Black and pregnant in the Australian health system
— By Lucie Cutting
I am a woman of colour, who proudly identifies as Nigerian-Australian. My partner is Anglo. We live in a mostly white community.
We’ve had more than one conversation about skin colour, objectification, and being a black person in a town where black people aren’t common enough to no longer be viewed as exotic and without curiosity. He has become just as keenly aware of the ‘where are you from?’ question as I, and the various frustrations that come with it. When we discovered that we were expecting a child, the lows of black and interracial objectification suddenly became a burden we shared in a new way. No longer were these experiences singularly mine to relay to my partner, these experiences became conversations that involved our soon to exist child.
‘Where are you from?’ a sonographer asks as I have my first trimester scan with my partner by my side. I explain my cultural background thinking it is relevant to the health of my baby. ‘You’ll have such cute mixed-race babies’ she responds with delight. ‘That’s not guaranteed’, I murmur back with a begrudging smile.
In the next room, and on a future visit, a clinician works through my paperwork with me, and stumbles on a checkbox.
‘I have to apologise, we usually would never do this without asking...but someone has put you down as black’.
‘That’s okay, I am - I mean, my mother is black and my father is white so technically I could be either’.
‘….you could be Tasmanian Aboriginal…on our paperwork they get listed as white…’
‘Sorry, we’d usually never check that box without asking…I don’t know why someone did’.
‘It’s okay. I’m black. I’m okay'.
Conversations centred on my skin colour are so regular that I blithely pass over or detour around them. The frustration and missed opportunity for a questioning retort only become evident in the stories retelling. Why am I consoling a health professional who has noticed I have been listed in the paperwork as a black person without first checking? Is their mounting embarrassment indicative of a deep-seated, or perhaps subconscious, belief that it’s always more desirable to be white?
These are questions I shouldn’t have to ask, or try to understand as part of my journey into motherhood.
In the final month of my pregnancy we visit the local public hospital in preparation for labour. A midwife guides us through the maternity ward with a small group of other expectant parents. She momentarily leaves the room with the promise of something special upon her return. That something special is a baby, perhaps two days old. We all admire the newborn and in the silence the midwife starts to talk.
‘She’s just a few days old, her mum is Thai and her dad Australian - so a beautiful mix.’
We’re the only interracial couple in the room and I’m suddenly very aware of the fact. I side-eye my partner, but we remain silent until we’re back in our car and travelling home.
‘Wow’ I say, ‘was that comment at all necessary?’.
I know the answer. Of course it wasn’t - but objectification seems to be the status quo. While these questions seem harmless, they work to erode a person of colour’s faith in the medical system. If medical professionals objectify, exoticise and denigrate the colour of your skin, it opens up the possibility of other types of racism and a different health experience.
Following an emergency cesarean a medical professional forgets to give me an important dose of pain relief. As the local anaesthetic wears off I start to experience excruciating pain. It’s worse than the two nights of contractions I’ve just been through. It’s the pain of layers of muscle and skin recently cut through and sewn together after a baby has been ripped out and your insides stuffed back in.
I press the buzzer and explain what’s happening. I’m gasping for breath, I have tears running down my face, my teeth are clenched. The nurse asks if I received pain relief, I say no and she glances at me with a seemingly suspicious look before leaving the room with the promise that she’ll ‘look into it’. I sit for another forty minutes and through two more requests for pain relief. When it eventually arrives it takes another thirty minutes to kick in.
A part of my mind questions if my request would have been taken more seriously, and dealt with more swiftly, if my skin were white.
I may be wrong about this (I hope I am). Nevertheless I am right when I say racism in healthcare exists.
In 2014 a survey of 755 Aboriginal Australians found that 97 per cent of participants had experienced at least one racist incident in the previous twelve months in health settings. Nearly one third experienced racism in hospitals and healthcare specifically. Some of the most frequently experienced examples of racism included jokes or teasing, or hearing comments that relied on stereotypes of Aboriginal Australians. 
In the United States research has found African-American women are disproportionately affected by pregnancy-related morbidity and mortality. From the period of 1998 to 2005, African American women were three to four times more likely to die from pregnancy related complications at every age interval compared with women of other races.  The numbers are just as alarming in the United Kingdom. The most recent statistics show that black mothers are five times more likely to die during their childbearing years than their white counterparts. The damage does not end there. Black babies are also at risk and are 50 per cent more likely to suffer neonatal death compared to white babies. 
‘The effects of racism and unconscious bias are difficult for African American women to avoid, because race and ultimately racism are based on physical characteristics (i.e., skin colour)’. 
Being black in the Australian, United Kingdom, and US health systems is a liability.
Unfortunately I’m not surprised by my experience as a pregnant black woman in the Australian healthcare system, my family and I have experienced or witnessed racism in almost every other facet of life. For my mother, it was at the hands of patients she treated during the 1980s and 90s as a nurse.
In 2015 I saw my first glimpse of it as I prepared to enter the Australian health system as a health professional. I moved to Tasmania that year to study nursing at the University of Tasmania. I dropped out of the degree after a mere six months. I’ll admit I found the workload of a fast track degree too much without family or government support, and I also quickly lost interest in the topics of study. In that first semester I did not learn much about nursing, but I did learn that some of my peers held deeply racist views that they would soon take into the healthcare system.
During the semester I attended an out of hours class in the northern suburbs of Hobart. I’d taken public transport and following the end of the session a fellow student offered me a lift back into the city. I took it gratefully but regretted the decision soon after.
In that short car ride we discussed my racial background and the woman, who seemed confused about what my skin colour represented, casually remarked that it was good I was ‘coloured’ and not black because ‘all black people are savages’. I was stunned. I argued against this point and she argued back, ‘no, they’re all savages in the end’. This nursing student had such a deep-seated hate of black people, how could she be trusted to care for anyone who is not white? And how can the system ensure people like this do not end up in positions of care?
It cannot, but changes can be made.
At present there is little research into how racial bias influences healthcare in Australia, but interest in the topic is growing.
Dr Shona Kambarami, an African-Australian women’s health professional and writer, has a special interest in racism and sexism in Australian obstetric care. She is in the process of writing a book on how Black women in Australia encounter racism in, and are thus mistreated by, the health system during pregnancy.
Dr Kambarami believes a multi-pronged response is required to address the issue. The first step is acknowledgement that medicine in its current form is inherently racist, ‘from the origins of some medical specialities built on the inhumane experimentation of non-white people to modern international standards, which are mostly built on white (male) bodies’. Dr Kambarami believes acknowledgement should include teaching on Medicine’s role in systemic racism (and its outcomes) in medical schools, as well as public awareness campaigns targeted at changing how health care is provided to a diverse Australia.
‘Cultural sensitivity in healthcare isn’t an accommodation to non-white people, it is good medicine. If you alienate people, they are discouraged from engaging in the medical system’, which for some can have dire consequences.
Dr Kambarami believes other approaches to tackling racism in healthcare include diverse staff, which could lead to better health outcomes for the whole community, and zero tolerance for racism. ‘Not just racist talk, but medical racism’ states Dr Kambarami, referencing ‘the built-in belief in healthcare that what works for Caucasians is universal, and that any deviation is a result of personal (or community) failure of non-white populations.’
Such initiatives have the potential to vastly improve the experience a person of colour has when they enter the Australian healthcare system and, with the addition of public awareness campaigns, place greater pressure on health providers to deliver better services.
My son was born in March of this year. He had complications and will need support throughout his life. He’s had more doctors appointments and tests in his four months of existence than I have had in my entire life.
His journey into the Australian health system is only just beginning.
What I have learned from my own, I will reiterate with him.
If I’m not comfortable with a doctor or other health practitioner, I’ll switch. If I feel I’m not being taken seriously, I’ll ask again. If I disagree with a decision, I’ll question it.
While it is important for the current system to change, at this point in time my health outcomes partially rely upon my ability to stand my ground because I am equal. As is my son.
Published July 2019