Maternal health inequalities among Black Minority Ethnic group in UK

How maternal health is been experienced in the UK by BME group

Black ethnic group in the UK are noted to experience increased rates of premature birth, low birthweight, cesarean and maternal death 50% more than the white counterparts (Higginbottom et al., 2019). These are mostly women that live in highest levels of poverty in the United Kingdom. Also, these women have reported unequal treatment from healthcare institutions when they sought maternal care services. According to Anekwe (2020), the maternal health sector is amongst the core examples of discrimination and inequalities in the United Kingdom. The maternal health care provision is thus a major source of concern in the U.K. According to the research carried out by the University of Oxford, the specific speculations on the effects of unequal maternity service provision; the UK proved to be suffering from the side effects of the named maternal medical services (Higginbottom et al., 2019). The latter provided such fine details as: a mortality rate of 9.2 women in one hundred thousand, from the year 2015 to 2017. The mortality rate was as a result of the death cases incurred by more than two hundred women; this mainly occurred to women who had delivered recently (a period of six weeks or less). Additionally, between the years 2012-2014, the morality rate remained constant, signifying the existence of the same medical challenges in the health sector (Higginbottom et al., 2019). The death of these patients was attributed to poor medical services, because after several research and analysis of the obtained data; the research organization (the university of Oxford) came up with various conclusions (Knight et al., 2009). The latter include: the 44 percent of the deceased women, were having proper health, as compared to the 29 percent who were seen to be having extremely poor health status. The poor medical condition of the patients is considered to be cardiac related, this confirms the research by Roos-Hesselink et al. (2019), that cardiac infections and diseases are the major causes of death among the maternity patients. In addition to the cardiac infections, the research by the University of Oxford found out that; thromboembolism and thrombosis are also responsible for the experienced maternal deaths in UK (Higginbottom et al., 2019)

In addition to the medical service provision among the Black minority ethnic group in the UK, there are several factors responsible for the poor medical service provision. According to Sharma, (2020), the women in specific economic levels in the UK, for instance, the Black minority ethnic groups, lack information that are essential in handling the maternity process. This lack of relevant information has complicated the lives of the women in low ethic groups. The information is key to proper maternal self-observation by an individual; however, due to the existence of language barrier, the maternity patients are not able to attain the required medical standard during the maternal period. The UK maternal service providers are also not in apposition to provide adequate information to the Black Minority Ethnic groups due to lack of translation assistance for the non-English speakers. The latter has disadvantaged the minority group; as a result, there is occurrence of maternal deaths. The minority group also lacks the continued service provision unlike the other UK citizens; this has resulted to an increased death rate among the minority ethnic society Hassan, (2017). The minority group experiences cultural insensitivity and racial related problems in the country, this is an obvious cause of the increased maternal deaths within the Black minority ethnic group. The racial related factors are commonly experienced as the women are denied the access to some essential maternal services. This discrimination causes an inevitable vulnerability amongst the women of such ethnic groups Higginbottom et al. (2020).

The BME group and the policy that has been put in place to tackle maternal inequalities among these groups

The Black Minority Ethnic group in the UK is made up of the less advantaged non-white descent communities, which are victims of several discriminations. The group constitutes mainly of the Black-African–Caribbean people. The group undergoes various medical challenges which are specifically designated to them. The black ethnic communities of the UK experiences disparities in health care provision. Medical services are crucial to proper health and general wellbeing of an individual (Foster et al., 2017). Racial discrimination in health among the BME community has been reported for many years within the UK. Undoubtedly, racism has been associated with poor health according to studies in the UK. Discrimination based on ethnic origin in the UK has been noted as one of the most common type of health prejudice in the UK (Foster et al., 2017). Different ethnic groups have been assigned different values in the UK with regard to health whereby the BME group is discriminated and given unequal care relative to the white counterparts. Ethnic inequalities limit access to healthcare by the black minority groups in a broad context. In the UK, it has been proven that such inequalities exist though they have not been addressed effectively. The black and minority ethnic groups have been noted to be more likely to report limiting health and poor self-rated health relative to the white British counterparts. This fact has greatly reflected on the complexity of the health inequalities among the various and distinct ethnic groups within the UK. This has also necessitated the development of health policies which would take into account the variations in both social and economic resources between various ethnic groups. Ethnicity factors must be considered when seeking to understand immunization decisions among parents from BME upbringings (Foster et al., 2017). In most cases the vaccination information should be targeted to tackle beliefs concerning ethnic differences that are held by most of the people from such disadvantaged Ethnic groups Forster et al. (2017). Ethnical diverse communities are many within the United Kingdom. Various factors have been noted to contribute to the growth and expansion of the minority populations in the UK. These are inclusive of nature, birth rates and immigrations. Most of the minority groups in the UK constitute of individuals that were born overseas thus moved into the nation via immigration. More so after the Second World War, the UK became increasingly ethnically and racially diverse. Consequently, race relation policies were developed that reflected the principles of multiculturalism in and broad context (Foster et al., 2017). Due to various grievances, the UK government diverted from the policy characterized by multiculturalism towards an assimilation of the minority communities

Several policies have been introduced in the UK to tackle the maternal challenges experienced by such communities as the BME groups (Ige-Elegbede et al. 2019). In

generation of these policies, the UK considered several factors that were considered to

be effective and much involving, with an aim of solving the BME group related

challenges (Sharma, 2020). Much priority was however, given to the physical activity among older adults. The latter was initiated by such organizations as; National Health Service; for

Instance, the National Health Service (NHS) Health heck program carried out in the year 2016. The latter program was aimed at tackling the improper ageing system among the older adults in UK (Ige-Elegbede et al. 2019). This was conducted through comparative study of the physical active hours of the adults and, the recommendations from the World Health Organization (WHO). Another organization that took part in the research, in addition to the National Health Service is the British Heart Foundations (Redshaw, 2018). The UK government had stood out to reduce maternal deaths through a number of strategies and policies that they had put in place. The government aimed to strengthen the health systems by providing a lifesaving emergency obstetric care. Besides, the government targeted investments in interventions with high impact which would include family planning, totally prevention of unsafe abortion through stringent and strict policies that term the same as an illegal act. The UK government had also put in place a policy to ensure universal access to sexual and reproductive health among the BME groups of women (Zilanawala et al., 2015). High level international advocacy would offer a number of chances for the UK to offer continued international leadership on maternal health. Also, they aimed to support civil society advocacy, a policy that would be important for the delivery of effective maternal health services among the BME women (Redshaw, 2018).

Policy Gaps

The rate of racial disparities in women’s healthcare is growing at an alarming rate and this worrying pattern is a call for the government to act through proper policy implementation to reduce the adverse health experiences among Black Minority Ethnic (BME) women. It is reported that the risk of BME women dying due to pregnancy and postpartum care is five times higher than the average white woman in the U.K (Howell, 2018). To address these disparities, the government needs to examine the root cause of maternal health inequalities among BME women so that a long-lasting solution may be developed reasoning from cause to effect of the problem. One of the primary ways to identify these problems is to give the women a priority and chance to air out their challenges. The government has strived to place women at the center of the discussion to obtain their input on how they desire services to be commissioned and delivered (Kirkham & Stapleton, 2017). In spite of the ‘woman-focused’ policy commitment, the rates of Maternal Health Inequalities among Black Minority Ethnic Women are still persistently high and this highlights the need to put more effort geared towards reducing the inequalities.

Based on statistical data, one of the key issues that needs due consideration when dealing with maternal health inequalities is the level of service satisfaction among minority women (King’s Fund, 2018). Studies show that women from Black Minority Ethnic backgrounds experience difficulty in accessing maternity services compared to their white counterparts and this affects even how they utilize these services (King’s Fund, 2018). As a result, women from BME groups are more likely to experience late antenatal checkups (their first booking is often later than the ideal period of twelve weeks in gestation), have irregular antenatal care, low chances of performing anomaly scans or undertake screening (Katbamna, 2010). The government can address the policy gap in this area by increasing the accessibility of maternal and pre-natal care among the BME groups to improve the maternal health. Often, these women live under poor socio-economic conditions which ultimately affect their maternal health and the need for accessible health care is more marked in their surroundings.

In addition to the poor accessibility of maternal health services, other potential health barriers include; insufficient delivery of crucial and accessible information; poor translation and interpretational aid for patients who are non-English speakers; inadequate care continuity and negative attitudes associated with little control or assistance levels; racism and disrespect together with cultural insensitivity showed by the healthcare providers as well as the service (Kirkham & Stapleton, 2017). The need for adequate information is a matter of prime importance as it relates to maternal health and every woman is entitled to timely and accurate information concerning childbirth. Sadly, the low level of English proficiency among BME women has proven to be a hindrance in the provision of crucial information as it relates to maternal and prenatal care.

The communication is also affected by the prejudice and biasness manifested by the healthcare professionals when handling women from BME backgrounds. The cold attitude and disrespect destroy the trust and confidence of the BME women thus making it difficult to exchange information between the health care providers and the women. It is important to note that the healthcare professionals are the key determiners of information exchange as they regulate the quality of information shared and the recipient receiving the message. The government should thus implement policies that ensure information is equally served to both English and non-English speakers in the U.K hospitals. Nurses and doctors who are engaged in providing maternal health care should receive lessons on cultural awareness and diversity management among the patients to create a good rapport and suitable environment which will favor the health of pregnant and nursing mothers from the BME community. The National Health Service commission should also make it their aim to gain a proper understanding of the minority population through statistics and evidence-based data which will assist in making key decisions related to maternal health care among women from BME communities.

Analysis of Maternal Health Inequalities Using Dahlgren and Whitehead Model

The Dahlgren and Whitehead Model offer a broad perspective on how social and economic circumstances play a vital role in shaping the social determinants of health among people within a population (Dahlgren and Whitehead, 2007). The framework for this model operates on five main structures which are presented in a rainbow format. This section thus aims to use the Dahlgren and whitehead model to explain how the social determinants such as race inequality, ethnicity inequality, age and geographical inequalities affect Black Minority Ethnic women in the UK.

Race inequality

Racial disparities are continually endangering mothers of the black minority ethnicity in the UK (Bartley et al., 2015, Dahlgren and Whitehead, 2007)). Maternal health is noted as one of the starkest of racial inequalities that are experienced within the United Kingdom. Comparing the statistical data in the UK between 2014 and 2016, the rate of maternal death was noted to be 8 in every 100000 white women relative to the 40 in the same number of Black women (Bartley et al., 2015). Researchers have noted that the causes of the differences that are noted in the maternal health outcomes are inclusive of racism and bias in the access of healthcare by women (Katbamna, 2010). Difference in the diagnosis of endometriosis in the white and the non-white women have been reported (Bartley et al., 2015). For instance, black women have been noted to be less likely than the white women to receive a correct diagnosis of the disease. Biasness of doctors based on the race of patients affects how the different women from different races are treated (Katbamna, 2010). Pain in black women is not treated in the same way as pain in the white women (Bartley et al., 2015).

Ethnicity inequality

Inequalities in the rates of maternal deaths among different ethnic groups in the UK have been highlighted by reports from the UK confidential Enquiry into maternal and child health (Dahlgren and Whitehead, 2007). The difference has been noted to be greater than fivefold where by the lowest rates of deaths have been reported among the whites while the highest rates are reported among the black ethnic groups (Anekwe, 2020). Clear differences have been identified in the risk of severe maternal morbidities between distinct ethnic groups within the UK (Forster et al., 2017). Notably, severe maternal; morbidities have been reported to occur more than one and a half times more occasionally among the non-white women relative to the white women (Anekwe, 2020). This increased risk of maternal morbidity have been explained to might be caused by the diversities that are in pre-existing maternal medical conditions between various ethnic groups. Black women in the UK have higher rates of pre-existing hypertension and diabetes relative to the white women (Forster et al., 2017). Access to care is also a contributing factor to ethnic differences in health. Some women from ethnic minority backgrounds that were noted to have died have been reported to either accessed antenatal care late. Some did not access the care at all (Anekwe, 2020). Ethnicity inequalities need to be addressed to ensure improved maternal health outcomes for the black minority ethnic women.

Age Inequalities

According to Dahlgren and Whitehead (2017), age impacts on health significantly. Research has noted that increases in age are directly proportional to potential risk of ill health. Notably, women aged 50 years and above have taken the major proportion of the victims of maternal deaths that have been record in the UK among the BME groups (Draper and Fenton, 2014). Among the BME group, their older population has seen a dramatic upsurge despite the fact that they suffer most of the poorer health outcomes as well as poor access to quality healthcare within the UK (Pinheiro et al., 2019). Maternal mortality rates in the UK increases with an increase in age (Draper and Fenton, 2014). Advanced maternal age has been linked with an increased risk of pregnancy complications such as gestational diabetes, pregnancy-induced hypertension and pre-eclampsia which contribute significantly to maternal deaths. Besides, twin or higher order pregnancies have also been associated with advanced age pregnancies among the BME group women (Age UK, 2019). Research studies have identified breech presentation and placenta praevia besides preterm births as resultant consequences of advanced age pregnancies among the BME women (Pinheiro et al., 2019). Other studies have detailed post-term death and severe maternal morbidity as consequences of advanced age pregnancies (Age UK, 2019). From these findings, age inequalities can be concluded as a significant contributor to maternal health inequalities among the BME group women within the UK.

Geographical inequality

As noted in the Dahlgren and whitehead model, the location where an individual lives affects their health. Researchers have associated geographical health inequalities with socioeconomic disparities mostly for the BME group women. This is so since poverty increases are followed by continued deprivation of quality and timely healthcare services. Geographical health inequalities in the UK have been linked to the concentration of health and other social services in more affluent areas as Dorling notes, (2010). In England, the deprived areas have poor health outcomes, mostly consisting of people from the north, as the area contains most of the socioeconomically disadvantaged ethnic groups. Research has noted that in the UK, people that live in the richest areas live longer relative to those that live in the poorest areas. Geographic access to obstetric care facilities has been noted to significantly influence on the women’s maternal care in the UK. Women who live in low and idle income regions within the UK have less access to maternal health care services relative to those who live in high-income regions. Besides, studies have indicated that those who live in rural areas also have less access to maternal healthcare services compared to those that live in the urban areas of the UK. In rural and crowded urban centers, the women would need to walk long distances to access maternal healthcare services. Other factors that influence the access to the healthcare services are those inclusive of the availability of transport services in a certain geographical location, nature of roads also determine access to health care services by women of the BME group.

Conclusion

This essay has discussed health inequalities that are related to maternal health among the BME group in the UK. The government policies and the various measures that have been put in place to curb the same have also been discussed broadly. Maternal health is a crucial issue of the public health concern that is faced unequally by various ethnic groups, age groups, and socioeconomic groups across the UK. Research is needed to address this crucial issue as it is of utmost significance to public health outcomes.

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