Why doctors want Canada to collect better data on Black maternal health
U.K. and U.S. data shows Black women have worse health outcomes than other groups. Canada's data is limited
A growing body of data about the heightened risks faced by Black women in the U.K. and U.S. during pregnancy has highlighted the failings of Canada's colour-blind approach to health care, according to Black health professionals and patients.
Black women in the U.K. and U.S. are four times more likely to die in pregnancy or childbirth than white women, according to official data. A recent U.K. study published in The Lancet found that Black women's risk of miscarriage is 40 per cent higher than white women's. In Canada, that level of demographic tracking isn't available.
"For our country, we don't have that data. So it's difficult to know exactly what we're dealing with," said Dr. Modupe Tunde-Byass, a Toronto obstetrician-gynecologist, and president of Black Physicians of Canada. "We can only extrapolate from other countries."
Black babies more likely to be premature in Canada
Tunde-Byass said one of the only race-based studies examining pregnancies in Canada, conducted by researchers from McGill University in 2016, showed 8.9 per cent of Black women gave birth to pre-term (premature) babies, compared to 5.9 per cent of their white peers.
Across demographic groups, the overall rates of pre-term birth in Canada are lower than those in the U.S., where 12.7 per cent of Black women and eight per cent of white women delivered prematurely. But the disparity between the two populations is about the same, challenging the assumption that Canada's universal health-care system would result in similar outcomes for all women.
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"We kind of live in this bubble whereby we don't think there is disparity within our health-care system, more so [because] our health-care system is free for everyone and is universal," said Tunde-Byass, adding that knowledge gaps have contributed to "unconscious bias within the health-care system."
For example, she said that Black women tend to have shorter pregnancies and are at higher risk of pre-term births. This means health professionals should be attuned to their pain symptoms because they could be an indication of labour.
Myths about Black women and pain
However, Toronto-based midwife Shani Robertson said the opposite often happens. "There's a myth, really, that Black women experience less pain than white women."
She said that means when a Black women encounters pain, there can be a misconception that she should be able to tolerate it. "This can result in Black women being offered less pain medication, being not even offered pain medication at all, sometimes, depending what they're experiencing, not being believed about their experience," Robertson said.
Health Canada documented the phenomenon in a 2001 report, Certain Circumstances Issues in Equity and Responsiveness in Access to Health Care in Canada, which found criticism from Black communities about "health professionals disregarding feelings of pain by Black women when performing routine procedures during the birthing process," which were attributed "to beliefs by health professionals that black skin is 'tough.'"
Robertson attributed the misconception to the racist legacy of the U.S. physician considered the father of modern gynecology, Dr. J. Marion Sims, who experimented on Black slaves without anesthesia in the 1800s.
Robertson said collecting data on race and ethnicity, alongside other details when registering births as the U.S. and U.K. already do, could help address health inequities.
A growing awareness about the importance of race-based data during the COVID-19 pandemic has prompted the Canadian Institute for Health Information to propose national research standards on race and ethnicity to "understand patient diversity and to measure inequalities."
Scientists also recently called on the Canadian Institutes of Health Research, the country's leading health research funding agency, to establish an Institute of Racism and Health as it has the Institute of Gender and Health and the Institute of Indigenous Peoples' Health.
Invisible, neglected and disrespected
Toronto resident Kimitra Ashman said she felt she was ready to give birth earlier than 40 weeks of gestation, a timeframe more common in white women. But she said she was dismissed, even though Black women often have shorter gestation periods.
She later ended up being induced.
"I do not believe it would have ended in an emergency caesarean had they listened to me when I said at 37 weeks, 'my body feels right. My pelvis is opening. What do I do?' I was directed, 'oh no, no, no, no, it's too early. Go put your feet up.'"
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The emergency caesarean surgery left her with a keloid, a type of raised scar more common on Black and dark skin, which can sometimes be avoided with the right surgical technique.
"I believe if their training had sensitized them to the unique needs of a Black woman's pregnancy, I feel the situation would have been avoided," she said.
Instead, she said she faced two years of not having sensation and a "raised scar that's very painful."
Ashman said these weren't her only experiences with bias in the healthcare system.
"It started when I came to check in and I had a nurse at the front desk roll her eyes at me. It's built into when you go to appointments and people assume you don't have insurance. Assume you're not educated. Assume you're a single mother.
"I felt invisible, neglected and disrespected."
Dismantling racism in Canadian healthcare
Ashman sought the care of a Black doctor for her second pregnancy. "I felt comfortable," she said. "I felt understood."
Tunde-Byass said Black women experience health care differently than other Canadians. "So these are things that we need to acknowledge that exist within the fabric of our system ... and then find a way to dismantle racism."
Part of the problem, she said, is that there aren't enough Black doctors relative to the population.
A U.S. study of birth records in Florida showed high rates of mortality among Black babies — but the rates were lower if patients had a Black doctor.
Margaret Akuamoah-Boateng didn't encounter any complications when she gave birth to her second child earlier this year in the small community of Alliston, Ont.
But she admitted to still feeling anxious about being treated by exclusively white hospital staff. "And I was just like, 'I'm looking for someone who has Black experience only because I feel comfortable if the doctor is Black or their staff is Black or they've ever operated on Black people.'"
That's when her doctor brought a Black physician in with him. "He didn't have to be there, but it was great . . . it's like having a relative there," Akuamoah-Boateng said.
For more stories about the experiences of Black Canadians — from anti-Black racism to success stories within the Black community — check out Being Black in Canada, a CBC project Black Canadians can be proud of. You can read more stories here.
With files from Melanie Glanz