The AHSN’s evaluation of the pilot (PDF), conducted with Unity Insight, found Black Maternity Matters improved cultural competency among midwives and maternity support workers. The evaluation also demonstrated the value of the education and training programme through participants’ feedback and their resulting actions.
Black women are four times more likely to die during pregnancy or in the postnatal period than white women. Stillbirth rates of Black and Black British babies are more than twice those for white babies.
The reasons for the disparity are often described as a ‘constellation of biases’. Unconscious bias, stereotyping and lack of diversity competency have the potential to result in health services that disadvantage women from non-white ethnic backgrounds.
The Black Maternity Matters pilot was developed by the West of England AHSN in partnership with Representation Matters and BCohCo. It was designed to deliver meaningful, actionable improvements to reduce inequity of outcomes for Black women within maternity systems through a collaborative quality improvement (QI) approach.
A key component of the eight-month pilot was cultural competency and diversity fluency education for midwives and maternity support workers from North Bristol NHS Trust and University Hospitals Bristol and Weston NHS Foundation Trust. The training aimed to examine unconscious biases and the role of the individual in perpetuating unsafe systems of care for Black women.
The NIHR ARC West evidence synthesis found limited research in this area, half of which was carried out in the US. Their analysis indicates improved knowledge of cultural awareness in staff who received the interventions, most of whom were midwives.
Findings from the synthesis emphasise similarities with evaluation insight, such as the effective use of QI approaches to influence healthcare providers and staff to address racial health inequalities. It also emphasised that it can be hard to know if training alone will sustain or contribute to reduced perinatal racial and ethnic disparities.
Dr Loubaba Mamluk, Senior Research Associate at NIHR ARC West and the University of Bristol and one of the authors of the evidence synthesis, said:
“Outcomes for Black women and babies during pregnancy and birth are significantly worse than for their white counterparts. Perinatal mortality is around four times higher in Black women than white women.
“Cultural competency training is one possible solution to this shocking chasm between outcomes. We found only six studies which looked at such training in this context.
“Our results indicate that this kind of training is acceptable to midwives and maternity staff. We also found it improved knowledge of cultural awareness among staff. We don’t know, however, if these learnings are sustained or contribute to reduced perinatal racial and ethnic disparities.”