Evidence suggests that patients from minority ethnic groups face barriers to care within women’s health, and have poorer outcomes overall. We believe the health care sector needs to take more action to address this.

Research shows that:

• Black women are 3.7 times more likely to die giving birth or in the 6 weeks after birth than white women.
• Asian women are 1.8 times more likely to die giving birth or in the 6 weeks after birth than white women.
• Women of mixed ethnic backgrounds are 1.3 times more likely to die giving birth or in the 6 weeks after birth than white women.

Despite being committed to holistic care, midwives have reported barriers for women from minority ethnic groups within maternity services. Obstacles for women included not being listened to or believed by health care professionals and a lack of cultural understanding. 

There is also evidence of systemic racism in maternity care in the UK, and women may feel unsafe, dehumanised, not given adequate choices and disproportionately face structural barriers to their care. The Women’s Health Strategy aims to address these health inequalities and tackle issues with service provision and overall health outcomes for women.

Reports indicate that women from these groups have a lower uptake of health screening. The number of women who do not attend for cervical screening in the UK is much higher.

Barriers to attending screening include:

• socio-demographic characteristics
• health service delivery
• cultural, religious & language
• the gap in knowledge and awareness
• and emotional, and family support.

The option to see a female health care professional for sexual and reproductive health (PDF) is not always available, which can also increase barriers to care.

Research has found that black women’s symptoms are often not taken seriously, despite chronic pelvic pain and abnormal menstrual bleeding being highly prevalent in this population. Black women are also more likely to have endometriosis which remains undiagnosed and are 2 to 3 times more likely to have fibroids than white women.

The Faculty of Sexual and Reproductive Healthcare (FSRH) says that women from minority ethnic groups have poorer access to contraception care and there should be more focus to ensure they receive a higher standard of care.

The COVID-19 pandemic has disproportionately affected those from minority ethnic groups, who experienced higher infection and mortality rates than white counterparts, in large parts due to deprivation, living arrangements and existing health conditions. The pandemic highlighted the need to reduce health inequalities and improve the management of ill health across this group. 

The menopause transition has a significant impact on a women’s life, with recent reports illustrating profound differences in the experiences reported by black and ethnic minority women. Although women's culture, race, and ethnicity largely shape the way menopause is perceived and understood, there is limited research in the UK to truly understand the differences. 

Download the ‘Menopause in Ethnic Minority Women’ guidance from the British Menopause Society (PDF).

The study Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women’s Health Across the Nation (SWAN) found that black women  reach menopause two years earlier than the median age and spend longer periods in the perimenopause phase.

Despite what is already known, ethnic minority women continue to face further barriers when accessing menopause care. Growing evidence suggests that although women are attending services, they are more likely to be given alternative treatments and less likely to be offered hormone replacement therapy (HRT).

Menopause and women from minority ethnic groups - barriers to accessing menopause care include:

• menopause continues to be a taboo topic and a lot of social stigma exists surrounding it
• lack of culturally appropriate services
• fear and mistrust of public services
• menopause viewed as the loss of fertility and femininity
• lack of education and knowledge
• lack of translatable terminology resulting in potential language barriers
• lack of adequate representation in the media and patient information leaflets
• the taboo nature and social stigma around it.

Nurses can make a difference by practicing anti-racism and embracing equity, inclusion, and diversity. Additionally, nurses can:

• listen to women with a view to understanding their needs, not just waiting to respond
• include women in decision-making throughout their care journey
• create an inclusive workplace culture and commit to a diverse recruitment approach
• prioritise cultural competency training
• ensure care plans are holistic and culturally aware.

Despite being entitled to the same protection as other ethnic minority groups in Britain under the Equality Act 2010, Gypsy, Traveller, and Roma groups continue to face harassment and discrimination. 

These groups, for reasons including poorer outcomes in health care and education, are among the most disadvantaged people in the UK. Other reasons include:

• lack of continuity of care and poor inclusion
• language barriers and low levels of literacy
• fear and mistrust of public services
• lack of awareness of cultural taboos within services.

According to statistics, life expectancy for Gypsy, Roma and Traveller groups is 10 years lower than the national average. Mothers are 20 times more likely to experience the death of a child than the general population. 

Recommendations for improvement include:

• mandatory Gypsy, Traveller and Roma inclusive services training for all health and social care services
• when discussing information, it is better to use verbal communication instead of issuing leaflets
• engage with Gypsies, Travellers and Roma people directly to ensure we hear their voices
• adaption of services to meet specific social and cultural norms of these ethnic minority groups.

For more information download the Tackling Maternal Health Inequalities in Gypsy, Roma and Traveller Communities PDF (Friends, Families & Travellers, 2023).

• Begum, A. (2023): The Importance Of Diversity, Inclusion, And Equality in Nursing, Nurses.co.uk.
• Harlow et al (2022): Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women’s Health Across the Nation (SWAN), Women's Midlife Health.
• Queen's Institute of Community Nursing. Homeless and Inclusion Health Network.