Back in 2023 the RCM worked with a wide range of stakeholders to develop and launch its Decolonising midwifery education toolkit which aims to empower midwifery educators to challenge the legacies of colonial perspectives in all aspects of midwifery education. The toolkit is an important first step in ensuring that future midwives can practise with cultural competence and in August this year we asked Lead Midwives for Education (LMEs) how they have used the toolkit. The good news is that 89% of those who responded said that changes have been made to their programmes as a result of the document and 82% had discussed it with practice partners. We also heard that practical change in clinical practice was still required and this echoed feedback from the wider RCM membership.
The evidence showing inequalities experienced by Black and Asian women is widely known. This year’s MBRRACE-UK report showed that compared to white women, Black women are still three times more likely to die, and Asian women are almost twice as likely to die, during pregnancy or up to six weeks after giving birth. Evidence shows that the lack of literature, education and training on the assessment of women and birthing people with varying skin tones exacerbates those health disparities. The NHS Race Health Observatory reviewed neonatal assessment and practice in newborns and found that existing guidance is unsuitable for Black, Asian or minority ethnic babies. Lack of trust, active listening and understanding of cultural variation has been identified as contributing to disparities in health outcomes in addition to the inadequate provision of independent interpreting services.
The evidence is already there. What is needed now is action so that our work focuses on the practical changes required in clinical practice to deliver culturally competent care. Some of these changes should come from governments, others from NHS organisations – and there are actions midwives and MSWs can take as well.
We want governments to urgently establish a target and strategy for eliminating disparities in maternal health. Ring-fenced investment for NHS interpreting and translating services with this reflected in workforce planning to support additional time for appointments is also vital. NHS organisations need to work across local and regional health systems to identify and spread good practice, update or implement electronic record keeping systems to ensure they enable accurate documentation of varying skin tones and aren’t based on a white normative standard.
Staff should receive protected time for training on anti-racist practice with training materials that represent varying skin tones and educate on differences in techniques for clinical assessment that are not based on a white normative standard. Midwives and MSWs should undertake relevant training, understand how to record and report assessments which rely on skin tone as the normative assessment and contribute to the collection of accurate ethnicity data when updating health records for women, birthing people and their infants. These are just a few examples of the recommendations in our recently-published position statement.
Over the coming weeks and months, we are looking to share some of the good practice that I know is going on across the UK, so if you want to get in touch please do contact me on alice.sorby@rcm.org.uk. We will also be building on some of the recommendations to keep up the pressure for the real change that is required and that has to be a priority for us at the RCM, NHS organisations and governments. We need to do more to reduce the shocking inequalities in maternity care – our decolonising practice position statement is a starting point in the call to action.
