Maternal, perinatal and child health: Safer beginnings for Black mothers and children

Black women disproportionately face challenges and disparities that affect their maternal health. Maternal mortality rates remain high in Africa, in the UK, in the USA and across the rest of the Black diaspora. In the UK, the latest national enquiry, MBRRACE-UK (2022 to 2024), found that Black women were 2.7 times more likely than white women to die during pregnancy or up to six weeks after giving birth. And these poor outcomes are driven not only by individual health but by societal and healthcare system factors.

One fact makes this especially clear. In the USA, even when you account for socioeconomic status and education, Black women still have higher rates of maternal death and serious illness than white women at the same income or education level. Black women with a university degree have a pregnancy-related death rate more than five times that of white women with a degree. Money and education alone do not protect us. In this piece I want to look at why, and then turn to the health of Black infants and children.

The challenges Black mothers face

Lack of access to prenatal care. This can be caused by financial problems, transport difficulties, or the distance to the nearest clinic or medical centre. The type of job someone does matters too: not every woman can take time off work, or afford the lost earnings and what that would mean for her family's financial security. In the United States, insurance and immigration status add further barriers.

Historical medical mistrust. The healthcare system exists within a wider society that has systemic racism, so it is affected by racism too, and that understandably leads to mistrust among Black patients. This has been deepened by a history of studies, tests and even treatments carried out on Black people, including Black women, without their consent. The Tuskegee syphilis study is one example among many.

Racism, racial bias, discrimination and implicit bias. These can lead to dismissive care from healthcare providers, delays in treatment, and a lower quality of care.

Socioeconomic issues. These feed into everything above. Financial pressure makes it harder for women to focus on their own health, and it reduces access to prenatal care, healthy food, exercise and rest.

A lack of culturally competent care. Care needs to be culturally humble as well as accessible if we are going to improve outcomes and support the behaviours that keep mothers and babies safe.

Why babies are dying: infant mortality

Infant mortality means a baby dying within the first year of life. The causes differ by setting.

In sub-Saharan Africa, some of the main causes are:

• Prematurity and the low birth weight that often goes with it
• Birth asphyxia, when a baby does not get enough oxygen around the time of birth
• Sepsis and other infections
• Complications in the mother, such as placental abruption or uterine rupture

Within the Black diaspora in the Western world, we see higher rates of low birth weight, congenital malformations, sudden infant death syndrome and accidental injuries, alongside higher rates of complications in mothers. Black infants are more vulnerable overall, partly because of lower birth weights, and Black mothers are less likely to receive prenatal care, or more likely to receive it late. Racism and racial bias also contribute to higher infant mortality among Black children compared with white children. In the UK, Black babies are more than twice as likely to be stillborn as white babies.

Childhood vaccine hesitancy: listening before persuading

I want to talk honestly about childhood vaccine hesitancy in the Black community. It is rooted in both historical and contemporary racism, marginalisation and neglect. Events such as the eugenics movement and the Tuskegee syphilis study deepened a medical mistrust that continues today.

That mistrust is multifaceted. There is mistrust of the healthcare system as it exists within society, mistrust of healthcare providers to give equitable care, mistrust of government to give safe and truthful information, and mistrust of the vaccine itself, whether it will be safe and effective for a child.

At the same time, childhood vaccines are one of the great public health successes worldwide. Many diseases, and the illness and deaths they caused, have been dramatically reduced because people are widely vaccinated. So while there are very justified reasons for hesitancy, education and promotion of vaccines are essential to stop health disparities getting worse.

The gap is real. In the US, children living below the poverty line have lower coverage for every routine childhood vaccine, and Black infants are still less likely than white infants to be fully vaccinated. In England, children from several minority ethnic groups, including Black Caribbean children, are less likely to be fully vaccinated than White British children. Closing that gap means:

• Identifying the barriers and addressing each one
• Partnering with trusted community voices to produce culturally appropriate materials
• Explaining and educating in a way that acknowledges people's real fears, which are rooted in things that truly happened
• Running community outreach programmes
• Offering vaccines in convenient locations to remove transport barriers

The childhood conditions that affect us more

Several childhood illnesses disproportionately affect Black children. Exposure to pollution is a key factor in asthma and allergies. There are higher rates of learning disabilities, which we must consider in the context of the education system, the quality of education children receive depending on where they live, and racism within education itself. And there are higher rates of obesity and type 2 diabetes, which are closely linked.

These disparities come from a complex interaction between genetics, the environment children live in, family history, the socioeconomic factors that shape every part of a child's life, and cultural factors.

Asthma: where a child lives matters

The main risk factors are family history and exposure to allergens. But environment plays a huge part.

Families on lower incomes are more likely to live near sources of pollution: close to industrial plants, near major roads with heavy traffic, or in older, high-rise buildings that may not be up to standard. In flats and apartments, families often have less control over the temperature and less ability to deal with pests, mould and dust. All of this means children from lower-income backgrounds are disproportionately exposed to toxins, which triggers a constant cycle of asthma and asthma attacks.

If your child has a cough, shortness of breath, or cannot keep up with their friends when exercising, please get them assessed promptly by a paediatrician or GP. Once asthma is diagnosed, effective management includes:

• Removing triggers
• Taking medication regularly
• Keeping up with regular check-ups

Well-controlled asthma changes a child's whole life. It means less time in hospital and fewer emergency visits, less time off work for parents and less strain on the family's finances, and less time out of school, so children do not fall behind their peers.

Lead poisoning, obesity and type 2 diabetes

In some countries, including the US, lead poisoning disproportionately affects children from lower-income families, because it often comes from old lead paint or lead pipes in older housing. It can affect neurodevelopment, with lasting effects on education and development as a child grows.

Obesity also disproportionately affects Black children. Food insecurity, food deserts, a lack of access to medical care and healthy food, lower incomes (healthier food tends to cost more) and cultural factors all contribute. Type 2 diabetes, which is closely linked to obesity, is rising in Black children too, and it can be related to obesity, genetics and lifestyle.

Understanding is the first step

The disproportionate impact on Black women, Black infants and Black children has now been well documented for many years. The first step in addressing any problem is to understand what is really going on, and that is what I hope this piece helps you do.

Every child deserves a healthy start, and every mother deserves to come home safely. If you have questions about anything here, please reach out to us.