care.
2.2 Understaffed, Overwhelmed: The NHS Reality
Broader operational pressures within the National Health Service (NHS) create an environment where poor care can flourish. NHS Trusts face major challenges with staff vacancies and turnover. At Bradford Teaching Hospitals NHS Foundation Trust, for example, nursing and midwifery staffing was placed on the Chief Nurse Risk Register. These pressures lead to “red flags” in maternity units—indicators of potential safety concerns. A report from the Bradford trust noted 73 red flags for “delayed transfers to labour ward” and 93 for “delays in the induction process,” citing unit acuity and staffing pressures as the cause. These are not isolated problems but reflect systemic issues affecting the NHS. The strain is also evident in the rise in patient complaints; at the same trust, maternity was the second-highest speciality, with a 46% increase in one year. Such overwhelmed systems foster dismissal of patient concerns, turning shortages into life-threatening oversights.
2.3 Gaps in Policy and Accountability
Failures in policy and accountability allow these dangerous conditions to persist. The MBRRACE-UK report, which reviews maternal deaths, found that in many cases, assessors felt that different care “may have made a difference to the outcome.”When women do attempt to seek accountability, they often face further dismissal. The APPG report on Birth Trauma noted a common theme that complaints were “often treated dismissively, with failings in care unacknowledged.” In some cases, birth notes were “often falsified or lost.” To address these issues at their root, the “Systemic racism, not broken bodies” report calls on the entire system to decolonise maternity curricula that currently centre white bodies as the norm.
3. Protection & Prevention: Knowledge as a Shield
With systemic failures ongoing, knowledge is vital for protection and advocacy. Key takeaway: Being informed equips you to navigate and challenge the system.
3.1 Know Your Rights, Own Your Care
You have fundamental rights as a patient. Being aware of them is the first step to ensuring they are respected.
- The Right to Informed Consent: You have the right to comprehensive education on your birth choices, including antenatal classes, where all risks must be discussed to ensure your consent is fully informed.
- The Right to Choose: Your choices about how and where you give birth, as well as your access to pain relief, must be respected by your healthcare providers.
- The Right to be a Decision-Maker: Advocacy groups are demanding that the maternity system make Black and Brown women decision-makers in their own care. Insist on being an active participant in every choice made about your body and your baby.
3.2 Recognising Red Flags: What to Watch For
The MBRRACE-UK report highlights several “red flag” symptoms associated with cardiac disease, a leading cause of maternal death. Knowing these symptoms can be life-saving. Seek urgent medical attention if you experience:
- Chest pain or atypical pain (e.g., shoulder pain)
- A raised respiratory rate
- Persistent tachycardia (a fast heart rate)
- Orthopnoea (breathlessness when lying down)
- Extreme anxiety combined with breathlessness. The report stresses that these symptoms “should always be fully investigated.” If you present repeatedly to a GP or health visitor with these concerns, they warrant serious attention.
3.3 The Power of Pre-Pregnancy Planning
For women with known risk factors for conditions like pre-eclampsia, such as a personal or family history of hypertension, planning is power. The MBRRACE-UK report recommends pre-pregnancy counselling to optimise your health and blood pressure control before conception, setting the stage for a healthier pregnancy.
4. The AMHG Protection Lens
The Afro Mosaic Health Guide is clear: these health disparities are not the result of biological deficiencies or inherent weaknesses in Black women. They are the direct consequence of systemic, structural, and preventable healthcare failures. Our goal is not survival against overwhelming odds, but to equip you—our mothers, sisters, and daughters—with protective knowledge and evidence to demand profound change and accountability from institutions like the NHS.
5. Conclusion: The Journey Forward
Safe, respectful, and equitable maternal care is a fundamental human right. Key to this is the healthcare system’s commitment to identify and dismantle systemic racism impacting Black mothers. This is just the first step in our investigation—our goal is to drive positive change and empower our community. Follow “The Global Black Lifespan Journey” for actionable health knowledge and resources. Stay connected via our website, newsletter, YouTube, Facebook, and X.
This infographic distills critical evidence on maternal health in London, showing why Black women face higher risks and how systems—not biology—drive harm. Review it to understand what’s happening, why it persists, and how informed action, rights awareness, and community advocacy can protect mothers, babies, and future generations.
