As A 20-Year-Old Black Woman, Why Is Private Healthcare My End Goal?

Twenty, it’s a strange age. I’m young enough still to be living rent-free in my parents’ house but old enough to have them pressure me about the contents of my savings account. The childhood conversations I had with friends about princess weddings and matching mansions are now anxiety activators. A mortgage looks more like a life sentence by the day and weddings, it turns out, aren’t cheap.  

I’m at university studying politics and international relations and my priorities, as I search for a graduate job, are heavily focused on how much my salary will allow me to save rather than finding a career I will entirely care for. Adulthood so far has been full of surprises and the price attached to creating the future I want is the biggest surprise of all. 

While the cost of a semi-detached new build or an ivory dress is horrifying, neither comes as a shock to me. One very expensive thing I never dreamed I’d deem necessary for my future, however, is private healthcare. This has put a lot of my dreams into perspective. Can I really pursue writing as a full-time job? Would that allow me to pay for the care I want and feel I deserve?

As a young Black woman, especially one who studies and actively involves themselves in politics, I am not ignorant of racial injustice. However I was horrified to read a government report, published in September, which confirmed that Black women are "five times more likely to die in pregnancy or six weeks after childbirth than white women". It horrified me politically and it horrified me on a deeply personal level. We know there is a gender health gap but, it turns out, there’s a gender and race health gap. 

These staggering statistics aren't down to biological differences of any kind. As the report notes, the bodies of Black women aren’t less able; our pain is just undermined and racial bias gets in the way of us receiving adequate care. As I read, I became frustrated and upset. The words swam on the page. It felt beyond insulting that this report could declare that "the NHS is the safest place in the world to have a baby" while stating that Black women are losing their lives at unjust rates in comparison to our white peers. 

This report is by no means the only one out there. Beyond the maternity ward, we know that women’s pain is regularly dismissed by doctors and Black women’s pain even more likely to be so. When it comes to conditions like endometriosis, there is a growing consensus that Black women face even greater barriers than their white counterparts to getting a diagnosis and then the treatment they need. 

Why are the lives of Black women deemed less valuable? Why are the cries of Black women not taken seriously? Where is this supposed safety for Black women – are our experiences not valid? It’s as if this judgement is made irrespective of our experiences, because how we feel just doesn’t count. 

And how do I feel? Honestly, I don’t feel safe. It’s haunting to grow up reading report after report like this. I should be able to trust the NHS with my life as much as anyone else. It shouldn’t be like this. At 20 years old, in a country which has a National Health Service that prides itself on healthcare being free at the point of delivery for everyone, should I really be trying to figure out how to get a job that will pay enough for me to go private? No. 

Yet here we are. 

If the information surrounding mothers isn’t heart-rending enough, the report also says that "BAME women are at an increased risk of having a preterm birth, stillbirth, neonatal death or a baby born with low birth weight". This reads like the shopping lists I jot in my notes app. In simple words, not only may Black women die in childbirth but the babies they are carrying, who they have spent months shopping for, dreaming about and falling in love with, are also at risk. 

We have long known that the NHS is strained. That it is overstretched and underfunded. Coronavirus has only brought that into sharper focus. It’s not that I am unsympathetic but my sympathy turns to rage when I think about the fact that it’s not a lack of funding preventing Black women from getting the care they need – it’s systemic racial bias, which leads to inequality in our healthcare system and in medical research more broadly. 

Sometimes I feel like we are going round and round in circles. Inevitably, the conversation circles back on itself and for us – the Black women behind the statistics, who are affected by them – it all starts to feel a bit surreal. Am I, at 20 years old, really supposed to feel the weight of all of this? To be forced to make difficult decisions about my future because I am concerned about what might happen to me if I don’t?

If you ever wonder why young Black women feel under pressure, think about that. We want to work hard and excel but we also know that we must because it's one of the few ways that we can level the playing field. 

When considering maternity care for the children I am not ready to have yet, will future me willingly put my life in the hands of the NHS, knowing it is of lesser value and that my pain may go ignored and my risks overlooked? Or will I pay for private healthcare as an investment in my wellbeing? If I pay more, will my life gain value? Is this what it will take to be listened to, cared for and treated as any woman should be? Is contributing to classism going to protect the babies of Black women? How much money would I have to spend for stereotypes to be ignored and biases placed to the side? Is that even possible? 

Right now, I am saving. I know what my goals are. I know how much I need to earn and how hard I need to work. Too many young people have already given up on their dream jobs in creative industries because the cost of living has risen so far beyond wages in recent years. This is particularly true of the cost of housing. If Generation Rent want to make it work, they have to sell out or risk being priced out. For young Black people, there are added pressures on top of all that. It’s not just that bills have to be paid one way or another; we live in the knowledge that we have to insure ourselves against the fact that the lives of Black women are not always treated as equivalent to those of white women. 

Earlier this year Dr Ranee Thakar, vice president of the Royal College of Obstetricians and Gynaecologists, put it best. "It is essential that we investigate the root causes of these very concerning trends to ensure that all women and girls have the ability to access the same high standard of healthcare," she said. "There are a number of reasons why these disparities could exist and the most effective way of examining these is to speak to the women who are affected by them on a daily basis. Women should always be at the centre of all decisions and actions pertaining to their own healthcare, and any policies put in place to protect and nurture their health."

Black women’s voices need to be heard. More than that, they need to be listened to. If Black women are affected by discrimination in maternity care then so are their children, who are directly impacted by prejudice and bias they do not even know exists.