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Racism in UK Sexual and Reproductive Healthcare Settings Rania KhanResearch Question How is the issue of racism within sexual and reproductive healthcare settings understood by governmental bodies and BAME staff working in these settings? • Healthcare settings – patients AND staffBackground • Black women are quadruple as likely to die during childbirth compared to non- BAME women, while Asian women are twice as likely (Selvarajah et al, 2022; Roxby, 2023) • Black women are also 40% more likely to suffer a miscarriage (BBC, 2022) • BAME individuals are often stereotyped negatively by workers in SRH i.e. South Asian families are said by staff to smell of curry and black people are considered hypersexual (McEvoy, 2022; Sowemimo, 2023) • Distrust towards maternity services, feeling that they are catered to non-BAME women (John et al, 2021)Background • Disparities within SRH • Historical precedent • Problem is not being completely ignoredMethods • Government (UK and Scotland) and NHS documents • Key informant interviews • Thematic analysis of documents and interviews separately • Reproductive justice lens Year Name of Paper Author Published 1 UK 2021 Commission on Race and Ethnic Government. Disparities: The Report 2 Black people, racism and human rights HoC HoL Joint 2020 Committee on Government Human Rights 3 NHS 2021 Documents Equity and equality: Guidance for local maternity systems 4 A Framework for Sexual Health DH and Cross 2013 • Non-probability sampling Government • purposive Improvement in England 5 Department of 2021 • Mention sexual health and Our Vision for the Women’s Health Strategy racism Health and for England Social Care • Published between 2013 and March 2023 6 BETTER BIRTHS Improving outcomes of NHS England 2016 • Published by government maternity services in England committee or NHS 7 The NHS Long Term Plan NHS England 2019 • Set out goals 8 Women’s Health Plan: A plan for 2021-2024 Scottish 2021 Government No. Job Title 1 Consultant in Assisted Reproduction Technologies Interview 2 Consultant in Sexual Health and HIV Participants 3 Consultant in Obstetrics and • Personal networks Gynaecology • Purposive sampling 4 NHS Interpreter • Link to SRH field 5 Community Gynaecologist • Healthcare backgroundThemes Division of Themes Themes identified in Documents Construction of Health outcomes Intersectionality Data Collection Problem Addressment of Acknowledgement Tailoring Care Problem Division of Themes Themes identified in Interviews Construction of Normalisation of Intersectionality Reporting System Problem Racism Addressment of Social Support Tailoring Care ProblemDocument Results • Health Outcomes: Maternal mortality is discussed more than any other health outcome or disparity that BAME face within SRH. • Intersectionality: “Potential cultural barriers may deter women from accessing help for menstrual problems – so this highlights the importance of understanding how sex, gender and culture and religion can intersect.” (D.8) • Data Collection: “The idea that all ethnic minority people suffer a common fate and a shared disadvantage is an anachronism” (D.1) • Acknowledgment: “Cannot accept the accusatory tone of much of the current rhetoric on race, and the pessimism about what has been and what more can be achieved” (D.1). • Tailoring Care: “Taking the extra time to gauge understanding of the language being used at an appointment or to understand cultural differences and the additional support that might be needed” (D.6)Themes in Interviews • Normalisation of Racism: • “’You know a lot about that. Were you in the prison in Pakistan?’” (P.1) • She [receptionist] just looked at me… and she said ‘Oh… do people from your background… not… get menopause’” (P.4) • “You often find you have to prove yourself to patients…You can see when you're walking up to them that they're just a bit more cautious and they wanna see how you speak, how you articulate yourself, how you approach them…You know, as a Black woman, I feel that I've experienced many times when I'm I can see when somebody's trying to suss me out” (P.2) • “When you go for a job interviews you know somebody is… definitely getting a job…there's a white person is definitely more likely to get the job” (P.3)Themes in Interviews • Intersectionality • I thought that because I'm not in competition with them [non-BAME colleagues] so it's [racism] not affecting me as long as you know, like if they have a threat that that person is going to compete in the job or something. (P.5) • “I'm in a leadership position… so already you've got privilege of the spaces that you occupy and the opportunities to speak back” (P.2) • “It used to be so simple in our times and all, you just bin all the [CVs of the] foreign graduates and you bin all the brown people, and you'll bin the women”. (P.1)Themes in Interviews • Reporting System • “What was the outcome of the disciplinary action? They're still working… So how do I know anything had been done?” (P.1) • “its impact in their future employment” (P.3) • viewed as a “troublemaker” (P.5) by other staff and management.Themes in Interviews • Social Support Type of Support x/5 Example Source 1 She [the director] saw one cleaner and he was wearing some cap with… P.5 Superior something written on it. And she said that “You can't represent certain management companies” or something “So don't wear it”. And he said that “Ohh, I've seen somebody with hijab. And if she's allowed hijab why I'm not allowed?” She said that “It's not [that] she's representing any company or anything. …This is a is a part of her dress code.” You know, like she protected me... So I feel that I had a good support, you know. Colleagues 5 I have discussed it [racist incident] with… other interpreters and you P.4 know we have we do exchange. You know our… experiences… but… I haven't really you know officially reported to anyone but… the other interpreters you talk to act as sort of a support system for when anybody goes through something like this. 3 I haven't been in a position where I feel that I have been wholeheartedly External Support limited or they’ve [racist incidents] you know, really affecting my self P.2 esteem… there are some things that have happened to me and luckily because of the support system, because of those who meant to me and sponsor me and I may have described it with friends and family, definitely and colleagues, but I haven't ever and reported it.Themes in Interviews • Tailoring Care • Although you're part of NHS… the way you know, like the staff would deal with you… obviously there is an element of the racism, because we are, you know, we are there to provide the service.” (P.4) • the “race-based scenarios” that they were taught when training tended to be “extreme” such as a “Jamaican lady that's smoking cannabis with her boyfriend” (P.2). • maternity safeguarding questions being overly emphasised to patients of certain ethnicities because they think it is “very common in your culture” (P.4).Discussion • Microaggressions • Intersectionality • Tailored CareConclusion • Some similarities in how they viewed the problems • Still many differences • Further research must be done References British Library (2011). Rowena Arshad discusses contraception and controlling poor women's bodies. British Library. URL: https://www.bl.uk/collection-items/rowena-arshad-contraception- andcontrolling-poor-womens-bodies [Accessed 18 April 2023] Brondolo, E. et al (2009). Coping with racism: A selective review of the literature and a theoretical and methodological critique. Journal of behavioral medicine, 32, pp.64-88. Brown, H.L., Small, M.J., Clare, C.A. and Hill, W.C. (2021). Black women health inequity: The origin of perinatal health disparity. Journal of the National Medical Association, 113(1), pp.105-113. Glover, L. (2021). Social Reproduction Theory: On regulating reproduction, understanding oppression and as a lens on forced sterilisation. Journal of International Women's Studies, 22(2), pp.34- 48. Hamed, S., Bradby, H., Ahlberg, B.M. and Thapar-Björkert, S. (2022). Racismin healthcare: a scoping review. BMC Public Health, 22(1) Ojanuga, D. (1993). The medical ethics of the 'father of gynaecology', Dr J Marion Sims. Journal of medical ethics, 19(1), pp.28-31. NHS Grampian (2022). Racism: Do not Suffer in Silence! A guide for Staff. URL: https://www.nhsgrampian.org/about-us/equality-and-diversity/racism-do-not-suffer-in-silence-aguide-for-staff/ [Accessed 19 Apr. 2023]. Parliament Petition (2020). Petition: Improve Maternal Mortality Rates and Health Care for Black Women in the U.K. URL: https://petition.parliament.uk/petitions/301079 [Accessed 19 April 2023]. Roberts, D. (2015). Reproductive justice, not just rights. Dissent, 62(4), pp.79-82. Ross, L. and Solinger, R. (2017). Reproductive justice: An introduction (Vol. 1). Univ of California Press. Scully, J. A. M. (2015) “Black Women and the Development of International Reproductive Health Norms,” in Levitt, J. I. (ed.) Black Women and International Law: Deliberate Interactions, Movements and Actions. Cambridge: Cambridge University Press, pp.225–249. St. Julien, J. and Hallgren, E. (2021). The Gaps of White Feminismand the Women of Color who Fall Through. New America. URL: https://www.newamerica.org/the-thread/the-gaps- ofwhitefeminism-and-the-women-of-color-who-fall-through/ [Accessed 17 February 2023].