Women from minority backgrounds in UK less likely to receive epidurals, research finds

Women from Black and Asian backgrounds are less likely than their white counterparts to receive an epidural while giving birth, research has revealed.

The findings, based on data collected from more than 2.7 million births in the UK, prompted experts to raise the alarm about an “ethnicity pain gap” that means people of colour are more likely to be deprived of adequate pain relief within medical settings.

It comes as Guardian analysis exposes evidence of racial inequalities in pain relief offered to people across all areas of healthcare – from children in A&E to palliative care offered to cancer patients.

Four medical royal colleges – the professional bodies for UK medical professions – called for better data collection on how patients from minority ethnic backgrounds are more likely to have their pain dismissed by health providers.

The analysis on pain relief provided to women giving birth, published in the journal Anaesthesia, examined data collected over a 10-year period up until 2021.

It found that women from a Bangladeshi, Pakistani and Black Caribbean background were less likely than white women to receive an epidural while having a vaginal birth. They were 24%, 15% and 8% less likely respectively.

It follows a report this week by the Labour peer and former diplomat Valerie Amos into maternity care in the UK, which detailed widespread failings, including women being ignored and poor triage of mothers-to-be. Her 181-page report found these were partly the result of deeper, more systemic issues such as institutional racism.

The research follows a string of reports in other countries, including the US and Australia, detailing examples of racism in the treatment and handling of patients.

Bell Ribeiro-Addy, the Labour MP and chair of the all-party parliamentary group on black maternal health, said the new findings left “little room for doubt that racialised assumptions are a key driver of unequal outcomes”.

“The disparities around pain relief identified in this report are shocking and indefensible, but sadly not surprising, given the way Black people’s pain has historically been doubted, downplayed and dismissed,” she said. She added that the findings were “inseparable from the wider context of racism and racial tropes such as the ‘strong Black woman’”.

Dr Nuala Lucas, the president of the Obstetric Anaesthetists’ Association and the study’s co-author, said: “We know that women with ill health during pregnancy, or those who give birth prematurely, may particularly benefit from effective epidural pain relief. It is especially troubling if these are among the women least likely to receive it.”

The analysis also found that Black Caribbean-British women in the UK were 58% more likely than white women to be given general anaesthesia instead of regional anaesthesia during elective caesarean births. Black African-British women were 35% more likely to have general anaesthesia than white women.

Most caesarean births are done while the mother is awake and under regional (spinal or epidural) anaesthesia, as this is considered safer and leads to quicker recovery. General anaesthesia is mostly used in emergency situations in which there is not time to administer a spinal or epidural anaesthesia.

The study adds to a growing body of research pointing to inequalities in maternity care. Studies have reported that Black women are often stereotyped as having “thick skin” and being able to tolerate pain by maternity staff, while Asian mothers were described as “princesses” who were “overly demanding” and unable to cope with pain.

Analysis from the University of Oxford, also shared with the Guardian, found glaring disparities in how Black and Asian women are helped to manage pain during labour.

Many women from Black and Asian backgrounds who took part in the research felt that they had been dismissed or ignored by healthcare professionals when questioning their pain relief options, and many had also been fearful to speak up. These women “often felt they were not involved in decisions around their pain relief” by healthcare professionals, according to the study.

The study concluded that many factors influenced the experiences of women from minority ethnic backgrounds during labour, including an “atmosphere of systemic distrust between ethnic minority women and their healthcare practitioners”.

“Maternity inequalities are well documented, but we urgently need to understand what lies behind the figures,” said Dr Lisa Hinton, the lead author of the study. “Ethnic disparities in maternity care, including experiences of pain relief, are shaped as much by communication and trust as by access to treatment – women need dialogue, not just options.”

Fiona Gibb, the director of midwifery at the Royal College of Midwives, said that “any suggestion that women’s pain is not taken seriously, or that access to appropriate pain relief differs by ethnicity, is completely unacceptable”.

“More consistent data collection is essential,” she said. “Without robust data on pain relief, interventions and outcomes broken down by ethnicity, it is harder to identify where inequalities exist and to hold systems to account for addressing them.”

Dr Christine Ekechi, a specialist in gynaecology from the Royal College of Obstetricians and Gynaecologists, said that the body had “seen the data that black and brown women are less likely to receive an epidural at the point at which they ask for it”.

“We should not be seeing these disparities by way of race. So what is important is for us to improve our understanding as to why that is happening and then to also close that gap.”

Ribeiro-Addy said eliminating inequalities in maternal care “means looking at everything from culture to resourcing and staffing”.

“Report after report has outlined how Black women experience discrimination, racism and unequal care in maternity settings,” she said. “We must embed a stronger anti-racist culture in our healthcare institutions. We must also ensure that the staffing and funding levels are there to provide every woman with the high standard of care she deserves.”