This week Five X More launched their second report into the findings of the Black Maternity Experience survey of Black women accessing NHS maternity services between July 2021 and March 2025.

This report followed on from their landmark report in 2022 and the MBRRACE - UK (Mothers and Babies; Reducing Risk though Audits and Confidential Enquires) reports which documents inequalities in maternal death rates between Black women and White women in the UK.

The most recent MBRRACE report found that Black women were 2.9 times more likely to die during pregnancy or postnatal ward compared to White women. On first glance reading this made me think things are getting better, however this change is not statistically significant as the rate of deaths in White women has increased, meaning that the gap may appear to have narrowed on paper, but the reality is far more complex.

Since the Five X More first report in 2022 the conversation around Black maternal health and maternal health inequalities generally has become more mainstream. There has been many a bold statement about change and need for institutional reviews. Most notably the Health and Care Select Committee has held sessions on Black Maternal Health.

As someone who has acted for many Black women with maternity claims, I had hoped that the experiences I hear about are not as common as I feared, and that progress is being made. Sadly, that is not the case and despite the political attention and the campaigning, this report shows that the lived reality for Black women accessing maternity care has not fundamentally changed since 2022.

Although the report found that with the increased awareness, Black women were now entering maternity care more prepared having researched their rights and ready to advocate for themselves, something which they considered to be necessary and not a choice.

Despite the awareness and the women being more prepared the report found that Black women were still being ignored, that discrimination remained widespread. Poor communication and limited empathy persisted, and basic rights were not being communicated.

Key findings at a glance

• 60% of respondents rated their antenatal care as good or high quality, yet 54% encountered challenges when interacting with healthcare professionals.

• 28% reported experiencing discrimination; of these, 25% attributed it specifically to race.

• During labour and birth, 45% raised concerns, and nearly half (49%) felt these were not properly addressed. - 23% did not receive requested pain relief and 40% of those received no explanation for the refusal.

• Only 39% were offered advice on nutrition and 27% on exercise at their booking appointment.

• Just 20% were informed how to make a complaint, and a mere 8% pursued a formal process.

The data reveals stark contrasts between intended standards of care and Black women’s experiences. While the majority received technically “acceptable” care, qualitative responses echo stories of ignored concerns, racially charged remarks, and a lack of cultural understanding. One respondent described repeatedly asking for a growth scan only to have her worries dismissed; another recounted being labelled “high risk” without clear justification. These patterns point to both individual bias and institutional blind spots.

Qualitative themes include:

• Attitudes: Use of dismissive language and microaggressions that erode trust.

Black women described begging to be believed. One common theme that echoed throughout the report was at nearly every stage of the maternity journey Black women were not being listened to.

“My baby had an undiagnosed broken collar bone which I raised concerns about the lack of arm movement on day 1. I was told I was a new mum and reading into things --- I was told I was wasting NHS services … 3 months later an x-ray at the paediatric department showed a broken collar bone which based on the healing would have been from birth – Mixed Ethnicity – Black British Caribbean and White, aged 26-35”

• Knowledge gaps: Limited clinician awareness of how conditions present in Black bodies.

“The health visitor told me my baby was a sickle cell carrier but did not know what that meant. This was the first time I had been told this but fortunately I know what it means … But if I didn’t know the details it could be very distressing. They should have training on this. Also, a nurse giving my baby his immunisations did not what it [sickle cell trait] was either and originally refused to give one vaccination in case it was affected by it – Mixed Ethnicity – Black British African and White aged 36-45”

• Assumptions: Prejudiced beliefs about pain tolerance, socioeconomic status, and family structures.

“I had a c-section done without enough anaesthetic. As much as a I tried to voice that I could feel the cold spray, I was ignored. During the incision, I screamed due to pain, but I was told it’s not pain that I’m feeling but pressure. I screamed throughout the whole 8-10 minutes while the obstetrician took the baby out. I was only put under GA after the baby was taken out. My experience was not positive at all but horrific and traumatising” – Black British African, aged 26-35”

“health visitor said in Africa they let their women die, so it was lucky I had the care I did in the UK” – Black British Caribbean, aged 26-35

“immediately after birth a nurse said to me “aren’t you glad you got that monkey out of you” I was so so shocked. I didn’t know if she meant it as a joke or if she was just blatantly racist. I sent myself home early I couldn’t sit there knowing she may come back” – Black British African, aged 18-25”

Recommendations:

1. Increase the awareness of and engagement with an improved Patient Advice and Liaison Service. By developing a centralised NHS PALS website. Ensuring there is clear, accessible information about rights and complaints process.

2. Strength clinical knowledge, resources and training on conditions that disproportionately affect Black women. This can be done by mandatory cultural-competency training that addresses racial bias and clinical recognition in diverse populations.

3. Install pain relief explanation posters in all NHS maternity settings. The report found out that 1 in 5 women did not receive their requested pain relief and 40% were not given an explanation highlighting serious gaps in communication, consent and trust.

4. Install maternity rights posters in all NHS maternity settings.

5. Develop a national digital health toolkit for women.

6. Advance existing digital maternity record systems.

A need for change

Despite multiple policy initiatives and renewed focus on maternal health inequalities, Black women in the UK remain disproportionately at risk of severe pregnancy complications and maternal mortality.

At a time when the Government has launched a National Review of Maternity care I would hope that the recommendations from the report would be considered as part of that review.

Sadly, from my own experience of representing Black women in clinical negligence claims they often recount the same feelings of being dismissed and their concerns not being taken seriously enough. They are often left with the uncomfortable suspicion that discrimination contributed to the harm they and their babies have experienced.

Reading this report was very difficult. Although Black Women are more informed and advocating for themselves discriminatory experiences continue to prevail. The fact that three years on from the first report we continue to see negative experiences shows that these are systemic features of UK maternity care. It is clear that regular audits of maternity services by ethnicity to track progress and enforce accountability is necessary.