Working towards racial equity within obstetrics and gynaecology in the UK
“One of my primary ambitions as President is to continue the progress made by the College in recent years as we work towards ensuring racial equity within the specialty. Inspired and supported by the passion, insight and dedication of our membership I know we can create a profession where everyone has the same opportunities to achieve success and feel listened to and supported throughout their career.” – RCOG President Dr Ranee Thakar
Confronting racism and cultural bias in Obstetrics and Gynaecology is imperative for achieving equitable and high-quality health care outcomes.
It is concerning that racial and ethnic inequities are still being reported in the careers and day-to-day working lives of O&G professionals, and in women’s health outcomes and experiences of care across their life course.
We have recently reviewed and refined our role in this area and are developing a plan for future work that is sustainable and continues to contribute to the wider field of race equality in health and medicine.
This work will carry forward the legacy of the Race Equality Taskforce, founded by previous RCOG President Dr Edward Morris and co-chaired by Dr Ranee Thakar and RCOG spokesperson Dr Christine Ekechi, to drive forward the College’s focus on these issues. We are hugely grateful for the time and expertise of all co-chairs and participants of this group.
Future work on race equality
The diversity of, and breadth of clinical expertise of our membership is a valued strength of the College. The RCOG has a unique role and sphere of influence in this area in the support we offer to members, both in terms of high quality clinical products and in support in the workplace during their careers – both areas central to the College’s strategic goals for 2020-2025.
Reflecting these strengths and remit, a future focus on addressing racial inequity in the O&G profession and supporting our membership in the delivery of care will allow us to have the greatest impact.
Tackling racial inequity in women’s health outcomes will remain at the core of all College work on maternity safety. We will also continue to work to improve the health of women and girls throughout their life course, support and respond to the work of expert organisations by reviewing recommendations, provide outcome data from the National Maternity and Perinatal Audit (NMPA) in partnership with others, and participate in expert groups.
Future work will also recognise the significant intersection between racial equity and environmental sustainability, another Presidential priority. The climate and biodiversity emergency is tightly wound with the exploitation of racially minoritised people, and in the UK environmental harm can disproportionately impact racially or ethnically minoritised people.[1]
This ambition sits alongside, and is supported by, our work to become a diverse and inclusive employer.
RCOG’s current work on race equality in the specialty
Racism, discrimination and differential attainment – disparities in average educational or career outcomes between different groups of individuals – are found throughout medicine, including across the professional life cycle of obstetricians and gynaecologists in the UK.
The RCOG is committed to working towards racial equity in the UK, through listening to our membership, raising awareness and sharing examples of good practice that can overcome differential attainment and workplace discrimination.
In 2023, we published Levelling the playing field: RCOG differential attainment, race and racism report (2023).
This paper summarises the findings of focus groups with RCOG membership ranging in seniority and ethnic background from across the UK. It also showcases examples of targeted individual support, departmental initiatives and national strategies that are making a difference.
This report can be accessed here by RCOG members when you sign into your online account.
We have committed to an action plan with the GMC demonstrating how we are targeting the attainment gap and working towards achieving fair training cultures. This work is overseen by both the RCOG Specialty Education Advisory Committee (SEAC) and the Exams and Assessment Committee as well as the College’s honorary Differential Attainment Advisor and Educational Supervision Champion. These issues have also been explored in past RCOG World Congresses and other quality improvement and development conferences.
Race Equality Taskforce members have published on differential attainment in Obstetrics, Gynaecology and Reproductive Medicine and The Obstetrician and Gynaecologist, and contributed to the development of BMA guidance on induction for International Medical Graduates recruited to the NHS. We have also worked hard to listen to lived experiences of these issues, surveying our membership and holding focus groups for over 400 trainees, SAS and LE doctors, consultants, and medical directors working in O&G in deaneries across the UK. Our annual Training Evaluation Form (TEF) now includes questions on racism and cultural bias. The information gained from these will inform future work.
In September 2022 we launched a coaching skills training pilot, which trained 12 doctors working in O&G, giving them skills to support doctors experiencing barriers to career progression. The RCOG also supports its members in the through the workplace behaviour toolkit and wellbeing resource hub.
Having open and honest discussions about the racism and bias that has been evidenced in maternity services and the profession is important for the College. Bias is a part of being human, and everyone should feel able to recognise and engage in continual learning and reflection on this. This is expanded on in RCOG’s Tackling Racism eLearning course. There are 6 modules available to all free of charge. The content covers what constitutes racism, why we need to address it, differential attainment, the impacts of racism on lived experience and opportunities, and what we can do together to tackle racism.
RCOG’s work on race equality in women’s health
Racial and ethnic inequity in women’s health in the UK exists throughout the life course, including in outcomes or experiences of fertility treatment, gynaecological conditions and cancer screening and diagnosis. Black women remain nearly four times more likely to die during pregnancy or shortly afterwards than white women in the UK, and Asian women nearly twice as likely, with research from organisations including Five X More and Birthrights finding that there is some way to go to before everyone needing maternity care can access it, is listened to, and feels safe.
The causes of these different outcomes are multifactorial, and differ between individual women, their ethnic or racial identity, and intersect with other factors including gender, disability, socioeconomic status and migration status. Racial inequalities in health are also related to structural disadvantages in society whereby ethnic minority women are overrepresented in more deprived groups, which itself can lead to poorer health and barriers to accessing care.
The College has led on work exploring the multifaceted reasons for inequalities in maternity outcomes. In partnership with the Royal College of Midwives, the Royal College of Paediatrics and Child Health and the London School of Hygiene and Tropical Medicine the National Maternity and Perinatal Audit (NMPA) has undertaken research into ethnic and socioeconomic inequalities in maternity and perinatal care, and the COVID Maternity Equality Project (CMEP) aimed to learn how service innovation during the pandemic may have mitigated existing inequalities. A Scientific Impact Paper on the relationship between social determinants of health and maternal mortality also explores these issues.
It is vital that the voices of those with lived experience are at the heart of all work tackling inequities in outcomes, with lay representatives a core part of the NMPA’s activities and the CMEP project. We have also worked with Five X More to create Five steps for healthcare professionals working in maternity care.
We consistently raise research findings and recommendations in our advocacy work, such as with parliamentarians for Black Maternal Health Awareness Week and in oral evidence to the Women and Equalities Committee. We have raised the disproportionate impact of air pollution on ethnic minority women in our calls for stronger action on air pollution in England. The RCOG President sits on groups including the NHS Race and Health Observatory’s Maternal and Neonatal Health Working Group and the UK Government’s Maternity Disparities Taskforce.
Following the publication of our policy position statement on structural factors affecting the health of migrant and asylum seeking women we have continued to regularly advocate for members and women in this area, including at our 2022 World Congress and joining with other organisations to highlight the potential impacts of the Illegal Migration Bill on pregnant women. We are also partners of the Migration And Maternal Health (MAMAH) Study identifying clinical and policy interventions to improve maternity care for underserved migrant women in the UK.
- Runnymede Trust and Greenpeace UK, Confronting Injustice: Racism and the Environmental Emergency (2022); Global Black Maternal Health, Air pollution in pregnancy: Exploring the views and experiences of Black mothers and Black pregnant women living in London (2023)