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A podcast: The Power of Privilege and AllyshipS4: Break the bias series – SPECIAL BONUS EPISODE – A pregnancy mindset expert feat. Dr. Ruth Oshikanlu MBE

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A podcast: The Power of Privilege and AllyshipS4: Break the bias series – SPECIAL BONUS EPISODE – A pregnancy mindset expert feat. Dr. Ruth Oshikanlu MBE

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We are all looking to make a difference but all too often, we do not realise the impact we have made.

Brought to you by The Austen Bronte Consultancy, 'The Power of Privilege and Allyship' podcast showcases the positive impact of using privilege to maximise allyship and transform lives.

In this episode, Dr. Funke Abimbola MBE (CEO and Founder of The Austen Bronte Consultancy) interviews Dr. Ruth Oshikanlu MBE (A Pregnancy Mindset Expert, Author, Speaker, Mentor and Coach) .

Please subscribe, rate and share with your friends, family, colleagues and network!

- More about The Austen Bronte Consultancy at:

https://funkeabimbola.com/austen-bronte-consultancy

Email us at: [email protected]

- More about Goal Mind at:
http://www.goalmind.co.uk/about.html

- More about Nurses and Midwives Talk at:
https://nursesandmidwivestalk.com/
Follow us on Twitter:

- The podcast: @AllyshipPodcast

- Funke: @Champ1Diversity

- Ruth: @RuthOshikanlu

Connect on Instagram:

- The Austen Bronte Consultancy: @theaustenbronteconsultancy

- Ruth: @ruthoshikanlu

Connect with us on LinkedIn:

- Dr. Funke Abimbola MBE - https://www.linkedin.com/in/funkeabimbola/

- Dr. Ruth Oshikanlu MBE - https://www.linkedin.com/in/dr-ruth-oshikanlu-mbe-frcn-frsa-frsph-duniv-06b9121b/

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S4: Break the bias series - SPECIAL BONUS EPISODE - A pregnancy mindset expert feat. Dr. Ruth Oshikanlu MBE - The Power of Privilege and Allyship

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We are all looking to make a difference but all too often, we do not realise the impact we have made. Brought to you by The Austen Bronte Consultancy, 'The Power of Privilege and Allyship' podcast showcases the positive impact of using privilege...

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For women who have escaped violence or traffickers, and are pregnant or with a young child, and seeking international protection in the UK

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For women who have escaped violence or traffickers, and are pregnant or with a young child, and seeking international protection in the UK

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A community of support for women who have fled from violence or traffickers, and are pregnant or with a young child and are seeking international protection in the UK.

HBC is committed to being a charity led and managed by women who have lived experience of migration into the UK.

(Image above used with the kind consent of Sarah Stirk www.sarahstirkphotography.co.uk)

"Every day in the week I stay in my home, just Mondays I leave the home and I go to the Happy Baby Community and meet friends and I have a good feeling"

"The best feeling that I have is on a Monday, I wake up with a good feeling and I have a happy face. It's the only place I feel I'm home."

"I am a young mum, 20 years old and I have a daughter, she is two months old, when she grows up and when she goes to school I would like to start a job, I would like to be a teacher. I like teaching others, even kids, who I love so much, this group helps me make plans for our future."

"I am feeling excited every Monday, I think today my baby will be happy when she meet other babies, because she smile when other babies speak with her."

Support our community

Happy Baby Community thrives because we have your support. We have five bases, in Thornton Heath, Dalston, Stratford, Acton and Redhill. The community is supported by over 160 volunteers who use their skills and energy to help make the Community flourish. We need your donations to cover our basic costs providing food, postage and travel refunds. We have an incredible team of volunteers, who use their skills and energy to help and support this community. If you'd like to know more, please get in touch below.

(Image above used with the kind consent of Sarah Stirk www.sarahstirkphotography.co.uk)

Volunteer opportunities

We're always looking for volunteers to join our communities in North and South London. If you're interested, we'd love to hear from you!

Make a Donation

Our community relies on the kindness of others. Donate here and you can make a real, practical difference to the lives of our mums and babies

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A community of support for women who have fled from violence or traffickers, and are pregnant or with a young child and are seeking international protection in the UK. HBC is committed to being a charity led and managed by women who have lived experience of migration into the UK.

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Emergency Care Access: [NHS Urgent and Emergency Care Services]

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Emergency Care Access: [NHS Urgent and Emergency Care Services]

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Services the NHS provides if you need urgent or emergency medical help

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Inclusive Leadership: WHITTINGTON HEALTH NHS TRUST: SEE ME FIRST

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Inclusive Leadership: WHITTINGTON HEALTH NHS TRUST: SEE ME FIRST

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In 2018, Whittington Health NHS Trust began a six-month independent workplace review conducted by Professor Duncan Lewis, Professor Emeritus at Plymouth University. In an organisation where 46% of the staff are from a Black, Asian or ethnic minority background, the review, found evidence of discrimination behind bullying and harassment, as well as discriminatory practices. The review identified a number of recommendations which included the need for the trust to place equality, diversity and inclusion at the heart of their values as an organisation.

In 2020, a series of events took place both here and abroad which put questions around race, diversity and inclusion firmly on the policy agenda. Early in 2020, the COVID-19 pandemic hit the UK. A pandemic that laid bare the sheer scale of healthcare inequalities in the UK, and the impact these inequalities have on Black, Asian and minority ethnic communities. The unlawful killing of George Floyd in May 2020 and the subsequent Black Lives Matter movement protests throughout the summer of 2020 added further impetus to Whittington Health's determination to expand their work in this area.

Three individuals from Whittington Health- Paul Attwal, head of performance, Delia Mills, executive assistant to the chief operating officer and chair of the Black, Asian and minority ethnic staff network and Beverleigh Senior, director of operations for acute patient access, women's health and clinical support services - decided to create an initiative that could drive real change in the organisation's culture, and the visibility of race equality issues throughout their workplace.

'Nothing changes if nothing changes'

On 29 October 2020 at the closing event of a very successful month celebrating Black History, Whittington Health launched the See ME First trust initiative. The initiative takes the form of a six-colour badge, which although not an exact science, aims to represents the differing levels of melanin in skin tones. The badge reflects the famous ideology at the heart of the Dr Martin Luther King's I have a dream speech: "that people should not be judged by the colour of their skin but by the content of their character" (August 1963).

See ME First is not simply a badge though. Any member of staff who wishes to wear the badge is encouraged to make a personalised pledge (and have a photo taken) to uphold the values that the badge symbolises. These pledges prove that everyone who wears the badge is part of an "open, non-judgemental and inclusive NHS organisation" and has an understanding of what wearing the badge means. Pledges vary from one porter's commitment to "respect all people regardless of race" to a school nurse's vow to "facilitate a better understanding of the need for equal rights".

Moreover, these pledges also confer a form of accountability. As Beverleigh explains, "When I see someone wearing the badge, I want them to be visibly exhibiting the values it represents". Paul explains those who wear the badge are, "no longer bystanders but upstanders". It sends a message that badge wearers can talk about the issues that affect Black, Asian and minority ethnic individuals and communities, and will call out behaviour that does not reach the standards of Whittington Health's inclusive community. All of the organisation's executive team have made their See ME First pledge, and wear their badges, demonstrating commitment from the senior leaders of the organisation.

'We all have a part to play, equality affects everyone'

See ME First has already had a huge impact on Whittington Health's culture. Despite launching the initiative during the COVID-19 pandemic, Delia states it has given their staff "a voice" and started "two-way conversations" about race and equality throughout their workforce. Beverleigh adds "This badge demonstrates that I belong to an organisation whose values, value me".

Over 1200 people have now made their pledge and wear their badge. For Whittington Health, however, the journey for this initiative has only just begun. They wish to continue to emphasise that the badge is for everyone, not just the 46% of their staff within the organisation who come from a Black, Asian and minority ethnic background. "There's strength in numbers," Delia explains, "1000 plus voices will continue to grow and need to be listened to in order to make positive changes in the trust".

The badge has been endorsed by numerous notable individuals. Adam Jogee, Mayor of Haringey and Janet Burgess, former Mayor of Islington have both made their pledges and wear their badges. Former health and social care secretary, Matt Hancock, was seen wearing the See ME First badge in the House of Commons. Yvonne Coghill, former Workforce Race Equality Standard (WRES) national lead, has been instrumental in promoting the initiative and has also made her pledge.

The badge now has a dedicated twitter page, which regularly highlights the individual pledges made by members of their workplace. As an integrated clinical organisation, it is important that all staff have easy access to support this initiative and so pledges can now be made by web form via the trust intranet,

'Cultural change for the country, cultural change for the NHS'

The goal for the initiative is not solely to grow within their own organisation but to rollout within the wider NHS and beyond. The story of an ambulance driver who noticed the badges worn by staff when he was on duty and arrived at the Whittington Health's A&E department was so taken with the initiative that he asked to make a pledge, saying "Seeing staff at the Whittington and all NHS hospitals I visit being bastions of equality by wearing the badge I wish to further this especially amongst my Black, Asian and minority ethnic colleagues". This shows the grassroots support that has so far accompanied the initiative.

The initiative is reinforced by a toolkit created to support other organisations who may wish to join the campaign. Indeed, North Central London clinical commissioning group launched their own See ME First campaign on 8 July 2021, Maidstone and Tunbridge Wells NHS Trust and Kent and Medway NHS and Social Care Partnership Trust are due to launch in August 2021. Other NHS organisations have also expressed an interest in joining the campaign too.

The team are in numerous conversations to extend the initiative and one day hope to extend the Whittington Health NHS Trust initiative throughout the wider NHS family.

For more information and to get involved

Twitter: @seemefirstbadge
Email: whh-tr.seemefirst.whitthealth@nhs.net

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In 2018, Whittington Health NHS Trust began a six-month independent workplace review conducted by Professor Duncan Lewis, Professor Emeritus at Plymouth University. In an organisation where 46% of the staff are from a Black, Asian or ethnic minority background, the review, found evidence of discrimination behind bullying and harassment, as well as discriminatory practices.

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NHS Registration Guide:[How to Register with a GP]

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NHS Registration Guide:[How to Register with a GP]

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Anyone in England can register with a GP surgery to access NHS services. It's free to register.

You do not need proof of address or immigration status, ID or an NHS number.

GP surgeries are usually the first contact if you have a health problem. They can treat many conditions and give health advice. They can also refer you to other NHS services.

How it works

Most people need to register with a surgery close to where they live.

You can use the Find a GP service to look for a surgery.

In the search results you can see:

if a GP surgery is currently accepting patients

reception opening times

reviews of the surgery

Once you've chosen a surgery, you'll need to fill in a registration form. These are usually available on:

the NHS App

the GP surgery's website

the GP surgery's profile page on the NHS website (Find a GP)

You can also get a paper form from the surgery.

It's also possible to register with a GP surgery outside your local area.

Do I need ID or proof of address?

No, you do not need ID, an NHS number or proof of address to register.

Some GP surgeries ask for supporting documentation as it can:

help the surgery find your medical records or transfer them from your current GP

confirm that you live in the surgery's area (or "practice boundary") if they do not accept patients from outside this area

If you do not have a permanent address you can still register using a temporary address or the address of the GP surgery.

Can a GP surgery refuse to register me?

A GP surgery can refuse to register you if:

they're not accepting new patients

you live outside their area and they only accept patients inside this area

you have been removed from that surgery before

If a GP surgery refuses to register you, they must write to you within 14 days explaining why.

If you have problems registering with a GP surgery, contact:

Registering children

Children under 16 need to be registered by their parent or guardian. This usually means filling in a separate form. You may also be asked to provide a form of ID to prove that you're their parent or guardian.

If you have a personal child health record (red book) from the birth of your child, it will help to provide this.

Changing GP surgeries

You can change your GP surgery if you need to.

This might be because:

you've moved

you've had problems with your current GP surgery

you were removed from the patient list

When you register with a new GP surgery, you'll usually get a message to tell you your registration has been successful.

Your medical records will be transferred from your old GP. This can take up to 28 days.

Changing your address

You should tell your GP surgery if you change your address.

If you do not tell your GP that you've moved there's a risk that:

NHS letters giving appointment dates or test results go to the wrong address

your GP surgery may not be able to provide home visits or other services if you move outside their area

If you register with a new GP, they will let your old GP know you've moved.

Registering as a temporary resident

You can register as a temporary resident with a GP surgery for up to 3 months. This can be helpful if you're living away from home but do not want to change your home GP surgery.

To register you'll need to fill out a temporary services form (GMS3), available from GP surgeries.

After 3 months, you'll have to reapply to register as a temporary resident or become a permanent patient.

You may also be able to register as a temporary resident if you are visiting from abroad.

If your application is refused, you can still receive any treatment you need immediately for up to 14 days.

Registering someone you care for under the Mental Capacity Act

If someone over 16 is unable to register with a GP because they cannot make decisions about their care, registration can be done by:

a relative

the main carer

a lasting power of attorney

a person appointed by a court under the Mental Capacity Act

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Find out how to register with a GP surgery in England.

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Website: NURSING NARRATIVES – RACISM & THE PANDEMIC

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Website: NURSING NARRATIVES – RACISM & THE PANDEMIC

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A traumatic read about the racist who invented the 'Sim's speculum'

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A traumatic read about the racist who invented the 'Sim's speculum'

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This is a difficult read with details about the horrendous experiments performed by Sim on enslaved Black women and children.

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Few medical doctors have been as lauded-and loathed-as James Marion Sims.

Credited as the "father of modern gynecology," Sims developed pioneering tools and surgical techniques related to women's reproductive health. In 1876, he was named president of the American Medical Association, and in 1880, he became president of the American Gynecological Society, an organization he helped found. The 19th-century physician has been lionized with a half-dozen statues around the country.

But because Sims' research was conducted on enslaved Black women without anesthesia, medical ethicists, historians and others say his use of enslaved Black bodies as medical test subjects falls into a long, ethically bereft history that includes the Tuskegee syphilis experiment and Henrietta Lacks. Critics say Sims cared more about the experiments than in providing therapeutic treatment, and that he caused untold suffering by operating under the racist notion that Black people did not feel pain.

Sims, who practiced medicine at a time when treating women was considered distasteful and rarely done, invented the vaginal speculum, a tool used for dilation and examination. He also pioneered a surgical technique to repair vesicovaginal fistula, a common 19th-century complication of childbirth in which a tear between the uterus and bladder caused constant pain and urine leakage.

His defenders say the Southern-born slaveholder was simply a man of his time for whom the end justified the means-and that enslaved women with fistulas were likely to have wanted the treatment badly enough that they would have agreed to take part in his experiments. But history hasn't recorded their voices, and consent from their owners, who had a strong financial interest in their recovery, was the only legal requirement of the time.
READ MORE: The Tuskegee Experiment: The Infamous Syphilis Study
Roots in the Market for Enslaved People

Born in Lancaster County, South Carolina in 1813, James Marion Sims entered the medical profession when doctors didn't undergo the same rigorous coursework and training they do today. After interning with a doctor, taking a three-month course and studying for a year at Jefferson Medical College, Sims began his practice in Lancaster. He later relocated to Montgomery, Alabama, seeking a fresh start after the death of his first two patients.

It was in Montgomery that Sims built his reputation among rich, white plantation owners by treating their enslaved workers. According to Vanessa Gamble, university professor of medical humanities at George Washington University, Sims's practice was deeply rooted in the trade for enslaved people. Sims built an eight-person hospital in the heart of the trading district in Montgomery. While most healthcare took place on the plantations, some stubborn cases were brought to physicians like Sims, who patched up enslaved workers so they could produce-and reproduce-for their masters again. Otherwise, they were useless to their owners.

"This brings up the concept of 'soundness.' " says Gamble. Being "sound" meant "they produce (for men and women) and reproduce (for women). For these women having this fistula made them less sound."

Like most doctors in the 19th century, Sims originally had little interest in treating female patients-and no specific gynecological training. Indeed, examining and treating female organs was widely considered offensive and unsavory. But his interest in treating women changed when he was asked to help a patient who had fallen off a horse and was suffering from pelvic and back pain.

To treat this woman's injury, Sims realized he needed to look directly into her vagina. He positioned her on all fours, leaning forward, and then used his fingers to help him see inside. This discovery helped him develop the precursor to the modern speculum: the bent handle of a pewter spoon.

From his examination, Sims could see that the patient had a vesicovaginal fistula. With no known cure for the ailment, Sims began experimenting in 1845 with surgical techniques to treat such fistulas. If the patients' owners provided clothing and paid taxes, Sims effectively took temporary ownership of the women until their treatment was completed. He later reflected in his autobiography The Story of My Life on the advantages he found to working on people that were essentially his property: "There was never a time that I could not, at any day, have had a subject for operation." According to Sims, this was the most "memorable time" of his life.
READ MORE: Henrietta Lacks: How Her Cells Became One of the Most Important Medical Tools in History
But Did His Enslaved Patients Consent?

Sims wrote that the women had "clamored" for the operations to relieve their discomfort-but whether they consented or not was never captured in any other historical record. As Bettina Judd, assistant professor of gender, women and sexuality studies at the University of Washington, points out, consent isn't always about "whether you can say yes; it's also whether you can say no."

Today, we know three of the names of the female fistula patients from Sims's owns records-Lucy, Anarcha, and Betsey. The first one he operated on was 18-year-old Lucy, who had given birth a few months prior and hadn't been able to control her bladder since. During the procedure, patients were completely naked and asked to perch on their knees and bend forward onto their elbows so their heads rested on their hands. Lucy endured an hour-long surgery, screaming and crying out in pain, as nearly a dozen other doctors watched. As Sims later wrote, "Lucy's agony was extreme." She became extremely ill due to his controversial use of a sponge to drain the urine away from the bladder, which led her to contract blood poisoning. "I thought she was going to die... It took Lucy two or three months to recover entirely from the effects of the operation," he wrote.

For a long time, Sims' fistula surgeries were not successful. After 30 operations on one woman, a 17-year-old enslaved woman named Anarcha who had had a very traumatic labor and delivery, he finally "perfected" his method-after four years of experimentation. Afterward, he began to practice on white women, using anesthesia, which was new to the medical field at the time.
READ MORE: 7 of the More Outrageous Medical Treatments in History
While some doctors didn't trust anesthesia, Sims' decision to not use it-or any other numbing technique-was based on his misguided belief that Black people didn't experience pain like white people did. It's a notion that persists today, according to a study conducted at the University of Virginia, and published in the April 4, 2016 Proceedings of the National Academy of Sciences.

Experimenting on Enslaved Children

Writer and medical ethicist Harriet Washington says Sims's racist beliefs affected more than his gynecological experiments. Before and after his gynecological experiments, he also tested surgical treatments on enslaved Black children in an effort to treat "trismus nascentium" (neonatal tetanus)-with little to no success. Sims also believed that African Americans were less intelligent than white people, and thought it was because their skulls grew too quickly around their brain. He would operate on African American children using a shoemaker's tool to pry their bones apart and loosen their skulls.

In the 1850s, Sims moved to New York and opened the first-ever Woman's Hospital, where he continued testing controversial medical treatments on his patients. When any of Sims's patients died, the blame, according to him, lay squarely with "the sloth and ignorance of their mothers and the Black midwives who attended them." He did not believe anything was wrong with his methods.
READ MORE: How an Enslaved Man in Boston Helped Save Generations from Smallpox
Sims' practices ignited controversy during his lifetime, says Washington. The medical community debated his methods, and some of his white colleagues even openly objected to his experiments, saying he took things too far.

Statues Have Prompted Protest

J. Marion Sims continues to loom large in the medical field, celebrated as a medical trailblazer. Statues were erected to him in, among other places, New York City's Central Park, the South Carolina statehouse and outside his old medical school, Jefferson University, in Philadelphia.

After several years of activism, the Philadelphia statue was moved into storage and the statue in Central Park was removed on April 17, 2018. Its plaque was to be replaced by one that educates the public on the origins of the monument and the controversial, non-consensual medical experiments Sims used on women of color. The names (and histories) of the three known women "whose bodies were used in the name of medical and scientific advancement" by Sims, Lucy, Anarcha and Betsey, were to be recognized on the new plaque.

It's a recognition some see as overdue. In a 1941 paper titled "The Negro's Contribution to Surgery," published in the Journal of the National Medical Associatio n, Dr. John A. Kenney of the Tuskegee Institute, considered the dean of Black dermatology, wrote, "I suggest that a monument be raised and dedicated to the nameless Negroes who have contributed so much to surgery by the 'guinea pig' route."

Fact Check

We strive for accuracy and fairness. But if you see something that doesn't look right, click here to contact us! HISTORY reviews and updates its content regularly to ensure it is complete and accurate.

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The 'Father of Modern Gynecology' Performed Shocking Experiments on Enslaved Women | HISTORY

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J. Marion SIms' use of Black bodies as medical test subjects is part of an unethical history that includes the Tuskegee syphilis experiment and Henrietta Lacks.

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Report: Workforce Race Equality Standard

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Report: Workforce Race Equality Standard

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NHS England » NHS Workforce Race Equality Standard 2023 data analysis report for NHS trusts

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The 2023 Workforce Race Equality Standard (WRES) report is the eight publication, since the WRES was mandated and covers all nine indicators.

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Racism and Bias in Maternity Care Settings

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Racism and Bias in Maternity Care Settings

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An official position statement of the Association of Women’s Health, Obstetric and Neonatal Nurses

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 Harmful cultural practices during perinatal period and associated factors among women of childbearing age in Southern Ethiopia: Community based cross-sectional study 

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 Harmful cultural practices during perinatal period and associated factors among women of childbearing age in Southern Ethiopia: Community based cross-sectional study 

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Haimanot AbebeID*, Girma Alemayehu Beyene☯, Berhanu Semra Mulat☯ Department of Public Health, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia

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Understanding childbirth practices as an organizational cultural phenomenon

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Understanding childbirth practices as an organizational cultural phenomenon

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BMC Pregnancy and Childbirth 2013, 13:205 http://www.biomedcentral.com/1471-2393/13/205

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Understanding childbirth practices as an organizational cultural phenomenon, a conceptual framework, Behruzi et al 2013

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CHILDBIRTH AND CULTURE: PRACTICES, BELIEFS, AND TRADITIONS

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CHILDBIRTH AND CULTURE: PRACTICES, BELIEFS, AND TRADITIONS

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Ethnic health inequalities in the UK's maternity services: a systematic literature review

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Ethnic health inequalities in the UK's maternity services: a systematic literature review

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Khan, 2021

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Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites

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Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites

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Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites

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Racial inequalities in maternity outcomes: what are the causes?

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Data from the annual MBRRACE reports, have for some years been highlighting the fact that mothers and babies of Black, Asian and mixed ethnicity backgrounds are significantly more likely to die than their white counterparts. Campaigning groups such as Five X More have been working to draw attention to this issue, and this has led to the setting up of various initiatives to try to tackle the problem. These include the RCOG Race Equality Taskforce and Birthrights Inquiry into racial injustice in UK maternity services. Recently NHS England published five pledges and guidance to Local Maternity Systems on how they should plan for and implement actions to improve equity for mothers and babies from Black, Asian and mixed ethnic groups and those living in the most deprived areas, and race equality for staff. For AIMS comments on the NHS England plans, and our calls for action, see this AIMS Journal article and look out for our position paper on Racial Inequalities in Maternity Services, to be published soon.

What has been lacking to date is a clear research-grounded explanation of the underlying causes of the observed inequalities between racial groups. It is sometimes suggested that this is simply due to people in these groups being more likely to be socially and economically deprived, to give birth at older or younger ages than average, or to suffer from underlying health conditions such as high blood pressure or diabetes. There has also been debate about the possible contribution of underlying biological differences that might make people from some ethnic backgrounds more prone to develop problems during pregnancy or labour. However, it has become increasingly apparent that it is likely to be due, at least in part, to differences in the care that is offered as a result of racial discrimination, bias, stereotyping, and cultural insensitivity. This article reviews several recent reports that have started to shed light on the question of what causes the observed inequalities.

MBRRACE data on perinatal deaths

The most recent MBRRACE-UK Perinatal Mortality Surveillance Report for births in 2019 1 published in October 2021, included analysis of stillbirth and neonatal death rates both by the mother's ethnicity and by the level of social deprivation in the area in which the mother lived. Small areas across the country were grouped into quintiles, with group 1 consisting of the areas of lowest social deprivation and 5 the highest. This shows that, for areas within a given quintile, the death rates are higher for babies born to mothers of Black and Asian ethnicity compared with babies born to white mothers from similar areas. This means that social deprivation cannot be the whole story. What is even more shocking is that the stillbirth rate for babies of Black mothers living in the least deprived areas was markedly higher than for babies of white mothers living in the most deprived areas - 6.05 per 1,000 births, compared with 4.65.

Data taken from Table 19 of the MBRRACE report for births in 2019: stillbirth per one thousand births

Some more detailed analysis of the last six years of ethnicity data was presented at the perinatal report launch meeting, but has not been published yet. This suggested that stillbirth rates across all ethnicities are highest in mothers under 25 or over 35, but in each age group the stillbirth rates were higher for babies of Black, Bangladeshi and Pakistani ethnicity than for white babies born to mothers in that group. They were also higher for babies of these ethnicities born to mothers in the 'lower risk' age groups (between 25 and 35) than for white mothers in the 'higher risk' age groups (under 25 or over 35). This data analysis shows that the inequalities of outcome are not fully explained by differences in deprivation or in the age at which women of different ethnicities give birth.

NMPA sprint audit on ethnic and social inequalities

This report from the National Maternity and Perinatal Audit (NMPA)looked at data on 1.37 million birthsin England, Scotland and Walesover the three years to March 2018. The audit reviewed variations in outcomes for mothers and babies across ethnic and socioeconomic groups. This is really important as previous reports have focused on inequalities in the most serious outcomes of maternal and perinatal deaths, but we know that those must only be the tip of the iceberg of health inequalities.

The authors note that, "The results presented in this report are crude and therefore descriptive." Such a study can describe the differences that are observed but cannot explain the factors which may be causing them, although it does comment on some variations between ethnic and socio-economic groups. For example, there were higher rates of high blood pressure and pre-existing diabetes, but less smoking, amongst women from South Asian and Black ethnic groups compared with white women.

There is a lot of detail in the report, but one interesting finding was that women from Black ethnic groups were slightly more likely to experience a birth without intervention (defined as spontaneous onset of labour, and spontaneous vaginal birth, without epidural/spinal/general anaesthesia or episiotomy) than those from either white or South Asian ethnic groups. This could be positive if these women were having straightforward labours and not being offered unwanted interventions, but the concern is that it could in part be because they were not offered interventions that were "desired or indicated". We know from other research that women of Black, Asian and mixed ethnicity are less likely to receive pain relief in labour.This is an area where more research into Black and Asian people's experiences of care would be valuable.

In contrast, though rates of planned caesareans were similar across ethnic groups, the rates of unplanned caesareans were " highest for women from Black ethnic groups and higher for women from South Asian groups when compared with those from white ethnic groups. " Taken together, these two findings could indicate that some Black and Asian women were not receiving interventions that could have helped them avoid an unplanned caesarean, although without more detailed research, we can't be sure whether or not this is the case. The fact that Black women in the sample were more likely than other ethnic groups to have a BMI of 30 kg/m2 or above, to be aged over 35, have high blood pressure or have had a previous caesarean, could all have contributed to their higher caesarean rate and higher chance of experiencing serious blood loss.

Babies born to mothers from Black ethnic groups were more likely both to have a low Apgar score and to be admitted to a neonatal unit when born at term than were white babies. However, whilst those born to women from South Asian ethnic groups were less likely to have a low Apgar score, they were more likely than those born to white mothers to be admitted to a neonatal unit. Again, the audit cannot give the reasons for this, though the authors comment that babies of South Asian ethnicity are more likely to be admitted for jaundice, and also more likely to be classed as 'small for gestational age' (SGA). The latter might reflect the use of growth charts standardised for white babies.

This audit raises some interesting questions and AIMS supports the authors' call to, " prioritise further research in NHS maternity and perinatal care that could improve outcomes for women, and their babies, from ethnic minority groups and those in the most deprived areas ", which should include both quantitative analysis to investigate the causes and qualitative research to explore the experiences of people accessing maternity care.

Cohort study: Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England

Further information on the underlying causes of some of the main inequalities comes from a recently published NMPA cohort study looking at data on stillbirth, preterm birth (before 37 weeks of pregnancy), and fetal growth restriction (FGR: defined as babies with a birthweight below the third centile - in the lowest 3% of the population). The data covered about 1.2 million births in 132 hospitals in England in the two years to March 2017. The authors looked at how these three 'adverse outcomes' varied by level of social deprivation and ethnicity and calculated the 'population attributable fraction' (PAF). This is defined as the proportion of a group that would not have experienced an adverse outcome had their group had the same rates of these outcomes as the 'reference group.' For social deprivation, the reference group was mothers in the least deprived areas, and for ethnicity it was white mothers.

The analysis showed a significant excess of stillbirths, pre-term births and FGR for those from more deprived areas, which increased with the increasing level of deprivation. Similarly, there was an excess of stillbirths and FGR for those of Black, South Asian, mixed or other ethnicity compared with white mothers, though little difference in preterm births.

The authors then looked at the impact of adjusting the PAF to correct for other risk factors. Here is the data from Table 2 of the report for PAF before and after adjustment.

In the case of socioeconomic deprivation, adjusting for ethnicity, smoking status and BMI resulted in substantial lower PAFs, with most of the impact coming from the adjustment for smoking and BMI. In other words, much of the difference that is apparently due to social deprivation can be explained by these other factors, although there remains a substantial contribution from social deprivation in itself. A further adjustment for other maternal risk factors made little difference to the figures.

In contrast, in the case of ethnicity, adjusting for socioeconomic deprivation, smoking, BMI and additional maternal risk factors made little difference to the PAF. This shows that higher rates of stillbirth and FGR seen in Black, South Asian and mixed/other ethnic groups compared with the white population is unlikely to be due to socioeconomic deprivation alone, or to factors such as rates of smoking or BMI, and we need to look elsewhere for the cause.

The authors comment that, "Other factors related to discrimination based on race, religion, and culture can contribute to a societal disadvantage and increase the risk of poor pregnancy outcomes" but also speculate on possible biological differences between ethnic groups. They call for research to understand the role of these possible causes to be a priority, but also for recognition that public health approaches and action to address wider inequalities are likely to be needed.

Conclusion

What these three pieces of research show is that racial inequalities in maternity outcomes are not a simple matter of socioeconomic or health/biological factors alone. AIMS welcomes the recognition that they are likely to be due at least in part to differences in the care that is offered, and to institutional racism, unconscious bias and lack of individualised, culturally competent care. These issues need to be acknowledged and addressed throughout the maternity services.

There is also a growing understanding of the impact of long-term everyday racism (for example, everyday microaggressions) on health, which means that there will be disparities in the underlying health of women preceding the point at which they access maternity services. AIMS welcomes the recognition in the NHS Long Term Planthat "we cannot treat our way out of inequalities", but that the NHS can (and AIMS would say must) "ensure that action to drive down health inequalities is central to everything [it does].

AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all.

The AIMS Journal spearheads discussions about change and development in the maternity services. From the beginning of 2018, the journal has been published online and is freely available to anyone with an interest in pregnancy and birth issues. Membership of AIMS continues to support and fund our ability to create the online journal, as well as supporting our other work, including campaigning and our Helpline. To contact the editors, please email: editor@aims.org.uk

Published on 1st March 2022

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Racial inequalities in maternity outcomes: what are the causes?

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Data from the annual MBRRACE reports, have for some years been highlighting the fact that mothers and babies of Black, Asian and mixed ethnicity backgrounds are significantly more likely to die than their white counterparts.

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Deep dive into how racialised communities are gaslighted (or is it gaslit?)

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Centric is a research lab and consultancy enhancing the user experience of the built environment. We help identify the unintended human consequences of the built environment. We do this through bespoke neuroscience informed systems and processes. Our consultancy enables practitioners to adopt sci…

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Systemic racism, not broken bodies: An inquiry into racial injustice and human rights in UK maternity care

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Systemic racism, not broken bodies: An inquiry into racial injustice and human rights in UK maternity care

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INVISIBLE: Maternity Experiences of Muslim Women from Racialised Minority Communities: A Summary Report

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INVISIBLE: Maternity Experiences of Muslim Women from Racialised Minority Communities: A Summary Report

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Urgent action is needed to tackle systemic biases contributing to unequal mortality outcomes in ethnic minority women and women facing multiple problems and deprivation, say experts.

The authors of a new analysis of maternal deaths in the UK, 1 issued by Oxford University's Nuffield Department of Population Health, say that the coronavirus pandemic is likely to have worsened the disparities they have highlighted.

Black women are four times more likely than white women to die in pregnancy or childbirth, says the seventh annual report from MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries). 1 Women from Asian ethnic backgrounds face a twofold risk, and women living in the most deprived areas of the UK are almost three times more likely to die than those in the most affluent areas.

The report includes surveillance data on women in the UK who died during pregnancy or up to one year afterwards in 2016-18 and details the lessons for maternity that can be learnt care from confidential inquiries.

The number of women known to have been experiencing multiple disadvantages when they died has increased by a third since the previous report in 2019, from 6% to 8%. Women in these situations often face mental ill health or domestic abuse and may misuse substances.

Wider action

Maggie Rae, president of the Faculty of Public Health, said, "Women who live in more deprived areas continue to be at greater risk of dying during or after pregnancy, and many of the complex factors underlying this increased risk need action much more widely than in maternity services, beyond the health sector, and often long before pregnancy.

"We will need to address this challenge of wider system actions in order to reduce deaths of women during or after pregnancy as well as their babies."

The report said that pregnancy remained "very safe" in the UK. In 2016-18, 547 women died during or up to a year after pregnancy from causes associated with their pregnancy, among 2.2 million women who gave birth in the UK. In that period 34 Black women died among every 100 000 giving birth, compared with 15 Asian women in 100 000, and eight white women in 100 000.

The report said that these figures were "fundamentally unchanged" from those documented in the 2019 report and that, despite encouraging responses to this disparity from groups including the NHS and government agencies, sustained focus was needed.

Marian Knight, lead author for MBRRACE-UK and professor of maternal and child population health at the University of Oxford, said that disparity in maternal mortality simply because of a woman's ethnicity was recognised as "unacceptable." She added, "It is equally unacceptable for women with pre-existing medical conditions such as epilepsy to receive a lower standard of care simply because they are pregnant."

The analysis reported a "concerning rise"-almost doubled from the previous three years-in maternal mortality due to sudden unexpected death in epilepsy (SUDEP). In many instances these deaths were linked to inadequate medicine management for these women either before or during their pregnancy.

Knight said, "Systemic biases prevent women with complex and multiple problems receiving the care they need. This needs to be addressed urgently, particularly since the impacts of social and ethnic inequalities, multiple disadvantages, and epilepsy are likely to have been amplified during the covid-19 pandemic."

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Disparity in maternal deaths because of ethnicity is "unacceptable"

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Urgent action is needed to tackle systemic biases contributing to unequal mortality outcomes in ethnic minority women and women facing multiple problems and deprivation, say experts. The authors of a new analysis of maternal deaths in the UK,1 issued by Oxford University's Nuffield Department of Population Health, say that the coronavirus pandemic is likely to have worsened the disparities they have highlighted.

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Birth Companions response to socioeconomic inequity

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Birth Companions response to socioeconomic inequity

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The latest MBRRACE reports on maternal mortality rates and rates of stillbirths and neonatal deaths during 2016-18 show significant and growing inequalities in outcomes stemming from deprivation and disadvantage:

Babies born in the most deprived areas are at an 80% higher risk of stillbirth and neonatal death compared to those living in the least deprived areas.

Women living in these areas are almost three times more likely to die themselves. As the level of deprivation increases, the risk of dying in pregnancy, birth or the year after birth increases. 37% of the women who died lived in areas ranked at the very highest index of multiple deprivation, compared to 7% in the least deprived area.

One in five (20%) of the women who died were known to social services - an increase from 12% in 2012-14. As the report states, "Involvement with social services is an indicator of the otherwise largely invisible levels of need and adversity experienced by many of the women who die".

These inequalities are widening. The number of women who are known to be experiencing multiple disadvantages when they die has increased by a third since the last report, from 6% to 8%.

These stark figures are rooted in the wider determinants of health including poverty, insecure and inappropriate housing, mental ill-health, domestic and sexual abuse, trauma and experiences of racism. While this data relates to deaths before the outbreak of COVID-19, it is clear that the pandemic is intensifying these issues and escalating levels of need across the country.

The tragic deaths of these women and babies are the tip of the iceberg. Behind the figures lie untold numbers of near misses and serious incidents, risking the lives and the long-term physical and mental wellbeing of women and their babies, and perpetuating cycles of trauma and disadvantage that have a lasting impact on families and wider society.

Our response
Work is underway to address the inequalities experienced by Black, Asian and other minority ethnic women and their babies; work that is greatly needed. But the other disparities outlined above, the consequences of deprivation and the social determinants of health, also require urgent attention. These inequalities have been known about for years, they are avoidable and they are unacceptable. We must act now.

Evidence shows that our health and social care systems do not know enough about the social determinants of health[1] and are ill-equipped to respond to the complexity of many women's needs during pregnancy and the year after birth[2][3].

The number of women who die while known to social services is particularly worrying. The needs of these women are very poorly understood, and they often remain invisible to many of the services that can and should be supporting them.

The increase in maternal deaths among this group runs alongside a dramatic rise in the number of children removed into local authority care in the first year after birth. Recent research found this has more than doubled since 2007/8 and there has been a significant increase in the proportion of newborns (less than seven days old) involved in infant care proceedings. The Nuffield Family Justice Observatory's further work in this area highlights the significant challenges involved in protecting children, protecting the rights of birth mothers and other family members and providing good care during this crucial early stage of a child's life and beyond. These challenges have increased as a result of 10 years of austerity which, as a recent discussion paper states, have "reduced the availability of preventative services and limited the resources that can help families stay together".

What needs to happen now
Systems, services and workforces that are already reeling from the impact of the pandemic will see more women living in complex and fragile circumstances than ever before. We need to be better prepared and equipped to respond to this challenge, or more lives will be put at risk.

This situation requires better data collection; better investment and coordination within and across systems; and better engagement with people with lived experience to eliminate these inequalities and improve outcomes for all women and babies.

National and regional NHS teams, local authority public health, child and adult social services, medical Royal Colleges, voluntary sector organisations and academics need to work together more closely and more creatively than ever before to build preventative, holistic care around women experiencing inequalities at the earliest opportunities. At the heart of these efforts there must be a recognition of the fact that women's needs often span several complex systems, including social services, immigration, criminal justice, maternity, housing and more. We cannot look for solutions within the siloes that so often dominate commissioning and delivery.
We will be engaging with stakeholders across all relevant systems in the coming weeks and months to discuss the best ways to move forward and to offer our support and the support of our Lived Experience Team in this work.

[1] Health Equity in England: The Marmot Review 10 Years On

[2] Holding it all together, Birth Companions and Birthrights

[3] Making Better Births and reality for women with multiple disadvantages, Birth Companions and Revolving Doors Agency

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Birth Companions' response to the MBRRACE 2020 report on maternal deaths

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The latest MBRRACE reports on maternal mortality rates and rates of stillbirths and neonatal deaths during 2016-18 show significant and growing inequalities in outcomes stemming from deprivation and disadvantage: Babies born in the most deprived areas are at an 80% higher risk of stillbirth and neonatal death compared to those living in the least deprived areas.

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Reports on the Maternity Equity Conversations

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Reports on the Maternity Equity Conversations

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The qualitative evaluation report on the Maternity Equity Conversations is now complete. The wonderful Dr. Ebele Mogo carried out interviews and focus groups with stakeholders involved in the programme and analysed the responses for themes. You can read it here. There's also a film - which you can see here.

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Donate to the Doula Access Fund. The Doula Access Fund ensures that every woman and all birthing people may access doula support regardless of circumstance. Families who are experiencing financial hardship and who find themselves in challenging situations or without a birth partner may be referred to us for free doula support from a fully recognised member of Doula UK.

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Report on the experiences of refugees, women seeking asylum, and those with insecure immigration statuses who are accessing maternity care

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Report on the experiences of refugees, women seeking asylum, and those with insecure immigration statuses who are accessing maternity care

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Amma works closely alongside NHS maternity services, as one of the main referrers into our service. We acknowledge there are many individual practitioners working hard to deliver trauma-informed, person-centred care. Although many of the women we spoke to about their experiences of maternity care highlighted issues, they also shared instances of positive feedback, which are included in their testimonies.

Through our collaboration with the NHS Equalities Team and regular liaison with midwives and maternity services management, we are also aware of several strategies for improvement, which are currently ongoing. NHS Greater Glasgow and Clyde's current work to improve birth outcomes and experiences for racialised women and birthing people includes:

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Sands - Saving babies' lives. Supporting bereaved families.

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National maternity reports | Sands - Saving babies' lives. Supporting bereaved families.

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© 2022 Sands - Saving babies' lives. Supporting bereaved families. Charity registration number 299679. Company Limited by Guarantee Number 2212082 * Scottish Charity Registration Number SC042789 * We also operate in Northern Ireland Registered address: Sands, 10-18 Union Street, London, SE1 1SZ

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House of Commons Women and Equalities Committee - Black maternal health - Third Report of Session 2022–23

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House of Commons Women and Equalities Committee - Black maternal health - Third Report of Session 2022–23

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Henrietta Lacks: How Her Cells Became One of the Most Important Medical Tools in History

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Henrietta Lacks: How Her Cells Became One of the Most Important Medical Tools in History

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Author of 'The Immortal Life of Henrietta Lacks' discusses the extraordinary ways medical research benefitted from an African American woman's cells—without her consent.

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https://www.nihr.ac.uk/documents/ppi-patient-and-public-involvement-resources-for-applicants-to-nihr-research-programmes/23437

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Published: 18 December 2019

Version: 1.0 - December 2019

Resources for PPI

Standards for Public Involvement

The UK Standards for Public Involvement in Research will help guide you to improve the quality and consistency of the public involvement in your research.

Guidance for researchers on PPI
NIHR has developed guidance for researchers on how patients and the public can be involved.
Payment and recognition for PPI
NIHR also provide guidance on reward and payment for involvement.
Co-production
Also you can find NIHR guidance on co-producing a research project.
Providing feedback to public contributors

Useful, practical and evidence-based guidance is available on providing effective two-way feedback between researchers and public contributors.

Online Public Reviewing Course

You may find the online interactive course for patient/public reviewers useful when considering how to design the PPI in your project. It will describe how patient and public reviewers and public committee members assess research plans.

Resources for evaluating the impact and reporting of PPI

In Stage 2 applications, you will be asked to describe how you will record and evaluate the impact PPI has on the research. The level of evaluation should be proportionate to the level and complexity of the proposed PPI activities. The following resources provide different frameworks for assessing impact and reporting PPI:

Evaluating public involvement in research
Guidance on evaluating PPI in research.
Assessing impact of PPI in research

The Public Involvement Impact Assessment Framework (PiiAF) has been produced to help researchers assess the impacts of involving public members in their research.

Reporting of PPI

GRIPP2 reporting checklists (tools to improve reporting of PPI in research).

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PPI (Patient and Public Involvement) resources for applicants to NIHR research programmes

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A list of available PPI resources for applicants to NIHR research programmes. These resources can be accessed by applicants to support the design of PPI in their research, as well as their PPI reporting.

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https://www.equality4blacknurses.com/

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Challenging healthcare race discrimination Forcing accountability Encouraging nurses to stand up against racism Black Nurses Black union for nurses blacknurses

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Guiding Principles for Culturally Appropriate Care

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Guiding Principles for Culturally Appropriate Care

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A foundation for personalised culturally appropriate care for service users with a Black Caribbean heritage, although parts of this guidance may also be applicable for people from the African, and South Asian diasporas.

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iDecide is designed to improve communication and the consent process between women and NHS staff during labour and birth.

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A handbook of clinical signs in Black and Brown skin

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Equity and equality: Guidance for local maternity systems

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Equity and equality: Guidance for local maternity systems

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Behind every privilege is an imbalance of power. It's invisible to those who possess it and ever-present for those who don't.

Privilege describes benefits that belong to people because they fit into a specific social group or have certain dimensions to their identity. You can have (or lack) privilege because of your race, gender, sexual orientation, ability, religion, wealth, and class, among many other characteristics.

Having privilege means having an advantage that is out of your control and that you didn't ask for. You may not even notice it until you educate yourself about its existence.

Privilege and the lack of privilege are how power is distributed.

It is hard to acknowledge our own privilege because privilege is the other side of oppression. Some people are against talking about privilege because they don't want to be framed as the aggressors or complicit in a system that gives them an advantage at the expense of others. Other critics of the word 'privilege' mistake it for a blanket term that suggests that, if you have a privilege, your whole life has been easy.

Ultimately, privilege is not a concept designed to make people feel guilty or to diminish their achievements. Instead, waking up to how you may have certain privileges is an essential first step towards being able to decisively act, in small and large ways, to use your privilege and make the systems we were born into fairer.

Below, we also describe five types of privilege with simple examples.

🚻 White privilege:

In many countries, white privilege benefits white people at the expense of people of color. Lacking white privilege can include being directly typecast or treated differently but it can also mean not seeing yourself catered for by the society you live in. While the existence of white privilege is ever-present and noticeable to those who don't possess it, white people may not notice their advantages. For example, a white person in the UK or the US does not need to search high and low to find products to suit their skin, like band-aids or make-up and will not know what it is like to turn on the TV to find that nobody looks like them or their family.

🛐 Religious privilege:

Religious privilege includes being able to find a place of worship near you and feeling a sense of connection between your religious celebrations and wider society. For example, automatically having a day off from work for your religious holidays is a religious privilege.

🚹 Gender privilege:

Gender privilege usually refers to male privilege, a set of privileges distributed to men on the basis of their gender.

In many cases, men are centered and catered for in career progression and pay and can be treated more respectfully and listened to more in everyday conversations.

It might come as a surprise that a huge number of popular movies fail the Bechdel Test, which measures whether a story (in books, movies or screenplays) includes at least two women who talk to each other about anything other than a man. Among the list are all-time favorites such as Star Wars, The Social Network and the entire Lord of the Rings trilogy.

👫 Heterosexual privilege:

Straight privilege described the advantages favorably granted to someone because of their heterosexual orientation.

Possessing this privilege means never having to worry about 'coming out', never feeling unsafe when holding hands with your significant other in public or never censoring yourself around different groups that find your orientation uncomfortable or wrong. Straight privilege also means seeing your romantic and family aspirations represented in films, music, everyday conversations and even Valentine's Day cards.

💰 Socio-economic privilege:

Socio-economic privilege is a complex concept because it looks very different for everyone. While to some people it means being able to afford luxury goods, to others it means being able to afford to go to university or simply to have a roof over your head and a place to sleep at night. Having socio-economic privilege doesn't necessarily mean being rich but it can mean having enough resources to be able to take on the opportunities that life has given you, such as unpaid internships or an after-school tutoring job - little privileges that can give you a head start in the job market.
Credit: Toby Morris
The bottom line?

Most of us are privileged in at least one way. That doesn't mean we didn't work hard or that we didn't experience any other hardships in life. Privilege can be hard to admit and even harder to talk about but it is important to understand our own privilege so we can give a voice to those less privileged.

In order to use your own privilege for good and to be a good ally you have to be aware, listen and speak up. Focus on equity instead of equality so that everyone is given what they need to be successful.
Inclusion Works by Hive Learning
Inclusion Works from Hive Learning is a group-based peer learning program designed to create large ripples of change across your organization. We give people the tools to make small changes to their daily behaviors and help them rapidly learn, relearn, and respond to the changing world around them.
Learn More About Inclusion Works
Inclusion Works >

This resource was taken from our Inclusion Works program, which was created with a network of more than +100 diverse contributors and advisers. We learn from, amplify and cite creators of different races, ethnicities, genders and cognitive styles and continually work to represent all dimensions of diversity.

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5 main types of privileges | Hive Learning

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Privilege describes benefits that belong to people because they fit into a specific social group or have certain dimensions to their identity. You can have (or lack) privilege because of your race, gender, sexual orientation, ability, religion, wealth, and class, among many other characteristics.

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This post was originally published on this date in 2016 and we find it enduringly relevant today. It contains a true story and a Facilitator's Guide for handling situations like this.
A True Story

At a recent training I was leading for an all queer and multiracial group, an older white man "John" took offense to my use of the word queer. As an icebreaker, I had asked the group to share in a pair, when did you first know you were queer? During the debrief, John took time to explain how the Q-word brought back painful memories of the many ways he was shamed growing up. As he explained, he got emotional and then said "using the Q-word is like using the N-word for me." And he actually said the N-word.

The air in the room suddenly got heavy and many people shifted uncomfortably in their seats. The three black men in the group looked stunned, and the rest of the people of color in the circle turned to me to do something. The white man kept talking, completely unaware of that this micro-aggression had caused a change in the room. I waited for a white person to address what happened. But folks remained silent, so just as the next person began sharing, I stopped the process.

"I want to stop and check something out with you and the group. Is it ok if I do that?" I asked John and turned to the group to seek their approval. "John, thank you for sharing the impact that I had on you when I used the Q-word in this circle. I want to account to you for that. I also heard you use the N-word and I am wondering if you would be open to hearing the impact that that word could have had in the space?"

John looked at me lost and unsure. So I repeated myself. Before finishing a black man in the circle jumped in. He was angry and loving at the same time. He spoke about how hearing that word made him afraid that this was not a safe space for him. He shared that challenging the use of the word was necessary for him to remain open and hopeful. At a moment there were tears in his eyes. As John listened, his facial expression shifted from looking lost to looking mortified. Yet he stayed present and listened.

John accounted for having used the N-word. And a few other people shared the impact they experienced. To create closure I said, "the expectations we need to have are that we will screw up. We can lean into love and trust that each person here is deeply commitment to justice, and stay engaged. Thank you all for being vulnerable and sharing your hearts to help us move forward. I asked the group: Is there someone here who is not ok, moving forward?"

A young Latino man spoke and said "I am not ok, but I am fine moving forward."

I offered the option of finding a way to get feedback from the group and to organize another time when as a group they could go deeper on this.

It takes this level of vulnerability in all of our parts to step into the scary place of facing our blind spots and hearing corrective information that can help us to change. As equity warriors, whether we are leading a process, participating in a process, or if we are the person that put their foot in their mouth; we must have skills to align our thinking and feeling before acting. At a personal level, knowing how my body will react in a moment of stress and how to calm myself enough to think through my options and try to foresee the impact of those actions are crucial.

Here are some tips to develop a strategy to support individuals and groups move through these kinds of challenges in a way that bridges people's experience instead of creating greater division.

Facilitator's Guide

Take Care of Yourself

Take a few deep breaths and ask yourself some questions:

Am I triggered right now? Can I bracket my trigger enough to show up strong for the group?

Do a quick triage of the group - who could be most hurt by what just happened? What are their internal conditions? Have you seen this person deal with a similar situation before and how did they react? Are there any wild cannons in the room? Is there a white ally?

How much time can we reallocate to manage this situation?

What are the competing issues, hurts, and emotions present?

Identify what needs to be named to have those most impacted feel heard by creating a safe space (but often deeply uncomfortable) for people to express their thoughts and feelings.

10 Steps to Facilitating Intervention

1. An open: Acknowledge to the group that discomfort is natural and needed when managing challenges across difference. And tell the group that you recommend slowing down the process to address what has emerged. Lower the expectations by naming your own vulnerability.

" Moments like this can derail the whole process, so let's address it. The way I prepare, and how I ask groups to prepare for an equity session, is different than what we've planned today. Let's see if by using some of our agreements we can hear the impact, account for behavior, and choose to continue."

2. Seek permission: In my example, I did it by first acknowledging and accounting for the impact of my use of the Q-word and then naming the violation I heard the person make, and asking if he was willing to hear the impact.

3. Anticipate response: Don't be afraid if one person starts to share the impact in a passionate manner and wait for a moment of pause to re-establish the expectations of how the conversation will unfold.

4. Check for agreement:
"It feels like there are a lot of feelings about this issue.Is it ok if we put a pause to our agenda and take some time to work through this moment?"
5. Time: How much time will be spent on resolving the issue? Reach agreement.

6. Check-in with the group norms: For this process, we were using the VISIONS INC. Guidelines for Cross-cultural Communications. We used: self-focus, notice intent and impact, and ok to disagree not ok to blame, shame or attack self or others.

7. Offer participants feedback: Interrupt and ask people to reframe their statements to "I statements" if anyone starts to point fingers or to assign meaning to people's action.

8. Track and honor the time: Once the time is up, say:

" The additional time we allocated is now over. I know this is the beginning of a conversation. I know that you all are committed to return to this conversation soon. For now, I am wondering if you are willing to continue with our agenda. Is there anyone here unwilling to continue with our agenda?

9. Consult with group leaders at the break: At the break, check in with the leaders and ask for feedback. Also, check in with the people most impacted and ask if they need anything else from you as the meeting facilitator.

10. Keep it empowering: Create a way for all participants to ask for what they need in order to continue to engage with the group in a healthy and empowering way. I pass around post-its and ask people to write feedback or ask for what else they would need. Collect them and give the feedback to the leaders and develop a plan to address the feedback.

Interrupt Dynamics

Addressing micro-aggressions is challenging in all environments, however in the spaces we create and invite others to participate in, it is our responsibility to build the skills necessary to step up and interrupt these dynamics. Letting comments or behaviors slip erodes the sense of safety and makes real connection across difference impossible. It re-enforces a sense of isolation and powerlessness by groups who are targets of oppression.

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Love While Challenging Racist Behavior - Interaction Institute for Social Change

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This post was originally published on this date in 2016 and we find it enduringly relevant today. It contains a true story and a Facilitator's Guide for handling situations like this. A True Story At a recent training I was leading for an all queer and multiracial group, an older white man "John" took offense...

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NHS pledges to improve equity for mothers and babies and race equality for staff

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NHS pledges to improve equity for mothers and babies and race equality for staff

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You've Been Called Out for a Microaggression. What Do You Do?

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You've Been Called Out for a Microaggression. What Do You Do?

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Useful step-by-step guide from Harvard Buisiness Review

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Tara Moore/Getty Images

It was a throwaway comment, and you were unaware that it was demeaning. But now that a colleague has brought the slight to your attention, you realize what you said was offensive. As a person who wants to be a good ally to your colleagues of color and members of underrepresented groups, how do you apologize after you've committed a microaggression? How and when should you try to make amends? And what's the best way to ensure that you do better in the future?

What the Experts Say

Microaggressions are the everyday indignities and insults that members of marginalized groups endure in their routine interactions with people in all walks of life. In the workplace, these "subtle acts of exclusion" come in many forms, says Tiffany Jana, founder and CEO of TMI Consulting and the co-author of Overcoming Bias: Building Authentic Relationships Across Differences. They include backhanded compliments (a white manager telling an African American employee that, "She's very articulate"; a group of co-workers jokingly ribbing a Latino executive that, "He's a diversity hire") and stereotypical assumptions (a male colleague asking his female peer to take notes and order lunch for the team).

These remarks and behaviors "happen casually and often without any harm intended," says Jana, but they offer a clear demonstration "that the initiator harbors unconscious bias." Meanwhile, the person on the receiving end who belongs to a group that's discriminated against - be it because of their race, gender, sexual orientation, disability, or religion - is often left to suffer in silence.

This is starting to change, however. Amidst a national conversation on race and equality, "we are increasingly holding people accountable," says Jana. The change has critical implications for managers who "care about creating an inclusive team and workplace," says , a diversity consultant and the co-author of Gender Ambiguity in the Workplace: Transgender and Gender-Diverse Discrimination.

If you've been called out for committing a microaggression you need to respond with compassion, concern, and humility. "You want people to feel respected, so you need to walk the talk," Zheng says. "It's important to get this right." Here are some tips.

Take a breath.

Being called out for a microaggression does not feel good. You may experience a range of emotions - "stress, embarrassment, defensiveness, and your heart rate may even go up," says Zheng. This is normal. But do not let these sensations rule how you react. Instead, " take a breath." Calm yourself. Understand that while you may have made a mistake, it doesn't mean you're a bad person. In these circumstances, people often fall prey to the fundamental attribution error - a "tendency to believe that things happen because of who we are as people rather than the situation," says Zheng. In other words, you can still be "a good person with positive intentions, who slipped up."

And there's an upside to being called out for a microaggression: It's an indication of trust. The person who labeled your comment believes that you can be better, says Jana. "If they don't think you're capable of, or interested in, evolving they would not have wasted their breath."

Don't make it about you.

While being called out for a microaggression may be awkward and uncomfortable, you don't want to get defensive. "You must not make it about you," says Jana. "When a human being tells you that they have been harmed by your words or actions, you need to focus on the injured party." It can be helpful to remember that "every callout has an entire history's worth of unsaid context behind it," says Zheng. "When someone says, 'What you said hurt me,' they're saying, 'You have hurt me in the way that people have hurt me, and people like me, in the past.'" In other words, your remark was not "just one interpersonal interaction." Rather it carried centuries' worth of discrimination, cruelty, and oppression. "And the weight of historical oppression is very heavy," says Zheng.

Listen.

Your first priority is to make sure the other person feels heard, says Jana. As difficult as it may be to receive the criticism, "they are taking a risk by putting themselves on the line." Listen to what they say with an open heart and an open mind. Be grateful. "It is a deeply sacred gift for someone to reflect back to you how you're showing up in the world and to help you become more evolved," explains Jana. Express appreciation, and then "follow the other person's lead," says Zheng. Sometimes the individual calling you out may "want to explain to you all the ways that what you said was harmful and give you a history lesson to go along with it," she says. Other times, all they may reveal is, "'Don't say that word.'"

Sincerely apologize.

Next, says Jana, you need to "replace your instinctive defensiveness with curiosity and empathy" and offer a genuine apology. According to Zheng, your apology must include three elements: "You must address the harmful comment, acknowledge the impact it had, and commit to doing better."

Start by saying something like, "Thank you for sharing that with me. It's hard to hear. And I appreciate you trust me enough to share this feedback." Then say, "I am sorry that what I said and did was offensive."

Your apology must be sincere. "Don't say, 'I am sorry if you felt offended.' The insertion of the 'if' makes it seem like you're humoring them," says Zheng. Finally, say, "I care a lot about creating an inclusive workplace, and I want to improve." Depending on your relationship with this colleague, you might also ask for a suggestion on how to be better in future situations. Zheng suggests saying something like, "If you can, and if you're willing, can you share a recommendation for how I could have said it differently?"

And don't overdo it.

Upon being called out for an offensive remark, some people have a tendency to over-apologize, says Zheng. "They go on and on, saying things like: 'I am so sorry. I feel so terrible. I am not a racist. What must you think of me?'" But these histrionics do not help, and in fact, they contribute to the insult. "You are flexing your power by [asking] this employee to take care of you," she says. It's not your colleague's job to assuage your guilt, and make you feel better about the situation. This shouldn't become "a pity party," adds Jana.

How to respond when you're called out publicly

All of the above steps become much harder if the conversation is happening in front of others. According to Zheng, most callouts for microaggressions tend to be private interactions because of the sensitive subject matters. That said, if your colleague draws attention to your behavior in a public setting, it's likely because "they don't feel psychologically safe with you" or "they're at the end of their rope," Zheng says.

In situations like these, tread carefully. "First, pause. Then say, 'Thank you for sharing that feedback. I am not going to use that word in the future,'" Zheng advises. Keep your response short and non-defensive. Later, "message the person privately and go through the same steps of acknowledging the hurtful comment, recognizing the impact it had, and committing to doing better," she says. You don't want to do this part of process "publicly because it is performative."

Seek to understand on your own time.

In the event that you don't quite grasp how what you said or did was prejudiced and hurtful, do not force your colleague into a drawn-out conversation or try to persuade them of your benign intent, says Jana. Instead, "Google it or ask other people" to help you understand. Importantly, adds Zheng, "that research needs to happen on your own time." Remember, this person didn't " commit to becoming your teacher," and so you need to "treat this as your own learning opportunity," she says.

Consider following up

"If you went on a hike with someone and they tripped and hurt themselves, you would follow up with them later to express your genuine concern for their wellbeing,"- particularly if their fall was due to your negligence, says Jana. The same should hold true for times "when you have been the cause of someone's emotional pain."

After a bit of time has passed, Jana recommends reaching out to let your colleague to let them "know that you care" and that you're "grateful that they were vulnerable with you." Essentially you're saying: "Your intervention worked. I could have gone through the world blind to that and I understand a bit more now. Thank you for helping me grow."

But Zheng recommends proceeding with caution. When your research sparks burning revelation about your biases and you have an urge to make further amends, she says you need to "interrogate your own feelings." Ask yourself: What am I looking for? A pat on the back? Validation? She says that the best way course of action is not to rehash the incident but rather to "take steps to make your colleague feel more respected."

Keep working on it

Finally, recognize that becoming a better, open-minded, anti-racist, anti-sexist person is hard work. "You're doing the best you can; you're human and fallible; and you're going to mess up from time to time," says Jana. "Rarely does one conversation erase a lifetime of programming."

The important thing is to "commit to opening your eyes and be willing to course correct at every opportunity" and to have "grace for yourself and grace for others," says Jana.Let your team know that this is a priority for you, adds Zheng. Say, "In the future I am going to work on this, and if you can, please keep holding me accountable."

Principles to Remember

Do

Make the other person feel heard and follow their lead in the conversation.

Offer a genuine apology that acknowledges the impact and harm your comment caused.

Keep striving to be better. It requires grace, humility, and commitment.

Don't

Fall prey to the fundamental attribution error. You can still be a good, well-intentioned person who said something offensive.

Make the conversation about you. Instead, express gratitude for your colleague's trust and belief that you're capable of evolving.

Overdo your apology by laying on your privileged guilt. Your apology should be sincere.

Advice in Practice
Case Study #1: Be grateful for your colleague's courage and listen to what they say.
Steve Waters, a social entrepreneur, says he has long strived to create an equitable, inclusive, and fair workplace. "Diversity and social justice are really important to me," he says. "And I consider myself to be very aware of how that comes across in my language."

Recently, however, he was called out by a female employee - we'll call her Sarah - for committing a microaggression. "I often use the greeting, 'Hey guys,' which I view as an easygoing way to greet a group of people," he says. "It didn't even occur to me that this was hurtful, and I was quite surprised when my colleague brought it up."

He admits that at first, he was confused. But he listened carefully to what his colleague was telling him. "Sarah explained that she came from the tech startup world, where sexism is rampant, and since 'guys' literally means men, it is often used as a subtle, or not-so-subtle, way of minimizing the women in the room."

Sarah explained that by addressing the group, which was predominantly men, as "guys," he was excluding her. Steve felt terrible. "This wasn't a conscious or purposeful effort to minimize her. Sarah is definitely an equally valued member of the team," he says.

But he knew that this incident wasn't about him. Rather, it was about making sure Sarah felt heard and understood.

Steve immediately thanked Sarah for bringing the comment to his attention. "I also let her know that I understood the impact of what I had said and because of that, I would no longer use that term. I apologized for using language that made her feel minimized," he says.

The end result was positive. Sarah thanked Steve for listening and for being open to change. And Steve learned a key lesson. "Just because something isn't offensive to you based on your life experience, it doesn't mean it isn't or can't be hurtful to someone else," he says. "If a colleague has the courage to tell you they feel minimized, take the time to really listen to what their experience is."
Case Study #2: Commit to doing better - and then follow through on that promise
Jesse Silkoff, founder of MyRoofingPal, which helps customers find local contractors, says that being called out for a mistake that "you didn't even realize you were making" feels awful.

"However, as a leader, you have to make sure you set the standard of how to make it right," he says. "In the case of using a microaggression, taking responsibility for the mistake is critical."

Earlier in his career, Jesse, who is white, managed an Indian American colleague who had a name that Jesse had a hard time saying. "After saying it wrong a few times in our initial conversations, I noted that was a very difficult name for me to pronounce correctly," he says. "I meant it as a light-hearted, offhand remark."

But Jesse soon realized that his employee took it differently. She grew stiff and lowered her head. She then explained to Jesse that comments like that were hurtful because it made her feel like an outsider.

Jesse felt badly. That was not his intention, but he could see his colleague's point. "This was very eye-opening to me," he says. "I realized that I was in the wrong for making such an insensitive comment and not trying harder to work on the pronunciation on my own."

Jesse knew his apology shouldn't be about how terrible he felt. He needed to choose his words carefully and express appropriate humility. "No one wants to hear a half-hearted apology when they've been slighted," he says. "I told her that I was wrong, and that I regret what I did. I then promised her that I would do better."

Jesse learned how to say his colleague's name correctly. And they went on to have a productive working relationship. "Sadly, I'm sure we all make mistakes like this all the time and are never called out on them," he says. "I'm glad this employee took the time to explain why this was hurtful because it was a great opportunity to grow as a leader and human."

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You've Been Called Out for a Microaggression. What Do You Do?

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It was a throwaway comment, and you were unaware that it was demeaning. But now that a colleague has brought the slight to your attention, you realize what you said was offensive. As a person who wants to be a good ally to your colleagues of color and members of underrepresented groups, how do you apologize after you've committed a microaggression?

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Names are how we identify who we are to each other. Knowing how to say a colleague's name correctly is more than a common courtesy: It's the most basic form of respect.

It's not just rude to keep mispronouncing a co-worker's name; getting it right is also critical to helping that co-worker advance in their career. A 2019 Twitter thread by Princeton University computer science professor Arvind Narayanan, for example, detailed how he lost out on a job opportunity because a peer didn't connect his name to the research he'd published.

Near the end of my PhD, I had three main publications. I ran into someone at a conference whom I knew from previous events. He asked me about my work, and I briefly mentioned my papers. His reaction was something I didn't expect...
- Arvind Narayanan (@random_walker) November 26, 2019

He'd seen and liked my papers, but the name hadn't registered. He didn't realize the 3 papers had the same first author and that it was someone he knew. He was embarrassed and apologetic. If he'd known, he said, he'd have advocated for me at his school for a faculty position(!)
- Arvind Narayanan (@random_walker) November 26, 2019

In academia, your name is your brand. In a game of reputation, that's everything. Having your name be known in the community is how your get invited to talks, how people look you up to cite your papers, and how they decide whether your job application is worth a serious look.
- Arvind Narayanan (@random_walker) November 26, 2019

At first I wondered if I was overreacting. But you know how when you learn a new word you suddenly start seeing it everywhere? I realized it wasn't just that one guy. People knew my work but didn't recognize my name. Paradoxically, my work was highly visible, but I was not.
- Arvind Narayanan (@random_walker) November 26, 2019

Sometimes the fallout can be even more blatant.

In an article for Harvard Business Review, Ruchika Tulshyan, author of " The Diversity Advantage: Fixing Gender Inequality in the Workplace," shared how a hiring manager directly told her that her hard-to-pronounce name was a reason why she didn't get a call back for an interview.

Name discrimination persists in hiring. In a 2019 study, economists sent out 83,000 job applications for positions at 108 major U.S. companies, and applicants with Black-sounding names were called back 10% fewer times across the board compared with those who had white-sounding names and had the same qualifications.

Beyond egregious acts of discrimination, the negative effects of name bias can also be subtle and insidious. Tulshyan said what she experiences more often than what the hiring manager disclosed to her is that people avoid making eye contact with her so they don't have to say her name.

"The challenge is in the subtle. The challenge is in 'Is my name being said in these rooms or is it not? Am I being invited to networking events that are not listed in the company website?'" Tulshyan said.

If you have a name that colleagues keep mispronouncing, there are tools on LinkedIn and Google Assistant that can record your preferred pronunciation for online communication. But technology alone will not stop this from happening: Everyone has a responsibility to make colleagues feel welcomed and included, from the very first introduction.

That's why it's so important to show respect to your colleagues and to avoid the easily avoidable mistakes people make when they don't know how to say a name. You can never undo that first impression.

Here are the most common mistakes to avoid at work:

1. Don't start an introduction by announcing that you are going to butcher their name.

Watch how you communicate in an introduction. Word choice makes a big difference.

In a recent popular LinkedIn post, Damneet Kaur, an HR analyst based in California, shared an instance in which a colleague said they were going to "butcher her name":

I was in a meeting in which the host went over the attendance and I knew it was time for them to say my name because they started the sentence with, "I might butcher this...", and then proceeded to do exactly that, "butcher" my name. As I turned on my microphone to introduce myself, my pronouns, and the correct pronunciation of my name, I felt the same embarrassing energy I have felt since moving to the US at the age of 5, where it has always felt like no one knows how to say my name.

"What does it mean to butcher something? It's easy to say that, but language is so important," Kaur told HuffPost. "People hold their own ancestral history to a name, people hold their own story to their name. Someone might've changed their name if they are transitioning. Names are very sacred."

Instead of bumbling through an incorrect pronunciation, be upfront about your lack of knowledge, and ask your co-worker how they say their name.

In her post, Kaur suggested that colleagues try leading with, "I may mispronounce your name because it is new to me, so I will spell it out and let you introduce yourself," or "There is a name in this room I do not know how to pronounce, and I would be grateful if you could teach us how to correctly pronounce your name."

Or, if there is time, you can avoid putting your colleague on the spot in front of their peers by asking them ahead of the meeting or asking someone who works with them.

In her article, Tulshyan shared how a professional award she received was tainted by how the emcee butchered her name. "I would've been delighted if she had clarified the pronunciation in the 10 minutes we were chatting before we went up on stage," she wrote.

2. Don't avoid saying your co-worker's name because it's hard for you to pronounce.

If you don't know how to say a co-worker's name, you cannot give up and avoid it.

"People's names are not mistakes, so we shouldn't be saying, 'I'm so sorry, I just can't get your name right.' We should be trying harder," Kaur said. "I know for me, having a name that isn't easily understood in English, it does make me feel more understood and seen for someone to at least try."

Tulshyan said that thinking it's not a big deal not to say someone's name is the biggest mistake people make.

"It really comes down to awareness and being thoughtful," she said, adding that because she has experienced all too often the cringey moment of "Oh, hello, welcome Miss... uhh... hi," she now knows to ask other people, "Can you please pronounce your name for me?" And if they do share, to really actively listen.

If you do mispronounce a colleague's name, don't make an apology about how hard it is for you to get it right. Apologize and hold yourself to a promise to do better the next time.

"Apologies should be rooted in accountability," Kaur noted.

3. Don't use a nickname without your co-worker's permission.

Your co-worker gets to decide when it is appropriate for you to use a nickname for them. Don't request that of your co-worker because you believe it is too hard to say their name.

Lawrese Brown, the founder of C-Track Training, a workplace education company, says this is a common mistake she sees people make.

"Sometimes when people's names are uncommon or unfamiliar to us, we jump ahead and say, 'I'm just going to call you 'Nic' or ... 'Mo' ― No! If that's not a name the person goes by, then don't use it," Brown said.

Don't assume that a nickname is a welcome way to address your colleague.

"If I'm the one who has the name, I can offer a solution maybe, but for you to just pitch a solution on, 'Oh, can I just give you a nickname?' It's like, 'No, you can't. We're not friends, we are colleagues,'" Kaur said.

4. Don't keep repeating their name as you learn it. Practice if you need to, but do it in private.

Sometimes it can take practice to commit a name to memory, but continuing to repeat your co-worker's name in front of them just serves as a reminder that you think of their name as foreign or unfamiliar. Don't make the act of learning to say their name a big deal.

Tulshyan said that repeating the name once or twice is OK, because it communicates that you are being an active listener. But saying it more than that comes across as disrespect.

"It could be perceived as you're making fun of it or you're doubling on making the other person feel like they're different," Tulshyan said.

If you need to say a name more than those few times to get it right, have that teaching moment by yourself. "If I need to practice, I'm going to do it in private," Tulshyan said.

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What Not To Say When You Don't Know How To Pronounce Someone's Name

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Names are how we identify who we are to each other. Knowing how to say a colleague's name correctly is more than a common courtesy: It's the most basic form of respect. It's not just rude to keep mispronouncing a co-worker's name; getting it right is also critical to helping that co-worker advance in their career.

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Three year delivery plan for maternity and neonatal services

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Three year delivery plan for maternity and neonatal services

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https://www.england.nhs.uk/wp-content/uploads/2023/03/B1915-three-year-delivery-plan-for-maternity-and-neonatal-services-march-2023.pdf

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This is a set of tests from Harard Univeisty in America, some not UK rlevant, but an interesting (and quite quick) exercise

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Preliminary Information

On the next page you'll be asked to select an Implicit Association Test (IAT) from a list of possible topics . We will also ask you (optionally) to report your attitudes or beliefs about these topics and provide some information about yourself.

We ask these questions because the IAT can be more valuable if you also describe your own self-understanding of the attitude or stereotype that the IAT measures. We would also like to compare differences between people and groups.

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Note: This site is designed for adults, aged 18 or older.

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Important disclaimer: In reporting to you results of any IAT test that you take, we will mention possible interpretations that have a basis in research done (at the University of Washington, University of Virginia, Harvard University, and Yale University) with these tests. However, these Universities, as well as the individual researchers who have contributed to this site, make no claim for the validity of these suggested interpretations. If you are unprepared to encounter interpretations that you might find objectionable, please do not proceed further. You may prefer to examine general information about the IAT before deciding whether or not to proceed.

If you have questions about the study, please contact Project Implicit at questions@projectimplicit.net. To obtain more information about the study, ask questions about the research procedures, express concerns about your participation, or report illness, injury or other problems, please contact:

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I am aware of the possibility of encountering interpretations of my IAT test performance with which I may not agree. Knowing this, I wish to proceed I am aware of the possibility of encountering interpretations of my IAT test performance with which I may not agree. Knowing this, I wish to proceed using a touchscreen OR using a keyboard.

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On the next page you'll be asked to select an Implicit Association Test (IAT) from a list of possible topics . We will also ask you (optionally) to report your attitudes or beliefs about these topics and provide some information about yourself.

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The Good Ally is an urgent call to arms to become better allies against racism and provides a thoughtful approach, centering collective healing, to do so.

It is a book for those against persistent racial injustice, hungry to expand their knowledge and understanding of systemic racism in Britain and beyond. It uncovers the roots of racism and its birthplace, anti-Blackness.

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If you better consume books by listening, good news, you can download the Good Ally as an audio book narrated by Nova herself, get exclusive content and listen to Nova's dulcet tones coaching and supporting you throughout the process.

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BEYOND SKIN: WHY REPRESENTATION MATTERS IN MEDICINE

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BEYOND SKIN: WHY REPRESENTATION MATTERS IN MEDICINE

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Beyond Skin is a thought-provoking and eye-opening book by Chidiebere Ibe, the creative genius behind the famous Black fetus illustration, and advocate for medical representation.

The book explores the importance of representation in medicine and highlights the disparities in healthcare for people of colour. The author delves into his personal story, sharing his journey and experiences, and how he has used art to challenge the status quo, and bring attention to the need for diversity and inclusion in medicine.

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Beyond Skin is a thought-provoking and eye-opening book by Chidiebere Ibe, the creative genius behind the famous Black fetus illustration, and advocate for medical representation.

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Using a step-by-step reflection process, she encouraged people with white privilege to examine their racist thoughts and behaviors. Thousands of people participated in the challenge, and more than ninety thousand people downloaded the Me and White Supremacy Workbook. Since then, the work has spread to families, book clubs, educational institutions, nonprofits, corporations, event spaces, and more.

Based on the original workbook, Me and White Supremacy leads readers through a journey of understanding their white privilege and participation in white supremacy, so that they can stop (often unconsciously) inflicting damage on Black, Indigenous and People of Color, and in turn, help other white people do better, too. The book goes beyond the original workbook by adding more historical and cultural contexts, sharing moving stories and anecdotes, and includes expanded definitions, examples, and further resources.

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DO YOU WORK IN MATERNITY CARE? USE THESE FIVE STEPS TO HELP REDUCE INEQUALITIES IN MATERNITY CARE

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DO YOU WORK IN MATERNITY CARE? USE THESE FIVE STEPS TO HELP REDUCE INEQUALITIES IN MATERNITY CARE

The Royal College of Obstetricians and Gynaecologists (RCOG) and Five X More are working together to eradicate maternal health disparities in the UK. Currently, Black, Asian and minority ethnic pregnant women are more likely to have worse experiences in the maternity care setting, or even die during pregnancy and childbirth, when compared to white women. We have developed five actions for healthcare professionals to adopt that will help drive change, change attitudes and put an end to these devastating inequalities.

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DO YOU WORK IN MATERNITY CARE? USE THESE FIVE STEPS TO HELP REDUCE INEQUALITIES IN MATERNITY CARE The Royal College of Obstetricians and Gynaecologists (RCOG) and Five X More are working together to eradicate maternal health disparities in the UK.

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https://nursingclio.org/2020/11/05/the-racist-lady-with-the-lamp/

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Tags: Florence Nightingale, nurses, Nursing, Racism By Natalie Stake-Doucet * Nursing historiography is centered on whiteness. Even worse, nursing history revolves largely around a single white nurse: Florence Nightingale. This, unfortunately, doesn't mean nurses understand who Nightingale was.

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Translated text of birthrights

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Your basic birth rights - translated - Birthrights

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It’s really important that women and birthing people and those that care for them, understand basic birth rights in maternity care. It is vital that conversations that lead to decisions, start from a shared understanding of what an individual can or can’t choose to do and the obligations on maternit…

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If you need emergency food, want to make a food donation or are interested in volunteering, find your nearest Trussell Trust food bank using our map.

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A national network safeguarding the welfare of destitute families, adults and care leavers who are unable to access benefits due to their immigration status.

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Isaac Ashe & Rob SissonsBBC News, Nottingham

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Nottingham: New mums report racism in hospitals, says maternity lead

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One woman, whose child had died, said she saw a staff member mimicking her accent and mannerisms.

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If you think this is all ancient history, take a look here

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If you think this is all ancient history, take a look here

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Publisher apologises for ‘racist’ text in medical book

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A book detailing how to deliver pain relief to ethnic groups has been removed after criticism on social media

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Senior nurse wins ‘landmark’ race discrimination case against NHS

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Senior nurse wins ‘landmark’ race discrimination case against NHS

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Parliament's Women and Equalities Committee discussing Black maternal mental health on 30/3/22

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Parliament's Women and Equalities Committee discussing Black maternal mental health on 30/3/22

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Witness(es): Dr Christine Ekechi, Co-Chair, Race Equality Taskforce, Royal College of Obstetricians and Gynaecologists; Amy Gibbs, CEO, Birthrights; Professor Marian Knight, Professor of Maternal and Child Population Health, National Perinatal Epidemiology Unit; Tinuke Awe, Co-founder, Five x More

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Subject: Black maternal health: one-off

Witness(es): Dr Christine Ekechi, Co-Chair, Race Equality Taskforce, Royal College of Obstetricians and Gynaecologists; Amy Gibbs, CEO, Birthrights; Professor Marian Knight, Professor of Maternal and Child Population Health, National Perinatal Epidemiology Unit; Tinuke Awe, Co-founder, Five x More

Subject: Black maternal health: one-off

Witness(es): Dr Christine Ekechi, Co-Chair, Race Equality Taskforce, Royal College of Obstetricians and Gynaecologists; Amy Gibbs, CEO, Birthrights; Professor Marian Knight, Professor of Maternal and Child Population Health, National Perinatal Epidemiology Unit; Tinuke Awe, Co-founder, Five x More

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Subject: Black maternal health: one-off Witness(es): Dr Christine Ekechi, Co-Chair, Race Equality Taskforce, Royal College of Obstetricians and Gynaecologists; Amy Gibbs, CEO, Birthrights; Professor Marian Knight, Professor of Maternal and Child Population Health, National Perinatal Epidemiology Unit; Tinuke Awe, Co-founder, Five x More Subject: Black maternal health: one-off Witness(es): Dr Christine Ekechi, Co-Chair, Race Equality Taskforce, Royal College of Obstetricians and Gynaecologists; Amy Gibbs, CEO, Birthrights; Professor Marian Knight, Professor of Maternal and Child Population Health, National Perinatal Epidemiology Unit; Tinuke Awe, Co-founder, Five x More

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Film about Maternity Equity Conversations

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Film about Maternity Equity Conversations

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The story of co-produced Maternity Equity Conversations

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Moving (and potentially distessing) film

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We felt that by focusing on bias we could really try to get staff to reflect on race issues from a different and important perspective. We realise how difficult it is to change attitudes unless you are aware of the personal lens of bias that all of us look through.

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Video: Nursing Narratives - Racism & the Pandemic

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Video: Nursing Narratives - Racism & the Pandemic

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This film was made as part of ‘Nursing Narratives: Racism and the Pandemic’. A research project funded by the Arts and Humanities Research Council under the UKRI Covid-19 Urgent Response Call.

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Nursing Narratives - Racism & the Pandemic

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Professor Mirza asks ‘how do we situate the raced and gendered ‘other’ in everyday discourse and why and how marginalised groups articulate alternative world views’.

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Professor Mirza asks ‘how do we situate the raced and gendered ‘other’ in everyday discourse and why and how marginalised groups articulate alternative world views’.

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Professor Heidi Mirza Recording 09 06 2022

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The difference between being "not racist" and anti-racist

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The difference between being "not racist" and anti-racist

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One hour TED interview

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Get a daily email featuring the latest talk, plus a quick mix of trending content.

By subscribing, you understand and agree that we will store, process and manage your personal information according to our Privacy Policy

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Ibram X. Kendi: The difference between being "not racist" and antiracist

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There is no such thing as being "not racist," says author and historian Ibram X. Kendi. In this vital conversation, he defines the transformative concept of antiracism to help us more clearly recognize, take responsibility for and reject prejudices in our public policies, workplaces and personal beliefs.

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Transformation and growth require discomfort, unease, and making mistakes. That doesn't make it easy; even as a lifelong teacher I struggle to be uncomfortable, to sit in that place where I don't know all the answers, to accept my imperfections and the work I still have to do.

The graphic above recently did the rounds on social media as a visual aid for how we can work towards being anti-racist. (It was adapted by Andrew M. Ibrahim MD, MSc from "Who Do I Want to Be During COVID-19" chart (original author unknown) with ideas drawn from Ibram X. Kendi's work.)

This model is based on Tom Senninger's adaptation of Len Vygotsky's zone of proximal development. (If you want more detail this article is a good start https://www.tes.com/news/30-second-briefing-what-zone-proximal-development) What this graphic makes clear is that being in our comfort zones won't make change happen. We need to be vulnerable, open and honest with ourselves.

For those of us who are White, it is uncomfortable to confront how our whiteness has privileged us in many ways. It is uncomfortable to consider how institutions have privileged us over others. However unpleasant it feels, we should embrace this discomfort. It is a gift, a sign that we are unlearning the biases and prejudices we inherited from the societies we grew up in, and we can start making genuine change. It starts with facing the parts of us we least want to, seeing them clearly, and committing to grow.

Anti-racism work is uncomfortable. I think that all inclusion work, done well, should be uncomfortable. Otherwise we aren't growing. And without growth there is no change.

To talk with the Inclusive Employers team about working within your organisation to become anti-racist get in touch at [email protected]

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Becoming anti-racist: it takes discomfort - Inclusive Employers

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Transformation and growth require discomfort, unease, and making mistakes. That doesn't make it easy; even as a lifelong teacher I struggle to be uncomfortable, to sit in that place where I don't know all the answers, to accept my imperfections and the work I still have to do.

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'Me And White Supremacy' Helps You Do The Work Of Dismantling Racism

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'Me And White Supremacy' Helps You Do The Work Of Dismantling Racism

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subscribe to Life Kit podcast

subscribe to Life Kit podcast

Learning about the dangers of systemic racism often leads people to ask: What can I do personally to make a difference?

Layla Saad, an East African, Arab, British, Black, Muslim woman living in Qatar, came up with an impressive answer - a 28-day process that she calls a "personal anti-racism tool" designed to teach those with white privilege how systemic racism works and how they can stop contributing to white supremacy in the world.

Her book is called Me and White Supremacy: Combat Racism, Change the World, and Become a Good Ancestor. It began a few years ago as a 28-day Instagram challenge, evolved into a free PDF digital workbook and has now become a New York Times bestseller. (It was sold out at Amazon when we recorded this interview, but Saad reported that her publisher was working to print more copies.)

Saad's process involves defining terms like "white centering" (the belief that white culture, values and norms are the normal center of the world) and "ally cookies" (the special praise sought by some white people for not being racist). She encourages readers to keep a journal and write answers for tough questions like "What negative experiences has your white privilege protected you from throughout your life?"

This is "the work," as Saad describes it: a tough journey that pushes readers to examine the often-hidden mechanisms of white supremacy and systemic racism in our lives. As an African American journalist who has written more than a few times about the subject myself, I had 1,000 questions for Saad, starting with a simple concept:
The word that struck me as I was reading through your book was "discipline." You're asking for discipline from people - to take on a demanding process with no easy answers.
This is about learning how to identify how you're seen in the world and how you see yourself so that you can essentially betray it. So you can say, "I'm not going to play this game anymore. I'm not going to walk on this earth as if I am superior and treat people as if they are inferior to me."

The first exercise in the book is on white privilege. When you hear "white privilege," you may think, "Yes, white people shouldn't be privileged. But that isn't as bad as white supremacy." When you hear the words "white supremacy," you're thinking of the KKK, neo-Nazis and skinheads.

And what I want people to realize is that white privilege is a part of white supremacy and upholds white supremacy. This isn't about generalizing or stereotyping white people as being somehow deficient or defunct. This is about seeing how you were born into a system that automatically gave you these powers and these privileges.
Why is journaling an important part of this?
Without the journaling, it's just an exercise in intellectual stimulation. You stay at the level of mental thought without any heart engagement. There's something about putting pen to paper, writing down what comes up, that unlocks past memories.

I really want people to understand that what we're talking about isn't conscious. You're not consciously in the world thinking you're superior to people of other races. It's deeper rooted than that. The process of journaling brings into consciousness these ways of being and thinking and believing that you're not conscious of. It's that feeling of seeing a black person walking down the street and crossing to the other side and not even thinking about it. The journaling helps unearth that instinct that kicks in at that moment.
Can you describe what "the work" is and how you came up with the idea for the book?
Despite the title and what people initially think when they see it, it's not for the "bad people." It's written for the people who think they aren't racist. Who say they don't see color. Who have black friends. Who voted for Obama. It's written for the people who really think they're allies.

In the book, I quote Martin Luther King Jr. and his letter from a Birmingham jail. He talks about [how] one of the greatest stumbling blocks to progress is actually the white moderate who doesn't see themselves as the problem. But through their silence, through their inaction, through saying, "Wait," they actually uphold white supremacy.

I wanted to write this book as a process for people to walk themselves through these issues and ask themselves, "How does white supremacy show up in my life?" Because white supremacy is playing out in your life and in your everyday interactions with people in your life.

As you begin to switch on the light and see how this plays out within you, you begin to change your behaviors and you begin to influence the people around you. Systems are maintained by people. But systems can also be changed by people.

For example, a school is a system. So if you're a parent and you see that subtle and not-so-subtle racism is taking place at your child's school, then you'll start to take responsibility for these actions if you're opening your eyes to your own racism. You'll start to hold the school accountable to create an environment where all children and staff members feel like they matter.
What do you think is the biggest obstacle or the toughest challenge for white people when they decide they want to take on this challenge?
People get stumped on white exceptionalism.
Can you define that?
White exceptionalism is this idea that I, as a white person, am actually one of the good ones. I think white exceptionalism is actually what drives a lot of people to buy my book in the first place, because I think that they have this belief that they're one of the good ones. An ally buys a book like this.

I think white exceptionalism is very dangerous because it separates the "good" from the "bad." And there is no good or bad. This isn't about your inherent goodness as a person. We're talking about the ways you're unaware of causing harm to other people. Because you're not aware. And so that's what we're bringing into the light.

You're going to have to redefine good. What does it mean to you to be good? Is it that everyone else thinks you're not racist? We see this with brands right now. Businesses are putting forth Black Lives Matter statements because they want everyone to know they're not racist and are doing the work. A statement isn't proof that you're one of the good ones. A statement shows that you have caught onto the fact that you need to say something or otherwise you're going to be perceived as agreeing with or co-signing that black lives don't matter. But that's not the work.

The work is digging in and looking at how you treat black people - your staff, your customers, your clients. What policies do you have in place, whether written policies or unofficial policies, that show us black lives don't matter here?
What are the benefits and drawbacks of doing this work on your own versus doing it as a group?
I don't think there's necessarily one preferred way or another. It's about returning to this work again and again and knowing there are benefits to doing it alone and to doing it with a group.

One of the things that people have to be wary of in the group is this idea that, "We're in this group, and we do this work. So we are the good ones." It can be dangerous when white people start congratulating one another for being good allies.

I think the benefits of doing it in a group is that you get to see and understand that it's not just you who is digging up these unconscious racist thoughts and beliefs that are very ugly. You get to hear from other people, which may spark things for you.

So, for example, you may read one of the [chapters] and think, "I don't center myself or think I'm exceptional." But if you're in a group with other white people and they tell you the ways they center themselves or find themselves exceptional, it might help you see how you also do certain behaviors that fall under white centering or white exceptionalism.

What we're trying to do is not just create individuals who are doing this work, but really a culture of doing the work - a culture of anti-racism. But I also think that shouldn't be a deterrent if you can't find community.
If you had to break it down, what are the three important things people can do to work on themselves and help unwind white supremacy?
Number one is, this work begins and ends with yourself as an individual. The one place where you have complete control is within yourself. So when you think - "Where do I start? What do I do?" - it's you. You need to start with you first. If you start doing things outside of yourself, if you think that you're here to save black and brown people, remember you're not here to save us. You're here to see the ways in which you are already causing us harm and stop doing that.

Second, impact the people you are in relationships with - your parents, your kids, cousins, friends, bosses, whoever. You have the ability to influence those people. So take what you've been learning about yourself, and have those conversations with the people with white privilege in your life. Because when you've been doing the work within yourself, you're actually able to understand what they're thinking from a more empathetic point of view, as opposed to just preaching at them and saying, "That's racist." Sometimes the call-out is necessary, but for long-term change we need ongoing meaningful conversations.

Lastly, look at the systems around you. What do you benefit from? What do you create and sustain? And how can you change those things? We can't wait for the lawmakers and the policymakers and the politicians to change things. They have a vested interest in things staying the same. But you as this collective can [effect] change by saying this isn't actually what we want - we're going to hold you accountable to a different world.
We'd love to hear from you. Leave us a voicemail at 202-216-9823, or email us at If you want more Life Kit, The audio portion of this story was produced by Clare Schneider. subscribe to our newsletter. LifeKit@npr.org.

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'Me And White Supremacy' Helps You Do The Work Of Dismantling Racism : Life Kit

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There's been a lot of talk about the work white people need to do to understand their role in racism. Layla Saad's book, Me and White Supremacy, helps readers do just that. Saad explains why it's important to dig into the uncomfortable work, why being an ally isn't enough, and ideas to combat white supremacy in your everyday life.

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The ‘People Like Us’ project is hosting a series of wellbeing and mental health chats with our partners from West London NHS trust. There will be a series of short live Q&A’s with our NHS partners to discuss topics that impact our mental health and wellbeing.

In our second session of the series, we will be discussing microaggressions and how they can contribute to mental health and wellbeing. Microaggression’s have a powerful, negative cumulative effect on mental health. The sessions will explore the impact of this and discuss new skills to manage emotions.

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Importance of diversity in medical illustrations

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Importance of diversity in medical illustrations

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How Diversity in Medical Illustrations Can Improve Healthcare Outcomes | Chidiebere Ibe | TEDxIHEID

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Not all superheroes wear capes - you have the power to change the world | Nova Reid | TEDxFrankfurt

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Not all superheroes wear capes - you have the power to change the world | Nova Reid | TEDxFrankfurt

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Not all superheroes wear capes - you have the power to change the world | Nova Reid | TEDxFrankfurt

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Report on the systemic failures to protect women and children from sexual violence and abuse in asylum accommodation.

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Our joint report with Imkaan on the systemic failures to protect women and children from sexual violence and abuse in asylum accommodation.

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Maternal Health Inequalities in Gypsy, Roma and Traveller Communities

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Maternal Health Inequalities in Gypsy, Roma and Traveller Communities

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A little cartoon Exploring Empathy and Sympathy

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A joint research report by Birth Companions and Revolving Doors Agency.

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A joint research report by Birth Companions and Revolving Doors Agency.

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Saving Lives, Improving Mothers’ Care 2024 - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2020-22 | MBRRACE-UK | NPEU

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The National Perinatal Epidemiology Unit (NPEU) is a multidisciplinary research unit based at the University of Oxford. Our work involves running randomised con

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Interpreting & Translation Services | LanguageLine UK

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Language Line is a UK language translation service agency that provides a wide range of interpreting, translation and localisation agency services.

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SayHi Translate lets you have a conversation in two languages and easily understand each other. Just tap a button and start speaking. 90 languages and dialects are available. Start a conversation today with SayHi Translate on iOS and Android.

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Google’s service, offered free of charge, instantly translates words, phrases, and web pages between English and over 100 other languages.

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Trans, non binary experiences of maternity care

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Trans, non binary experiences of maternity care

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Trans, non binary experiences of maternity care

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Ethnicity and maternity systematic review 

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Ethnicity and maternity systematic review 

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Ethnicity and maternity systematic review .2021.29.2.100

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Today, Wednesday 30 March 2022, marks the publication of our final report of the Independent Review of maternity services at The Shrewsbury and Telford Hospital NHS Trust. Our independent multi - professional team of midwives and doctors including obstetricians, neonatologists, obstetric anaesthetists, a physician, cardiologist, neurologist and others have examined the maternity care and treatment provided to 1,486 families over two decades at the Trust.

This report identifies more than 60 Local Actions for Learning for the Trust and another 15 key Immediate and Essential Actions to improve all maternity services in England, including financing a safe and sustainable maternity and neonatal workforce and ensuring training for the whole maternity team meets the needs of todays maternity services. We state that trust Boards must have oversight and understanding of their maternity services. Trust boards must ensure that they listen to and hear local families and their own staff.
Read the Final Report | Read the Press Release
This is the official website for the independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust.
The review was commissioned in 2017 by the then Secretary of State for Health and Social Care, Jeremy Hunt MP. Since the original launch of the review many more families have come forward with concerns about their care.

Donna Ockenden is leading a team of independent health professionals to review cases of serious and potentially serious concern in maternity services at the Trust. We would like to hear from anyone who feels that they or their family have a potential case of significant concern and ask that they please get in touch by the end of May, 2020.

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Ockenden Maternity Review | Independent review of maternity care at Shrewsbury and Telford Hospitals NHS Trust

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Today, Wednesday 30 March 2022, marks the publication of our final report of the Independent Review of maternity services at The Shrewsbury and Telford Hospital NHS Trust. Our independent multi - professional team of midwives and doctors including obstetricians, neonatologists, obstetric anaesthetists, a physician, cardiologist, neurologist and others have examined the maternity care and treatment provided to 1,486 families over two decades at the Trust.

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The Black Maternity Experiences Report

A nationwide study of Black women's experiences of maternity services in the United Kingdom.

Despite the stark disparities in maternal outcomes, Black women's voices and lived experiences have been notably absent from the literature. The findings in this report highlight the urgent work needed to ensure that rapid improvements are made - because a positive birthing experience is deserved not just by some, but by all.

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Black maternal experinces report - FIVEXMORE

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A nationwide study of Black women's experiences of maternity services in the United Kingdom. Despite the stark disparities in maternal outcomes, Black women's voices and lived experiences have been notably absent from the literature. The findings in this report highlight the urgent work needed to ensure that rapid improvements are made - because a positive birthing experience is deserved not just by some, but by all.

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A grassroots organisation committed to changing and highlighting Black maternal health outcomes in the UK

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WE NEED YOUR HELP

Our team is working tirelessly to increase awareness of the disparities in maternal mortality rates for black women in the U.K.

With your support Five X More has an ambitious and exciting plan to play a leading role in eradicating the statistics for good.

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Our team is working tirelessly to increase awareness of the disparities in maternal mortality rates for black women in the U.K. With your support Five X More has an ambitious and exciting plan to play a leading role in eradicating the statistics for good.

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A series of films from the SWL Perinatal Equity Group

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A series of films from the SWL Perinatal Equity Group

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Please be aware that some content may be triggering

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PEGs Video 3  The Conversation is Urgent

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Black Maternity Experiences Report 2025 — FIVEXMORE

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Pregnancy and Parenting App Specifically Designed For Black Mothers & Women

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Five X More Black Maternal Health App and Maternity Support for Black Mothers — FIVEXMORE

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The Five X More Learning Hub App provides Black mothers with culturally tailored pregnancy and parenting support. Join a community dedicated to improving Black maternal health and access expert resources. Available on Apple and Google Play.