For serious activists liberation is a life and death issue. However, an increasing body of evidence shows that bringing forth life is a precarious endeavour for Afrikan women. According to the UK Confidential Enquiry into Maternal Deaths the chance of death from complications surrounding pregnancy and childbirth is 40 per 100,000 for Afrikan women five times the rate for white women and more than twice the rate for Asian women. (1)
The situation is not unique to the UK. The disparities affecting Afrikan women in the USA, for example been, documented for several decades but this new report indicates that it’s actually currently worse in the UK. (2)
The situation is more severe in the Caribbean where the rate is about 180 per 100,000 but worst in in the Motherland with an average of 546 per 100,000. (3) Although within the context of active “underdevelopment” the situation in Afrika should surprise no one. (4) In fact, ninety-nine percent of all maternal deaths occur in the so-called “developing world,” due to factors like:
- Severe bleeding (mostly bleeding after childbirth)
- Infections (usually after childbirth)
- High blood pressure during pregnancy (pre-eclampsia and eclampsia)
- Complications from delivery
- Unsafe abortion (5)
But clearly from a maternal health prospective, the benefits of being in the so-called “developed world” have yet to be fully conferred on Afrikan women. One assumption might be that the situation is poverty related as in both the UK and USA Afrikan people do tend to be economically worse off. In the UK there is “the appalling reality of how a Briton’s ethnicity affects their chances of a good life” (6), while in the USA “the average Black family would need 228 years to build the wealth of a white family today.” (7) However, both the UK and USA have plenty of poor Europeans and Asians that are not afflicted as much as Afrikan women, so simply being poor does not explain the disparities.
To emphasize this point we can factor in the likes of tennis legend Serena Williams and global icon Beyoncé Knowles, worth several hundred million between them. Both of these superstars have shared accounts of difficulties experienced during their recent pregnancies.
The singer was swollen from preeclampsia, a pregnancy complication that involves high blood pressure and protein in the urine and is 60 percent more common in Afrikan women in the USA. Due to the complication, the 36-year-old artist was placed on bed rest for more than a month before having an emergency caesarean section because her and her babies’ health were in danger. (8)
The record breaking tennis player recounted her experience saying how even though she should have been able to count on the most attentive health care that money can buy, medical personnel initially ignored her concerns as she experienced a pulmonary embolism, the sudden blockage of an artery in the lung by a blood clot – “I could have died.” (9)
Williams went on to acknowledge that, in spite of her experience, she was luckier than many Afrikan women who do not survive. Indeed, in the USA research suggests that “black middle-class women were more likely to die in childbirth than white working-class women.” (10)
In trying discern the basis for the disparities, the evidence suggests medical and non-medical factors. As Serena Williams complained, that at the point of delivery Afrikan women find that they are less likely to be listened to than white women and treated with less empathy. (11) This preconception also holds that Afrikan women feel less pain and are less likely to receive pain relief during labour. (12) This belief can be at least traced back to the mid-1800s and James Marion Sims, regarded as the founder of modern gynaecology, who conducted countless surgical experiments on unanaesthetised enslaved Afrikan women because he believed, consistent with the pseudo-science of the day, their race made them more durable and thus well suited for painful medical experimentation. (13)
Pre-pregnancy issues also appear in the research as contributory factors such as it being unplanned. These pregnancies are also associated greater likelihood of premature birth, increased mortality for the mother and infant and are said to occur at higher rates among Afrikan women. (14).
These pre-existing aspects might reasonably be described as symptoms of oppression which are brought to bear in the lived experiences to the extent that “racism may cause black mothers to suffer the death of their infants.” (15) One startling piece of research undertaken by Dr. Arline Geronimus, a professor in the department of health behaviour and health education at the University of Michigan School of Public Health revealed that:
“Black women in their mid-20s had higher rates of infant death than teenage girls did — presumably because they were older and stress had more time to affect their bodies. For white mothers, the opposite proved true: Teenagers had the highest risk of infant mortality, and women in their mid-20s the lowest.” (16)
Although some, like “The Skeptical OB”, Dr. Amy Tuteur are quick to eschew the idea that racism plays a part based on the idea that other groups are subject to racism but don’t have comparably poor mortality rates. Tuteur points to genetic factors as possible cause, citing the sickle cell mutation as an example. (17)
Nevertheless, 1997 data from Chicago neonatologists, Richard David and James Collins and referenced Linda Villarosa, who was health editor at Essence magazine and directs the journalism program at the City College of New York, in Harlem emphasizes the intergenerational aspect of oppression:
“Babies born to new immigrants from impoverished West African nations weighed more than their black American-born counterparts and were similar in size to white babies. In other words, they were more likely to be born full term, which lowers the risk of death. In 2002, the same researchers made a further discovery: The daughters of African and Caribbean immigrants who grew up in the United States went on to have babies who were smaller than their mothers had been at birth, while the grandchildren of white European women actually weighed more than their mothers had at birth. It took just one generation for the American black-white disparity to manifest.” (18)
In the UK, the Royal College of Obstetricians and Gynaecologists is calling for a national strategy around women’s health as a matter of urgency. But it remains to be seen what this strategy will produce, especially in the light of the challenges to the health service that Brexit will more than likely compound. (19) The USA for its part is ostensibly bereft of policies to reverse this trend given that it is currently one of only 13 countries in the world where the rate of maternal mortality is now worse than it was 25 years ago. (20)
The strategies in the USA that have been effective, but quite localised are community midwives and doulas, that, according to the American College of Obstetricians and Gynecologists “in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labour.” One example of this is the collective of forty-five black and Latina doulas in Charlottesville called Sisters Keeper, that offers “birthing services free to women of color.” Since 2015, the Sisters Keeper doulas have attended about 300 births — with no maternal deaths and only one infant death among them. (21)
This kind of work is being undertaken in the UK by the likes of Elsie Gayle through Mimosa Midwives who “provide a bespoke one-to-one service for clients, utilising all combined clinical midwifery knowledge and skills. We also provide alternative and holistic therapies and approach our support to women with an eye for using creativity to enhance the physiological process of childbirth.” (mimosamidwives.co.uk/)
There is also a view that what may be seen as a crisis some, is an objective for others. As far back as 1974 the National Security Study Memorandum (NSSM) 200, also known as the “Kissenger Report” was the first of many documents that outlined the USA governments need for “creating conditions conducive to fertility decline,” “greatly intensified population programs,” and “effective, safe, long-lasting and acceptable methods of fertility control,” among what it terms the “Least Developed Nations (LDC).” This was while noting that “the U.S. should also take steps to convey the message that the control of world population growth is in the mutual interest of the developed and developing countries alike.” (22) Within the framework of the internal colony Afrikan people essentially function as LDC enclaves within the so-called developed nations and are therefore subject to the same imperatives. (23)
Whichever, theory explains the vast disparity in maternal mortality between Afrikan and all other women it’s clear that state agencies, even in so-called developed countries have proven ineffective in remedying the issue – if that is indeed their aim. The grassroots approaches have been proven to work but, as usual, it is a question of resources. Many in the community wring their hands in exasperation about knife and youth violence but the rate of maternal deaths is more than six times greater than the total amount of these homicides, indicating that it at least deserves comparable attention. It has to be a liberation imperative. (24)
(1) Emma Kasprzak (12/04/19) Why are black mothers at more risk of dying? https://www.bbc.co.uk/news/uk-england-47115305
(2) Dr. Amy Tuteur (12/04/18) Why are black mothers and babies dying? It’s unlikely to be weathering. https://www.skepticalob.com/2018/04/why-are-black-mothers-and-babies-dying-its-unlikely-to-be-weathering.html
(3) Leontine Alkema, Doris Chou, Daniel Hogan, Sanqian Zhang, Ann-Beth Moller, Alison Gemmill, Doris Ma Fat, Ties Boerma, Marleen Temmerman, Colin Mathers, Lale Say, (12/11/15) Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2815%2900838-7
(4) Walter Rodney (2012) How Europe Underdeveloped Africa. Pambazuka Press. p. 205
(5) World Health Organization (18/02/18) Maternal mortality. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
(6) May Bulman (08/08/16) Racial inequality in UK: The appalling reality of how a Briton’s ethnicity affects their chances of a good life. https://www.independent.co.uk/news/uk/home-news/racial-inequality-uk-racial-disparity-audit-government-report-theresa-may-bme-black-ethnic-minority-a7992016.html
(7) Joshua Holland (17/09/18) 5The Average Black Family Would Need 228 Years to Build the Wealth of a White Family Today. https://www.thenation.com/article/the-average-black-family-would-need-228-years-to-build-the-wealth-of-a-white-family-today/
(8) Jacqueline Howard (06/08/18) Beyoncé, Serena Williams bring attention to risks of childbirth for black women https://edition.cnn.com/2018/08/06/health/beyonce-vogue-pregnancy-complication-bn/index.html
(9) Ibid.
(10) Kasprzak. Op. cit.
(11) Ibid.
(12) Konnie Huq (02/05/19) After Brexit, black women will be less safe when giving birth in Britain. Leaving the EU is dangerous. https://www.independent.co.uk/voices/brexit-nhs-maternity-care-pregnancy-bame-black-asian-women-a8896371.html?fbclid=IwAR27kNbQMv71KQrAhCDFiQhqpJuJgM-_IE_x4aWqLWe0a6Z_zLFJ2AGcpw0
(13) Joy DeGruy Leary (2006) Post Traumatic Slave Syndrome. Uptone Press. p. 80-1
(14) Mary Beth Flanders-Stepans (2000) Alarming Racial Differences in Maternal Mortality. J Perinat Educ. 2000 Spring; 9(2): 50–51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595019/
(15) Rhitu Chatterjee and Rebecca Davis (20/12/17) How Racism May Cause Black Mothers To Suffer The Death Of Their Infants. https://www.npr.org/sections/health-shots/2017/12/20/570777510/how-racism-may-cause-black-mothers-to-suffer-the-death-of-their-infants?t=1557682410346.
(16) Linda Villarosa (11/04/18) Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis. https://www.nytimes.com/2018/04/11/magazine/black-mothers-babies-death-maternal-mortality.html.
(17) Tuteur. Op. cit
(18) Villarosa. Op. cit.
(19) Kasprzak. Op.cit; Huq. Op. cit.
(20) Villarosa. Op. cit.
(21) Ibid..
(22) National Security Council (10/12/74) NSSM 200 Implications of Worldwide Population Growth For U.S. Security and Overseas Interests (The Kissinger Report). https://pdf.usaid.gov/pdf_docs/Pcaab500.pdf
(23) Jared A. Ball (23/02/11) Black History Month and The Unspoken Nature of Internal Colonialism. https://blackagendareport.com/content/black-history-month-and-unspoken-nature-internal-colonialism
(24) BBC News (07/02/19) Knife crime: Fatal stabbings at highest level since records began in 1946. https://www.bbc.co.uk/news/uk-47156957
we ask the question:
Can we be liberated if Black maternal mortality rates are so high?
1) How should the government respond to the UK Confidential Enquiry findings?
2) If teenagers are least at risk does is the cumulative effect of living in racist societies a key factor maternal mortality?
3) Are genetic factors the cause of the maternal death disparities?
4) Do we need a national strategy to develop community midwives and doulas?
5) Is the Black maternal death rate part of a population control agenda?
6) Do we take it as seriously as knife crime or is that a false dichotomy?
Our Special Guest:
Sis. Elsie Gayle: is a Jamaican born experienced independent midwife part of the Mimosa Midwives Practice and founder of ‘Midwifery Conversations’ a holistic non-governmental organisation dedicated to sustainable and ‘culturally safe’ maternity services (http://mimosamidwives.co.uk/). Having worked in Jamaica, the UK and Botswana, Sis. Elsie she was awarded an Honorary Fellowship by the University of Wolverhampton in 2017, recognising her “passion and commitment” passion towards midwifery and her commitment towards the BME community and women’s rights, particularly in the areas of childbirth and mental health services. In May 2019 Sis. Elsie was a recipient of the Iolanthe Award to will put on a conference aimed at ameliorating the root causes of black maternal and perinatal mortality, learning from international expertise in reproductive justice.
Sis. Elsie is regularly called upon to speak nationally and internationally and she is Patient Leader for NHS Midlands and East, and regional lead for maternity, obstetrics, patient safety and patient voice within the Healthwatch and Public Involvement Association. In addition to this she belongs to Wolverhampton’s African Caribbean Community Initiative. She works to reduce workplace bullying as chair of the Tim Field Memorial Lecture Committee; is a member of the Nursing and Midwifery Council’s BME Research Advisory forum, dedicated to improving the regulatory experience of nurses and midwives; and co-chairs the Society of African and Caribbean Midwives in the UK.