Disparities in Induction of Labour

The discussion surrounding the induction of labour and the NICE (National Institute for Health and Care Excellence) guidelines in the UK has stirred considerable debate, particularly focusing on the implications of systemic racism, bias, and the perpetuation of inequitable disparities in maternal healthcare.

The #NotSoNice campaign that I had led in 2021 spotlighted these concerns, highlighting

a critical view that the draft guidelines not only failed to address the nuanced needs of marginalised groups but also seemed to infringe upon the human rights of those it sought to serve.

This think piece explores the intersectionality of healthcare guidelines, systemic bias, and the real-world impacts on marginalised communities, with a focus on black women and birthing peoples’ experiences in the maternity care system.

The NICE guidelines on the induction of labour are intended to offer evidence-based recommendations to healthcare professionals on the best practices for inducing labour in pregnant women. However, the contention arises from the perception that these guidelines, particularly in their initial draft form, overlooked the nuanced and individualised care needs of marginalised groups, especially black women. This oversight is reflective of a broader issue within the healthcare system: the failure to recognise and address systemic racism and bias, which perpetuates inequities and disparities in maternal health outcomes.

The #NotSoNice campaign highlighted the fear that these guidelines could be interpreted in a way that allows for a silencing, controlling, and obstructive approach to maternity care, particularly affecting those who are already vulnerable and marginalised. The concern is not only about the content of the guidelines themselves but also about the potential for their misinterpretation by healthcare professionals who may not be aware of their own biases.

Such misinterpretations can and has been known to lead to a blanket approach in the care provided to black women, disregarding the individual’s rights, preferences, and specific healthcare needs.

Evidence shows that black women are more likely to experience adverse outcomes in maternity care. Research published in the British Medical Journal (BMJ), MBRRACE report and The Lancet review have consistently highlighted the disparities in maternal mortality rates, with black women inthe UK significantly more likely to die in pregnancy or childbirth compared to their white counterparts. These disparities are not merely statistical but indicate the severity of deeper systemic issues rooted in racism and bias within the healthcare system.

The potential for guidelines to be applied in a one-size-fits-all manner, without consideration for the cultural, social, and individual contexts of each patient, raises significant concerns.

Such an approach not only undermines the principle of informed consent but also the autonomy of women and birthing people in making decisions about their bodies and their care. It is crucial that healthcare professionals are trained to recognise and counteract their biases, ensuring that guidelines are applied in a manner that is truly person-centred and tailored to the needs of each individual.

So, while the intention behind the NICE guidelines on the induction of labour is to improve outcomes for all women, the initial response and the concerns raised by the #NotSoNice campaign highlighted a

critical need for these guidelines to be reviewed and applied with a deep knowledge and sensitivity to the systemic issues at play. There are many conversations among those with lived experience yet it is paramount we are heard and offered a seat at the table of these discussions. It underscores the importance of incorporating the voices and experiences of marginalised groups in the development and implementation of healthcare policies, programmes and practices.

Addressing these concerns requires a focused effort towards systemic change, including education on implicit bias, promoting diversity within the healthcare workforce, addressing the already inflicted trauma through generations and ensuring that guidelines are both evidence-based and equity-driven.

Only through these recommended measures can we hope to dismantle the biases and disparities that currently exist within the healthcare system, moving towards a more inclusive and equitable model of care.