Proposed guidance that recommends inducing labour at 39 weeks in pregnant women from black, Asian and minority ethnic backgrounds has raised concerns from doctors and midwives and been branded “racist” by activists.
White women with uncomplicated pregnancies should be offered an induction of labour at 41 weeks, according to the draft guidelines from the National Institute for Health and Care Excellence (Nice). The institute’s clinical guidelines such as this apply in England, Wales and Northern Ireland but do not cover Scotland.
But the guidelines advise healthcare professionals to consider induction of labour from 39 weeks in women with otherwise uncomplicated pregnancies who are at increased risk, including those aged 35 and over, those with a high BMI, and those “with a black, Asian or minority ethnic family background”.
Black women are four times as likely as white women to die in pregnancy or childbirth. Women from Asian ethnic backgrounds have a twofold higher risk.
Doctors and birth campaigners say offering a blanket induction to those from ethnic minority backgrounds is not the answer to complex factors that result in poorer maternity outcomes.
Christine Ekechi, co-chair of the Royal College of Obstetricians and Gynaecologists’ race equality taskforce, told the BMJ that “stratifying risk by race alone is a blunt tool”.
“Although highlighting higher risk is important, it does not move our understanding further as to why this group of women is at greater risk,” she said. “Women should always be able to make informed decisions about their own care, based on real evidence.”
Amy Gibbs, chief executive of Birthrights, said: “Singling out particular groups for different treatment without evidence that it improves outcomes is racist and discriminatory. This episode is a stain on Nice’s reputation and we hope that it will review its processes to ensure that this cannot happen again in future.”
Mars Lord, a doula and birth activist, said lots of pregnant BAME women were ‘fearful about their birth because they are not seeing any choices’. Photograph: Steve Kraitt/Handout
In a separate statement, the pregnancy and childbirth rights charity said: “The proposed guideline takes no account of the fact that many women and birthing people already feel pressured or even coerced into having an induction.”
Aisha Sharif, a Birmingham GP, suggested the guidance sounded like “a very poor cover-up of the institutional racial discrimination this group has been subjected to for decades”.
More than 25,000 people have signed a petition urging the government to reject the guidance. Mars Lord, a doula and birth activist who started the campaign #notsonice with her colleague Leah Lewin, said the recommendations were already affecting people’s mental health.
She said: “I’ve been contacted by dozens of black and brown pregnant women and birthing people who are fearful about their birth because they are not seeing any choices.
“They are never ‘offered’ anything – instead they are told what to accept and they are frightened to be put on ‘watch lists’ and reported to social services if they don’t comply.”
Lord, founder of Abuela Doulas, said the guidance was a poorly thought-out kneejerk response, adding: “We are taking a group of people that we have decided are at risk because of their outcomes and we are adding additional risk – because there is no qualification for how to explain the risks that are inherent with induction.”
“When you say we will offer a blanket induction to anyone who is not white then that is inherently racist as there is no medical reason to do so,” she said.
Each year in the UK a fifth of labours are induced – meaning labour is started artificially using drugs via a pessary or hormone drip.
The Royal College of Midwives warned against “blanket-approach recommendations” in favour of personalised care. It said: “Black, Asian, mixed and ethnic minority women face a constellation of biases when accessing maternity services, often experiencing poorer quality of care and lower satisfaction.
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“Introducing an intervention that is singling out women on ethnicity alone, when there are likely to be large differences in health status and values within the group, could itself be considered discriminatory.”
Nice said the draft guideline was subject to change based on feedback received during a consultation period, which closed on 6 July.
A spokesperson said: “The draft recommends healthcare professionals consider offering induced labour to this group of women from 39 weeks. However, healthcare professionals must discuss the risks and benefits of induced labour with the woman and take her preferences into account. They should respect and support her decision if she chooses not to have labour induced.
“It’s clear there are still significant health inequalities in maternity outcomes which need to be addressed, and we hope the final recommendations will go some way towards doing that.”
This article was amended on 13 July 2021 to use a more appropriate main image.
