“We need to be heard. We need to be seen”: A thematic analysis of black maternal experiences of birthing and postnatal care in England within the context of Covid-19

Abstract

ObjectiveInequalities for Black women within maternity settings are longstanding, with evidence showing higher mortality, complications and distress compared to White women. The Covid-19 pandemic saw unprecedented changes to maternity services, with emerging evidence highlighting a disproportionate impact on mothers from ethnically minoritized backgrounds. This uniquely positioned study explores Black women's experiences of services during Covid-19. DesignThe study used a qualitative design with semi-structured interviews, data were analysed using reflexive thematic analysis. SettingThe study took was open to all in the UK, participants who took part were from England and were recruited via social media and community led organisations. ParticipantsThe study recruited 13 self-identifying Black women, aged between 23 and 41 who received maternity care across settings (NHS wards, home birth and birthing centre) across England. Measurement and findingsThree themes were generated from the study: ‘The Ripples of Covid’, ‘Inequality within Inequality’ and ‘Conscientious Change for Maternity Systems’, with sub-themes including the impact of regulations, the invisibility of pain and the importance of accountability. Alongside multiple layers of inequality and emotional labour for Black women, the study found connection and advocacy as facilitators of good care. Key conclusionsSupporting existing research, Black women's experiences of maternity services during Covid-19evidence ongoing of structural racism within maternity provision, founded on stereotypes of strength and pain. Though moments of advocacy and connection, however, Covid-19 appeared exacerbated ongoing existing inequalities for Black women. Changes to service provision contributed to isolation, distress, and consequential inadequate care. Implications for practiceThe findings, generated by Black women, established important implications for practice and policy, including an emphasis on creating conscientious change of systems through a racialised lens, the importance of meaningful equity, representation, and the need for co-production alongside Black communities.