Tackling racism in maternal health

Inequalities in maternal health outcomes for ethnic minority and Indigenous populations across the globe are driven by cultural, structural, and interpersonal racism. Strategies to mitigate this racial injustice require government commitment, structural policy changes, and community led solutions. Biomedically driven interventions alone will not fix this, and novel systemic approaches are required to tackle the social determinants.

Maternity care provides a unique setting for understanding the links between social determinants and health inequity through its focus on the experiences at a critical transitional period of life. We focus here on high income countries, where our experiences mostly lie and where data tend to be more widely available. In this context, there is a clear and alarming pattern of people from racialised groups (that is, those who are disadvantaged based on their skin colour or indigeneity through the normalisation and legitimisation of an array of dynamics that favour white people1) experiencing worse maternal outcomes.2

Inequities in maternal mortality show how disparities in social determinants are shaped by racism and colonial legacies and give rise to inequalities in social conditions and health risk factors that cost women´s lives. Maternal mortality is a barometer of more widespread inequalities experienced by racialised and Indigenous populations, including adverse birth outcomes, morbidity, access to care, and experience of the services.34 Data driven technologies are increasingly used to identify inequalities in access, experience, and allocation of resources, but current health datasets lack consistency and completeness of ethnicity recording.5 In most high income countries the gulf of inequity is not decreasing, and it has been exacerbated by the covid-19 pandemic.67