Black women in the UK are nearly three-times more likely to die during pregnancy and the year after birth, compared to white women. Not only are these statistics shocking, but they are also growing at a startling 20% higher rate than findings in 2010. Despite years of research, public scrutiny and political commitments to tackle racial inequalities in maternal healthcare the question is no longer whether these disparities exist, but why they continue to persist? The answer lies not in a lack of awareness, but rather pallid policy inconsistencies have failed to translate policy commitments into meaningful changes to the care black women receive during and after pregnancy. Institutional racism and racial biases within the healthcare systems will continue to silence, dismiss and kill, until institutional reform, accountability and valuable interventions are implemented on the ground. Rendering black maternal mortality as a stark manifestation of the perpetuated silencing and dismissal of black communities in Britain there is a need to expose such gaps within legislation, acknowledge racial disparities, and the continued racialised and institutional mistreatment of black women’s healthcare provisions during and after pregnancy, which ultimately underpins a troubling pattern of words without action.
The persistence of healthcare inequalities amongst black women questions the effectiveness of previous policy commitments and the extent to which they have translated into meaningful change in reducing black maternal mortality rates. It seems that recognition of disparities alone has not been enough to dismantle the institutional practices and racial biases that shape and limit black women’s experience of care during and after pregnancy. However, marking a significant ‘turning point’, for black women in the UK, according to Labour MP for Birmingham Erdington, Paulette Hamilton, the House of Commons Health and Social Care Committee’s (2025) inquiry into black maternal health documented several accounts of black women whose maternal health concerns were dismissed within the NHS. Some of these testimonies included, a midwife blaming a slow labour on an “African Pelvis” instead of checking for medical complications, and another black mother who was told that as a “big and strong” Black woman, she could “handle the pain,” even as she was losing a concerning amount of blood.
Other testimonies included withholding of pain relief during labour, despite requests and pleads for help. These testimonies, collectively underscore the gap in healthcare where almost 50% of black women that raise pregnancy healthcare concerns with medical professionals during labour felt their concerns were not adequately addressed. Collectively, these testimonies should not be interpreted as individual mishaps, but rather as cases of institutionalised racism, racial stereotyping, inadequate medical support and a failure of accountability within the NHS. These accounts are undoubtedly bound to racialised assumptions of black women possessing a higher pain tolerance than white women. Notably these accounts illustrate how racialised myths of black people’s strength, historically used to justify enslavement, have become ‘medicalised’ through the routine dismissal of black mothers' pain within the NHS.
Institutional failure remains an understatement; the silencing of women to their deaths does not start or end in the delivery room. Rather the institutional dismissal of Black women’s pain can have fatal consequences long before childbirth begins. Previous research has illustrated the severity of poor maternity care, with statistics exposing that women who died during pregnancy or after childbirth were nearly sixteen times more likely to have received inadequate antenatal care than women who survived. Notably, black women remain almost four times more likely than white women to experience inadequate antenatal care. Such statistics are embedded within institutional barriers to care, explicitly in the form of racial microaggressions and the failure to consider black women’s pain and health. Surveys conducted by ‘Five X More’, underscore an eroded sense of trust amongst black women of healthcare services due to previous and continuing dismissal, ultimately discouraging these mothers from seeking early maternity services.
The systematic silencing of black women extends in this regard beyond individual dismissal but encompasses a patient-safety issue with potentially life-threatening consequences. Neither does the extent of this institutional failure end in the delivery room. MBRRACE-UK’s latest report further identities that alongside black women’s disproportionate rates of maternal mortality, suicide remains the leading cause of maternal death between six weeks and twelve months after birth. These findings emphasise the stakes when women’s pain, postnatal depression and medical distress go unrecognized by doctors and medical professionals.
Following the House of Commons Health and Social Care Committee’s (2025) inquiry into black maternal health, the Government has formally responded with the ‘Perinatal Equity and Anti-Discrimination Programme’, intended to tackle racist and discriminatory practice across NHS maternity services in England. All NHS trusts are expected to complete the training programme by the end of 2027, with the goal of ensuring that neither patient nor staff experience racial discrimination within maternity wards. In addition, developing a new ‘Maternity and Neonatal Equity and Equality Dashboard’ to identify specific disparities in maternity outcomes across NHS services to inform targeted interventions ‘and more equitable support’.
“This set of metrics will be used to monitor performance in maternity and neonatal services in all parts of the system” with trusts having insight to their own progress and balanced score of “operational, outcome and patient experience measures”. These commitments sit alongside the wider ‘10 Year Health Plan for England’, introduced under Starmer’s Labour Government. Starmer’s health and social care reform similarly proposed a ‘Maternity Outcomes Signal System (MOSS)’ using existing data to identify failing maternity services. These plans ultimately propose greater transparency and accountability of medical care across NHS England.
These commitments matter, however, acknowledging failing institutions is not uniform to directly challenging discrimination. Training programmes and dashboards, regardless of their intent to tackle racist and discriminatory practice, cannot, by themselves, guarantee that all NHS practitioners will cease to ignore, belittle or dismiss black women’s pain. To what extent will these reforms ensure accountability? What consequences will NHS staff face for failing to complete training, or uphold non-discriminatory standards of care?
Indeed, institutionalised racism cannot be measured through clinical outcomes alone, or by rating an experience on a scale of 1-10. Instead, transcends these metrics through the everyday interactions, and institutional conditions that make accessing and trusting healthcare services difficult for black women, who remain vulnerable to racial microaggressions and discriminatory treatment. While the NHS’ ‘Thee-Year Delivery Plan to Improve Maternity and Neonatal Services’emphasises listening and working with women and their families to ensure effective healthcare provisions, will the proposed dashboard be able to capture these less quantifiable experiences and subtle interactions; from dismissive body language, racial undertones, and minimised concerns that ultimately erode black women’s trust in maternity services and their sense of safety?
Whether these reforms are sufficiently enforceable and measurable to deliver the systematic change the 2025 government inquiry acknowledged as imperative remains to be seen. It is imperative for black women and mother’s lived experiences to inform the design, delivery and evaluation of maternity services, as well as its reforms. Crucially, the government ought to establish measurable targets and introduce meaningful consequences where services and staff repeatedly fail to improve services or attend updated training programmes.
When silence continues to cost lives, acknowledgement is not enough. Closing the black maternal mortality rates in the UK demands a healthcare system that actively challenges this gap in everyday healthcare practice to delivery rooms, and post-natal care. Until black women are heard, respected and treated with equal concern as white women, the question remains; how many more lives will be lost before Britain acts?