Joint Committee on Human Rights Inquiry: Black people, racism and human rights

Briefing from the Royal College of Midwives – July 2020



The Royal College of Midwives (RCM) is the trade union and professional organisation that represents the vast majority of practising midwives in the UK. It is the only such organisation run by midwives for midwives. The RCM is the voice of midwifery, providing excellence in representation, professional leadership, education and influence for and on behalf of midwives. We actively support and campaign for improvements to maternity services and provide professional leadership for one of the most established clinical disciplines.

This briefing set out the policy position and actions undertaken by the RCM in relation to black women’s experience of maternity services, whether they use maternity services or care for the women who do. We are sharing this information with the Committee because we recognise that as an organisation, as professionals and as a community with a common purpose, that there is a problem with the way in which black, Asian and minority ethnic (BAME) women and families experience maternity services and a problem with the way in which BAME staff are treated.

In acknowledging that a problem exists, we all need to be part of the solution.

The experience of maternity services for BAME women and families

According to the most recent data on the causes of maternal and infant deaths, and severe morbidity, black women in Britain are five times more likely to die because of complications in pregnancy than white women[1], and the risk is increasing year on year. BAME women are also more likely to have pre-existing health conditions, are at significantly greater risk of other adverse pregnancy outcomes and this is all compounded by the socioeconomic inequalities that disproportionately affect BAME communities.

The impact of the COVID-19 pandemic on BAME communities has only served to sharpen existing inequalities for black women. A study published in the British Medical Journal (BMJ) last month indicated that more than half of pregnant women recently admitted to UK hospitals with a COVID-19 infection were from BAME groups[2]. This is in addition to recent reviews from Public Health England (PHE) which found that BAME groups are more likely to test positive for COVID-19 and that those dying from the virus were more likely to be from BAME backgrounds[3].

The RCM has campaigned for and highlighted the need for urgent action to better support these women. The publication of an action plan by NHS England to provide additional support for BAME pregnant women is a welcome step in this direction. The plan focuses on four actions that the Chief Midwifery Officer (CMO) has asked maternity services to take to minimise the additional risk of COVID-19 for BAME women and families:

  1. Adopting a lower threshold to review, admit and consider multidisciplinary escalation in women from a BAME background
  2. Reaching out and reassuring pregnant BAME women with tailored communications
  3. Ensuring hospitals discuss vitamin supplements and nutrition in pregnancy with all women
  4. Ensuring maternity information systems record the ethnicity of every woman, as well as other risk factors, to identify those most at risk of poor outcomes.

The RCM supports these steps and has called for swift implementation of this plan. We have also called for clear guidance and support to be given to providers of NHS services, so that risks can be assessed sensitively, confidentially and in partnership with staff – and, most importantly, acted upon.

In addition, we have launched our own campaign aimed at pregnant women from BAME backgrounds to ensure that they are not missing important antenatal appointments or scans[4]. It is vital that we reassure these women that maternity services are open, and midwives are there to support them. We have developed new guidance for midwives and MSWs to ensure that they are aware of the increased risks for BAME women and can pass on relevant advice and support to the women in their care[5]. We will continue to review the latest evidence and update our guidance for BAME women, working in partnership with the Royal College of Obstetricians and Gynaecologists (RCOG), the CMO and other key partners.

The experience of BAME midwives and maternity support workers (MSWs)

Ensuring BAME staff are treated fairly and their talents valued and developed is a challenge that all NHS organisations need to meet. Ethnicity remains the most common cause of discrimination in the NHS, with nearly half of all NHS staff who had experienced discrimination citing their ethnic background as the reason why[6]. It is unacceptable that BAME midwives and MSWs are more likely to experience bullying at work, more likely to face disciplinary processes and are less likely to advance in their careers than their white British counterparts.

Protecting NHS colleagues during the COVID-19 crisis is not just about ensuring sufficient PPE is available. It is also about acknowledging the risks to health and wellbeing caused by discrimination and tackling the root causes of this discrimination. Of the healthcare workers who have died from COVID-19, we know that over 60% are from BAME backgrounds. It is imperative therefore that everything is done to ensure that BAME workers, who will be understandably anxious, are encouraged to seek out risk assessments without fear.

As more evidence emerges as to how COVID-19 is having a disproportionate impact on BAME workers, it has become imperative that trade unions and professional bodies provide more information, guidance and tools to support our BAME members. Accordingly, the RCM has produced wraparound guidance that will help members understand and apply existing legislation to the issues arising in the current crisis[7].

The RCM supports and encourages implementation of the Workforce Race Equality Standard (WRES), which has been developed as a tool to measure improvements in the workforce with respect to BAME staff. The WRES can help RCM representatives protect our BAME members in the workplace and ensure that they are not discriminated against. This is not only about doing right by our members, but it is a crucial element in delivering safe, high quality maternity care to women and their families. It is an NHS initiative that has been conceived by the NHS Equality and Diversity Council, through collaboration with NHS staff and independent researchers.

Race matters to the RCM

The RCM is determined to be a positive force for our members and the women they care for, but we know that we have not always got it right. As part of a sustainable Race Matters strategy[8], we have formulated the following five-point plan as a first step to ensuring inclusivity and diversity: