For Black Women In The UK, A Fear Of Pregnancy Is Far From Irrational

Unbothered's Birth Rights acknowledges inspiring mothers and showcases the beautiful diversity and depth of Black parenthood. As Black birthing people continue to reconsider what motherhood looks like, we are spotlighting Black maternity, reproductive health, and exploring cultural conversations on re-parenting ourselves and the next generation.

“You know what the problem with your generation is,” my mother tells me, “you all know a little too much…'' she says, gesturing to the phone in my hand. We’re talking about pregnancy again, a conversation dance we do every so often, during which she tells me about the joys of motherhood and I bring up every conceivable reason why it’s something I am terrified to do (this time it’s a Tik Tok video of a mother of triplets leaking milk into her armpits).

Motherhood has always mystified me — both the concept and bewildering physical experience — especially Black motherhood, where there is an unfortunate expectation of strength in spite of, well, everything the world throws at Black mothers. Social media hasn’t helped my anxiety. In the age of too much information, I know as much as possible about the greatest, transformative, worst, and ugliest parts of Black parenthood due to being online. It’s overwhelming, I try to explain to my mum. “I just did it, L'Oréal,” my mum says, shrugging, “you just do. Obsessing over the what-ifs isn’t helpful.” But I do obsess over them. For me, embarking on motherhood in 2022 means confronting the very unsettling reality that for Black women in the UK, pregnancy comes with a heightened risk. I think I want to become a mother but, here in the UK, what could that mean for me, my health and potentially, a child?

“Black women are still four times more likely to die than white people during childbirth,” according to a 2021 report by Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE); Black pregnant people in the UK are also 40% more likely to suffer a miscarriage, confirm The Lancet, a medical journal which analysed data on 4.6 million pregnancies in seven countries. The numbers are hard to ignore.

It is obvious race is a factor in these shocking figures and yet the reports had failed to look at the issue through the lens of racism. The full picture, confirmed by the NHS race and health report in 2022, is that “stereotyping, disrespect, discrimination and cultural insensitivity” has led to Black pregnant people feeling “poorly cared for.” From the myth that Black women have a higher pain tolerance, pervasive microaggressions from health professionals that cause harm or distress, to the lack of research regarding race-specific health concerns, such as fibroid conditions and autoimmune disorders, it’s hard to ignore that systemic racism plays its part in the high rate of Black deaths in pregnancy. 

The mistreatment of Black pregnant women within the health service were chronicled in the 2021 Channel 4 documentary The Black Maternity Scandal, which featured harrowing death and near-death experiences from Black mothers and families, who shared similar stories of being ignored or dismissed or denied pain relief due to racial stereotyping. In 2020, we also learned the devastating story of Nicole Thea, a 24-year-old Youtuber who died whilst eight months pregnant from what was believed to be a heart attack. Thea’s family told news outlets that she had repeatedly complained of breathing issues before she passed. As a young Black woman with no pre-existing conditions, Nicole Thea’s untimely death furthered widespread discussions about whether race could have played a factor in her fate. 

Whilst pregnancy is considered “very safe” in the UK, given these numbers and headlines, for Black women in this country, a fear of pregnancy is far from irrational. 

“Pregnancy is an emotional and scary time to begin with, especially if it’s your first baby,” says Dope Black Mums founder Nina Malone. “But to add these statistics on top of pregnancy feels like our burden as Black women,” she explains to Unbothered of this omnipresent feeling of doom/dread. "I don’t feel like the statistics add more fear, it’s just constantly there. It always has been,” she explains to Unbothered. From London, Malone has had two high-risk pregnancies, the first of which doctors discovered a blood clot in her leg during her first trimester. As Malone shares, her six-hour labour experience involved three drips, two epidurals, being “pumped with so many drugs” and delivery by forceps. As she previously described to Huffington Post, “There were so many people in the room – a team for me, and a team for the baby – and so many words, jargon, things I didn’t understand.”  Through Dope Black Mums, Malone has since worked to create a digital safe space — from a bi-weekly podcast to a private Whatsapp group — for Black women to navigate motherhood together.  “I think [Black women] go into it knowing racism exists,” she says. “You go into it with your armour knowing that something can happen.”

The so-called armour gets heavy after a while, especially in moments of childbearing and childbirth where Black women have a reasonable expectation to be soft and vulnerable. A common thread of advice for Black women and people in pregnancy is to “advocate” for themselves by making formal complaints if, for example, they feel they are being mistreated in hospital, all the while having to care for the child they’ve just birthed. The onus is on Black women and people to speak up even when it has been proven we aren’t always listened to. It should be on the healthcare system to fix systemic problems that have existed for centuries.

“It’s not fair,” says Malone. “Not everyone’s in a position to advocate for themselves. Not everybody feels confident. Having to be able to digest all the technical lingo and be able to articulate at that moment doesn’t feel right. That’s really hard to do. That’s hard to do as an adult in everyday life being able to say — I don’t feel okay in this situation. It’s a lot.”

Well, not that much, really. Over the past few years, there’s been a widespread acknowledgement of the ways in which systemic racism has played its part in the UK’s shocking Black maternal health figures, however, until recently, the government had only offered platitudes of regret instead of actionable targets. 

As calls for action grew louder through widespread petitions and campaigns, on Feb. 22 the UK government introduced a new Maternity Disparities Taskforce to ‘explore inequalities in maternity care and identify how the government can improve outcomes for women from ethnic minority communities.’ The taskforce and its team of experts say that it is now “taking action” and aims “to halve the rate of stillbirths, neonatal deaths, maternal deaths and brain injuries by 2025.”

It’s being led by Minister for Patient Safety and Primary Care Maria Caulfield, who held the taskforce’s first meeting on March 2022, alongside Chief Midwifery Officer, Prof. Jacqueline Dunkley-Bent and a team of experts from across the health system, government departments and the voluntary sector to tackle disparities in maternal and neonatal outcomes.

Caulfield tells Unbothered that these to-be-confirmed actions will be revealed as soon as May this year, and says factors such as unconscious bias won’t be an afterthought.

 “The taskforce will focus on improving access to effective maternity care and care for women trying to conceive. It will learn lessons from previous attempts to tackle these disparities and address potential factors such as unconscious bias or cultural insensitivity,” Caulfield says in a statement sent to Unbothered. 

 “I look forward to the taskforce's next meeting in May, where we will agree specific actions that aim to improve maternal care and ensure that the NHS is a safe place for women from all backgrounds to give birth.” 

The taskforce says that it is looking at solutions such as “improving personalised care” and “empowering women to make evidence-based decisions.” On the face of it, the plans sound great, but is it enough?

Tinuke Awe and Chlotide Rebecca Abe, founders of grassroots maternal health charity FivexMore, say no. They tell Unbothered that they had hoped to be involved in the taskforce meetings being held in March and April this year. They’ve been leading public protests for years now. In 2020, they launched a now award-winning petition calling on the government to invest in much-needed research and improve health care for Black women through action. It went viral with over 187,000 signatures, leading to Black maternal health being debated in parliament for the first time in history. 

“Why did we not know about this? Why are we not involved?” asks Chlotide Abe over Zoom. “Obviously, we support [the taskforce]. This is a step in the right direction. But one of our key asks during our campaign is that Black women be involved at every single step of the next stage. Have they not listened to anything we’ve said?”

Awe is no stranger to some of the difficulties Black women face in pregnancy and childbirth,  which is why she set up Black maternal health charity FivexMore along with Chlotide Rebecca Abe in 2020 when she was heavily pregnant. Her own story about her pain being “dismissed” and “fobbed-off” by hospital staff before being diagnosed with life-threatening preeclampsia made headlines as she helped bring the issue to mainstream news. “I grew so tired of hearing Black women are five times more likely to die during childbirth over and over,” Awe said over Zoom. “At one point I said, OK, so what are we doing about it? We didn’t want to just raise awareness.” 

One of FivexMore’s main criticisms of the government's taskforce is that they haven’t listed any clear “targets". They are urging for something more “tangible.” That starts with collecting extensive and “never-seen-before” data which the pair have been doing and plan to share later this year. 

“Black women don’t know what’s going on behind all the statistics,” shared Awe. “We always say there are real people behind the statistics and for every Black person who passes away, there are hundreds more that have had serious complications. It is not documented anywhere. But we know because we’re on the ground,” shares Awe.

Until the government gets their act together organisations like Dope Black Mums are empowering people with tools to use in these situations, from how to find Black doctors and midwives to creating birth plans. For Malone, it will take the government committing to an "entire culture change" for Black women to feel safe in pregnancy in the UK.

“I don’t think anything is enough,” says Malone. “If there’s going to be some real change, from education to money, then great.

“I feel we’ve heard [about the taskforce] before in different guises, in different set-ups, in different funding pots and different taskforces. We've been around the block with this,” Malone added. “It’s great that people are talking about it, great that people are documenting it. I think the taskforce will just back up what we’ve already been saying for years.”

As a Black woman, yet to become a mother, I don’t feel any more confident about my own prospect of motherhood after having these conversations. Yet I am empowered by the motivations of the Black women fighting in the corners for those who will soon see the inside of a birthing room. “I wish I knew what I know now,” said Awe. “My second birth was absolutely perfect because I had that agency — I knew what I wanted to do and how I was going to ensure I got it. I also had a great midwife so that helped. I felt way more confidence going in.”Malone shares similar advice and urges anyone going through a pregnancy journey to do it with someone, anyone, you can be “brutally vulnerable with” and will confidently advocate for you.

Taking this research to my mother inspires a very frank conversation about motherhood we’ve never had before. I’ve turned my “hard no” about becoming a mum into a tentative “maybe” and she is now rooting for me to be informed in pregnancy over not-so-blissful ignorance. “It’s interesting,” she tells me, thoughtfully, “Black motherhood is often shown as rooted in pain, but I truly believe it is doubly an experience of joy, love and, yeah, most definitely courage.” This, to me, is more than worth remembering.