Healthcare in pregnancy, or lack of it, is one of the starkest examples of racial health inequalities in the United Kingdom and in the United States.
Work in the UK by University of Oxford researchers has found that between 2014 and 2016 the rate of death in pregnancy was 8 in 100,000 white people, compared with 15 in 100,000 Asian people and 40 in 100,000 black people.
It’s a similar picture in the US, where African-American, Native American, and Alaska native pregnancies are three times more likely to result in death, according to a May 2019 report by the Centers for Disease Control.
The Royal College of Obstetrics and Gynaecology (RCOG) has launched a race task force to look at disparities in care which will also examine racial disparities within gynaecology services, including the late diagnosis of gynaecological cancers and lower uptake of cervical screening amongst black women.
Previously much of the discussion of racial discrepancies in health care has focussed on physiological differences which may make pregnancy in black and Asian people more difficult or dangerous. This is clearly very dodgy territory. Our races are social constructs. There are not black, white and Asian bodies which can be medically differentiated. There is a huge diversity in our bodies and health, shaped by a variety of genetic, social, and environmental factors. Rather than building health services around a statistical average of a “white woman” we should have obstetrics and gynaecology fit for human variation.
Ultimately, rather than seeing race as a risk factor that predicts disease, we should see race as a proxy for bias and societal disadvantage. You are more likely to be poor, with all that comes with that (worse diet, worse housing, etc., and effects on your health), if you are black in the UK that if you are white.
But even outside these risks, experiences and outcomes differ across different socioeconomic statuses. This points to racism within healthcare as a major factor in death during and immediately after pregnancy.