Women from black and Asian backgrounds in the UK are significantly less likely to receive an epidural during childbirth compared to their white counterparts, according to new research. The findings, based on data from over 2.7 million births, have prompted experts to highlight an “ethnicity pain gap” that affects people of colour across medical settings.
Study reveals specific disparities
The analysis, published in the journal Anaesthesia, examined data collected over a 10-year period up to 2021. It found that women from Bangladeshi, Pakistani, and black Caribbean backgrounds were 24%, 15%, and 8% less likely, respectively, to receive an epidural during vaginal birth compared to white women.
Dr Nuala Lucas, president of the Obstetric Anaesthetists’ Association and co-author of the study, said: “We know that women with ill health during pregnancy, or those who give birth prematurely, may particularly benefit from effective epidural pain relief. It is especially troubling if these are among the women least likely to receive it.”
Broader context of racial inequalities
The research follows a report by Labour peer Valerie Amos on maternity care in the UK, which detailed widespread failings including women being ignored and poor triage. The 181-page report attributed these issues partly to institutional racism. Similar patterns have been documented in the US and Australia.
Bell Ribeiro-Addy, Labour MP and chair of the all-party parliamentary group on black maternal health, said: “The disparities around pain relief identified in this report are shocking and indefensible, but sadly not surprising, given the way black people’s pain has historically been doubted, downplayed and dismissed.” She added that the findings are “inseparable from the wider context of racism and racial tropes such as the ‘strong black woman’.”
General anaesthesia disparities in caesarean births
The analysis also found that black Caribbean-British women were 58% more likely than white women to receive general anaesthesia during elective caesarean births, while black African-British women were 35% more likely. Regional anaesthesia (spinal or epidural) is considered safer and leads to quicker recovery; general anaesthesia is typically reserved for emergencies.
Studies have reported that black women are often stereotyped as having “thick skin” and being able to tolerate pain, while Asian mothers are described as “princesses” who are “overly demanding.”
Patient experiences and systemic distrust
Research from the University of Oxford, shared with the Guardian, found that many women from black and Asian backgrounds felt dismissed or ignored by healthcare professionals when discussing pain relief options. Many were fearful to speak up and felt excluded from decisions. The study concluded that an “atmosphere of systemic distrust” exists between ethnic minority women and healthcare practitioners.
Dr Lisa Hinton, lead author of the study, said: “Maternity inequalities are well documented, but we urgently need to understand what lies behind the figures. Ethnic disparities in maternity care, including experiences of pain relief, are shaped as much by communication and trust as by access to treatment – women need dialogue, not just options.”
Calls for action and improved data
Fiona Gibb, director of midwifery at the Royal College of Midwives, stated: “Any suggestion that women’s pain is not taken seriously, or that access to appropriate pain relief differs by ethnicity, is completely unacceptable. More consistent data collection is essential.”
Dr Christine Ekechi, a specialist in gynaecology from the Royal College of Obstetricians and Gynaecologists, said the body had “seen the data that black and brown women are less likely to receive an epidural at the point at which they ask for it. We should not be seeing these disparities by way of race. So what is important is for us to improve our understanding as to why that is happening and then to also close that gap.”
Ribeiro-Addy emphasized that eliminating inequalities requires addressing “everything from culture to resourcing and staffing. Report after report has outlined how black women experience discrimination, racism and unequal care in maternity settings. We must embed a stronger anti-racist culture in our healthcare institutions. We must also ensure that the staffing and funding levels are there to provide every woman with the high standard of care she deserves.”
Kate Brintworth, chief midwifery officer for NHS England, said: “Racism and discrimination have absolutely no place in the NHS, and every single pregnant woman should be listened to and involved in decisions about her pain relief. That’s why this week’s 10 point plan for maternity and neonatal services requires all trusts to roll out perinatal equality and anti-discrimination training for their staff by the end of the year.”
