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Mama, we need to battle racial bias in healthcare

Updated: Aug 26, 2021


One week away from giving birth to my firstborn son, I sat in the office of one of the best-regarded

paediatricians in town.

A friend had recommended that I meet the doctor before my child's birth, and as a first-time-mum eager to do the right thing, I went in to discuss his care.

One of the first questions was whether I planned to breastfeed.

When I said yes, the paediatrician replied: "Well, it shouldn’t be very difficult for you."

I blinked, waiting for clarification.

"Black women have tougher nipples, you know. Breastfeeding isn’t as painful for them. So you’ll be fine."

A few months later, I looked down at my baby and tried to put together the pieces of the postpartum whirlwind that I had just been through.

After my son was born with a severe tongue-tie and a tight-jaw (two concepts that had been totally alien to me up until this point), I came down with a terrible case of mastitis. By the time I saw a doctor, it was too late.

A breast abscess had developed and I needed to see a specialist surgeon who could drain it.

After two rounds of antibiotics, I emerged from this experience exhausted, shell-shocked and with a few questions for myself: ‘Should I have seen a doctor sooner?

Had I convinced myself that the pain I was experiencing was normal and that as a woman of colour I should be able to withstand it?’

It seemed ridiculous but the paediatrician’s words had made an impact.

Implicit bias in the medical field, it turns out, is pervasive and ongoing and can affect pain management care.

Many studies in recent years have found that medical students and professionals believe that people of colour have a higher pain threshold.

The reality is that until I looked into racism and implicit bias, and the way this affects medical care for women of colour in many countries, I never would have thought that breastfeeding rates would be low amongst Black women.

My father is from Mauritania in West Africa, caught between the Atlantic Ocean and the Sahara desert. When he was born, Mauritania was still under French colonial rule and wasn’t yet an independent nation. My grandmother was only sixteen when she gave birth to my dad, and the story goes that he was born too soon and her milk had not come in yet.

The women of the village came together and nursed her tiny baby until both he and his mum were stronger.

I grew up listening to that story and in my time in Mauritania, and the other countries in Africa that have been lucky enough to live in and visit, breastfeeding seemed to be the norm. Breasts are not as sexualised as they have been in the West and breastfeeding in public is perfectly normal.

In many ways, African mums are the original attachment parents - they breastfeed, co-sleep, and carry their babies with them everywhere.

And so I know that the breastfeeding challenges that are faced by Black and mixed-race mothers in the U.K. and the US are generally not linked to a physical inability to breastfeed. But when you add structural racism within medical institutions to the breakdown of communities and support networks and the general hustle of modern life...

It’s no surprise really that breastfeeding rates are even lower for women of colour.

Sadly, breastfeeding is only one of the many poor maternal health outcomes that ethnic minorities face: in the US, Black women are three to four times more likely to experience a pregnancy-related death than white women. In the U.K. the chance of death is 1 in 2,500 for black women according to the UK Confidential Enquiry into Maternal Deaths - a figure five times higher when compared to white women over the same time period of 2014 to 2016.

One of the reasons for the above - beyond medical reasons and poor social and economic outcomes - is that women of colour may not be taken seriously when they are in pain. And if these women are completely depleted after difficult labours and not supported in the hours after, this of course has a negative impact on breastfeeding and - in turn - on the health outcomes of newborn babies.

In the U.K. babies born to Black or Black British parents had a 67 per cent increased risk of neonatal death compared to babies of white ethnicity in 2017. Babies born to Asian or Asian British parents had a 72 per cent increased risk of neonatal death compared to babies of white ethnicity.

Neonatal mortality rates in babies whose mothers are of white ethnicity have decreased between 2015-2017, whereas the death rates for babies born to mothers of Asian, Asian British and Black British ethnicity have increased.

These statistics are quite overwhelming, but they reinforce the value and importance of a support system in pregnancy, post-birth and in the first few months as breastfeeding is being established. After my first (and only!) mastitis episode, a lovely lactation consultant told me over the phone that it shouldn’t be this difficult.

The breast infection, tongue tie, nipple shields. ‘I shouldn’t be saying this but it’s okay if you decide to stop, Zahra. It shouldn’t be this hard’, she whispered down the phone. Strangely, it was exactly what I needed to hear.

I knew I could stop if I wanted to.

But in the end I breastfed my first son for twenty months, my middle child until just after his second birthday. And I am now four months in with my third.

It’s so important in the early days to feel supported and loved, and during a pandemic in particular without our families able to visit for many of us.

We all need to find our community.

Black Breastfeeding Week runs from August 25 to August 31 and focuses on the unique and additional challenges faced by women of colour in maternal, post natal, and neonatal healthcare.

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