‘The NHS is wonderful, but it is also a microcosm of our society. The same inequalities are played out’

Shakia Stewart, 34, global head of content, British Council, London

I always wanted to have children, and my first pregnancy, in 2019, was a really positive experience overall. I was exhausted and had nausea, but zero complications, and we’d conceived easily too. Some women are understandably terrified of birth, but I couldn’t wait, and I desperately wanted to do it at home.

As our due date approached, we had all the plans in place, but at a late-stage scan doctors detected an excess of amniotic fluid. When I still hadn’t gone into labour naturally just shy of 42 weeks, they pretty much insisted on inducing me.

I was on the induction drip for 18 hours, but eventually had to be taken for an emergency C-section. The whole experience was so beyond what I had wished for. There was so much going on, I didn’t even realise they had lifted my baby – a boy we named Kofi – out of me. I didn’t get to hold him or have skin-to-skin contact for more than two hours. It’s hard to feel like you have agency when you’re under someone else’s knife.

The feelings of failure, disappointment, sadness and trauma were overwhelming – every time he cried, I believed he was angry with me about how he’d been brought into the world. It took a long time to start to come to terms with how horribly my first pregnancy ended.

When I got pregnant again, in 2021, it began relatively easily. I desperately wanted a vaginal home birth this time, so I did lots of research before meeting a consultant. She spent less than two minutes with me before declaring: “Looking at you, I don’t think the question is whether you can have this baby at home, but vaginally at all.” “Looking at what,” I thought. It felt to me that she was assessing me based on my skin colour.

The NHS is a wonderful service, but it is also a microcosm of our society. The same inequalities are played out in a hospital setting, and the same outcomes replicated. The Black maternal experience is a symptom of this, and that consultant was, for me, the mouthpiece for inherent biases and snap judgments.

I felt second-guessed and distrusted by my healthcare providers at so many points during my two pregnancies. It was a lot of little things – odd comments, tones of voice, dismissive answers. I had to fight to feel in control. At one point during my first birth, I couldn’t feel the contractions showing on the monitor. The doctors looked at me like I was crazy or lying. I felt compelled to apologise even though I had nothing to apologise for.

I knew the risks to me, as a Black woman, before getting pregnant. However, I am also mixed race, and I have an English accent. I can acknowledge that my life has been made easier by not being darker. Perhaps this is why I didn’t feel the need to arm myself with the details; I avoided reading about these risks wherever possible during my pregnancy. But my lighter skin colour did not protect me entirely: to some, I am still seen as an “other”.

The fact that Black women are four times more likely to die during pregnancy than white women is not down to a few bad apples – if it was, it would be easier to fix. The fact is, those who have the power to change things don’t care enough to do so, because the issues don’t directly affect them. So there is a lack of training, education and understanding, which means health professionals like that consultant can’t see how or why their words or actions are the wrong ones. Staff across all healthcare areas need to understand that many of the conditions that put Black women more at risk are driven by these external factors. It’s devastating that something as important as a person’s health could be impacted by them.

I learned so much during my first pregnancy, and in the end decided on an elective C-section for my second birth. It was a much more positive and peaceful experience than the first time around. Having gone through both types of C-section, I know just how much you need to feel like you’ve been listened to, and not like you’ve been pushed down a certain route. It can make all the difference; it did for me.

Throughout my pregnancy there was a whole narrative playing in my head: what are my babies’ lives going to be like in this society? Racial injustices cross every social level – you can want for nothing and still worry about their future. If, in 20 years’ time, that consultant was assigned to look after my daughter’s pregnancy, I would want to remind the doctor that the facts are crucial, but they only say so much. All pregnant people need treating on a personal, human level. Black women should be no different.
• Shakia had her baby in October 2021

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‘Being pregnant and giving birth in China as a Black woman is, shall we say, interesting’

Olivia Mendy, 38, preschool teacher, Shanghai, China, now living in Toulon, France

When my husband visited China as a student just over a decade ago, he became convinced it was the future. Then, one day, he cajoled me into moving there from our home in France. At the time, I was five months pregnant with our first child. I was sleeping well and eating well, and had no complications, so I was as active as a rabbit, doing anything and everything.

We settled in Shanghai, but went back to France for a couple of months for Jillian’s birth, because at the time I didn’t speak Chinese and I wanted to be somewhere familiar. After she arrived, we began to put down roots and learn the language. It meant that when we had our second, Malcolm, four years later, we were able to stay in China rather than pull Jillian out of school. My second pregnancy was much harder. I had all the classic symptoms: heartburn, insomnia, nausea and sciatica.

Jillian and Malcolm are now 10 and six, respectively, and I’m pregnant with my third child. It’s been harder going still, because I’m 38. I always used to say: “Age is just a number.” Now I want to lie in bed and yell: “Leave me alone!”

Having the language has certainly made pregnancy and birth easier than it would have been. Non-Chinese-speaking women here often need to go to a private hospital to access foreign doctors who speak their language. If you don’t have the money or the insurance to cover that, it’s a gamble whether you’ll find English staff at your local government hospital.

It’s incredibly expensive to have a child in Shanghai. The initial blood tests to check my thyroid, hormones and iron was ¥30,000, which is about £185. My next appointment cost ¥20,000. They won’t tell you the total price of each appointment until afterwards, which is frustrating.

When you first arrive in China as a Black person, you think there are no other people like you in the entire country, but there are. You just have to find them. I’ve had a pretty good experience overall, aside from the stupid questions: “What do you eat?” and “Do you wash your hair?” They aren’t asked out of malice, just ignorance. Being pregnant and giving birth in China as a Black woman is, shall we say, interesting. With all my pregnancies, doctors panicked about the size of my belly, thinking that I must be expecting twins or that the baby was too big for a natural birth. One of my Black friends was told to have a C-section because the baby was big; he was born small, at 3kg (6lb 10oz). I was also taken aback during my pregnancies by old ladies coming up to me in the grocery store to tell me I shouldn’t be drinking this or eating that. In Europe we mind our own business.

Back in France, I had to have a C-section with Jillian, but I insisted on a vaginal birth with Malcolm. I’ve heard of vaginal births after C-sections (VBAC) being flat-out refused in private hospitals. I had been seeing an English-speaking doctor at the local hospital, and told him what I wanted, but when I arrived at 40 weeks he wasn’t on shift and the staff all freaked out. I insisted again on a VBAC, which they weren’t happy about, and they brought me all sorts of paperwork and waivers to sign. In the end, all went to plan.

I wish I was a little mouse that could go into the hospital to hear the staff talk about vaginal births. It’s like they’re scared or not really trained for them – C‑sections have been practised for years in China, so that’s what they put in women’s minds as the standard. But for me surgery seems riskier, because it’s surgery.

The maternity system is much better in France. It’s free and it feels like the staff are your friends – they take time to talk to you. When I gave birth to Jillian in France, a nurse looked after her on the first day. On the second day she showed me what to do, and on the third day I had a go myself. I stayed six days in total, sharing a room with just one other woman. They want to know you can take care of a baby before they send you home.

In Shanghai, there are just so many women to take care of. You feel part of a chain, just a number. When you start having contractions, you’re put in a room with lots of other women, and only when you’re ready to push is your partner called. Some places don’t allow partners in at all. You leave the hospital as soon as you physically can.

One positive aspect is that the one-child rule is now a thing of the past, and the government wants people to have more children, so they have improved maternity leave and benefits. Unfortunately some companies are trying to get around it or cut corners – they hope their staff won’t know the new laws. But there is a movement of women fighting for their rights that is starting to gain traction.

We moved back to France this year after the two-month lockdown in Shanghai. We just felt it was time to go home. A lot of the Black community left due to Covid – it’s yet to be seen whether they will return.
• Olivia’s baby is due in August 2022

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‘The problem isn’t white doctors, it’s doctors who lack respect, care and humility when their patient is Black’

Louise Whittemore, 36, office manager, Office of the Ombudspersons for Families, Minnesota, US

I fled the civil war in Liberia when I was five years old. We were in a port town and had the opportunity to leave by boat, but the war had separated my family. I left with my mum, auntie, uncle, cousins, brother and sisters, but my dad was missing. We spent the following eight years in a refugee camp in Ghana, where we lived in a tent before building our own house. It was Africa, but it was still a strange land. On 19 February 1999 – I still remember the date – I arrived in the US. I was 13; my mum didn’t come until much later, in 2013.

I’m 36 now, and pregnant with my seventh child. I have two daughters, Mackenzie, seven, and Makayla, six, and a baby son, David, who is one. I also have a stepson, Otto, who is 18. He lives in Liberia, and we live in a small city in Minnesota called Monticello.

I also have two children I lost through miscarriage. Both times I was four months pregnant. I think about them all the time and ask myself if they’d have been boys or girls, if they’d have looked like my other children, if they’d have made me a better person. I imagine holding them. I still have my ultrasound pictures – I keep them in my Bible. I know they’re in heaven, but I miss them.

Because of my miscarriages, my later pregnancies were fraught with anxiety, so I’ve kept them very private, and I haven’t gone out much, unless I’ve really needed to. Thankfully, I have an amazing doctor – she takes her time in appointments, asks me about my family, even checks in on my mental health. I drive back to the area where we used to live, an hour away, especially to see her. We are one of only a few Black families in our area of Minnesota, but house prices were a lot more affordable here than in the more urban community where we used to live when I was a single mother buying my first house alone.

My doctor is worth the drive, because I’ve seen first-hand how some medical professionals treat women, especially Black pregnant women. I tore badly during my first daughter’s birth and needed a lot of stitches, but they weren’t done well. You know yourself when something isn’t right, and I wasn’t healing properly, but the doctor refused to consider that a mistake had been made, and dismissed me. As a result, when I had my other children I tore badly in the same place, so after my next birth I may need surgery. Both my doctor then and my doctor now are white. The problem isn’t white doctors – it’s doctors who lack respect, care and humility when their patient is Black.

Even so, I feel very blessed to have given birth in the US and not Liberia. I’ve heard a lot of horror stories from friends and family who still live there. When someone is sick it can take two or three hours to get to the nearest hospital, which is overcrowded and poorly equipped, and they might be out of the necessary medication. If you don’t have enough money, they won’t meet your medical needs, which is why a lot of women die in childbirth there.

I was at a school event recently and a mother asked where I was from. I found it odd. There are a lot of white people in the US who aren’t from here, but they’re never asked about it. It’s one of the many reasons I’m considering moving to Liberia soon. You never feel 100% at home as a Black minority in America. Even though I was naturalised years ago, that can always be ripped away from you and you can be deported. My children were born here, but I don’t want them to ever forget their roots. We are African. Some kids born in the US have a sense of entitlement because they haven’t seen how people suffer in other countries. After living in a refugee camp, I can’t stand it when people here are wasteful. I want my children to have respect for a dollar.

I would love to retire to Liberia. I went back for the first time to marry my husband, 20 years after I left. I’ve never known peace before, but when I arrived there, I did. That’s how you know you’ve arrived home.
• Louise had her baby in April 2022

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‘I wish there was more education around pregnancy, because Brazilians are so afraid of natural birth’

Priscila Messias, 40, president of the Brazilian Women’s Union, Rio de Janeiro

The last time I was pregnant, the Zika virus was running rampant through my country. No one really knew what was happening or what the risks of birth defects were. We just heard stories and rumours, so I stayed home as much as possible. Thankfully, the baby was born safely. He’s called Pedro and is six now; he joined two older brothers, Leonardo, 16, and Rafael, 14.

I couldn’t have imagined that not only would I become pregnant for a fourth time – with another boy – but that there would be another dangerous virus, Covid, to worry about. This pregnancy was unplanned. I’m 40 and I already have my wonderful boys, but abortion is illegal here, so that wouldn’t have been an option. Once I knew I had the support of my family and friends, I was able to embrace it, and though we’re anxious we’re excited too. He’ll be called Mateous. It’s very common here to announce your child’s name to loved ones before their arrival.

I will be having my fourth C-section, because that is the expected method of birth here. With my first, I wanted a natural birth, but I reached 41 weeks and was pressured into having a caesarian. The doctors don’t want to wait for natural labour – C-sections are faster, easier, and can be planned and controlled.

I wish there was more education around pregnancy, because Brazilians are so afraid of natural birth. Our fear comes from our grandparents and ancestors who lost babies this way, but they didn’t have the knowledge we have now. C-sections are done to benefit the doctors’ schedules, not women or their babies. Pregnancies in Europe seem so beautiful and relaxed by comparison.

Healthcare only became free to all in 1988, and it’s still a postcode lottery. Since Jair Bolsonaro came to power in 2019, he has redirected money away from maternity services and the cracks are showing. I saw on the news that a woman in northern Brazil gave birth on the street. The hospitals in the bigger cities can be chaotic.

It tends to be the case that the smaller the city, the safer you are. I live a two-hour drive from the capital, in a municipality of Rio state, and the system works well enough here. I’ve had appointments once a month and will go more often as the birth approaches. If there are any issues, you will see a doctor rather than the usual obstetric nurse. But giving birth in Brazil you don’t feel safe, you don’t feel protected. I hope things are better by the time my grandchildren arrive.

During this birth I’ll opt to be sterilised. That’s another thing about Europe: the economy is more stable, so people can have many children if they want. Here, life gets harder and harder the more children you have. I don’t regret this pregnancy, though. Mateous will be so loved by all of us.
• Priscila had her baby in March 2022

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‘At 23 weeks, I began bleeding and was feeling unwell. The midwife’s advice was to take paracetamol, drink folic acid syrup and use some pads’

Namisa Jabbie, 29, project facilitator of Girlz Empowered, Freetown, Sierra Leone

Earlier this year, my home pregnancy tests kept coming back negative, but then I felt movements inside my stomach that I recognised. I went to the local hospital, tests in hand, and a blood test confirmed my suspicions. I was already four months along. I’m 29 and already have two daughters: Kadijah, seven, and Aminata, two. This was an unplanned pregnancy, and I’m scared – we can’t afford the cost.

Sierra Leone is one of the very worst countries in the world for maternal mortality rates. I signed up to a basic local maternity hospital, and over the nine months will have 18 prenatal appointments, two a month. They don’t see you that often out of kindness – it’s for money. You have to pay for each appointment. The nurses are paid by the government, but you also pay unofficially the equivalent of about £1 to see them. If you’re having any issues or complications and want to see a doctor, that’s another £9. At a private hospital, it could be £15. If you have a minimum-wage job here, you’re only earning the equivalent of £37 a month. The appointments aren’t mandatory, but if you don’t go they will be angry with you, and women are reluctant to upset the people who will look after them and their baby, especially when death before, during and after childbirth is so common. On top of that, it’s very common to have to bribe medical professionals to make them pay proper attention to you. Some women can’t afford hospitals at all and have to rely on traditional midwives, who are local women who make house visits.

Covid made the situation even worse. Going back to the Ebola outbreak in 2014, many doctors lost their lives, and families were minimally compensated, many not at all. When Covid hit, the fear was so great that the moment doctors noticed a patient had Covid symptoms, they would bribe a nurse to take the case instead.

At 23 weeks, I began bleeding and was feeling unwell, so I called the midwife. She said: “I can’t help you right now – I’m in church.” Her advice was to take paracetamol, drink folic acid syrup and use some pads. The next morning, I went to the hospital and saw a different nurse. She told me to just go and lie down. Eventually, they told me I was pregnant with twins and that one of the twins was not well and was in a bad position. Again, they said all I could do was go home and rest. There was zero psychological or emotional support, let alone any physical support, and I had to pay for each midwife I saw. I don’t know if I trust what they told me.

When a pregnancy is planned, it’s beautiful, but in Sierra Leone there are many reasons why women get pregnant. There is a lack of proper family planning and awareness. There is poverty – I work with two pregnant teenage girls at a community club who mingled with the wrong boys. Another reason is status. Women aspire to get pregnant – bringing home a baby is held in higher regard than bringing home a college degree.

We also need education for men, because sympathy from the father is usually nonexistent. They just think about all the women who manage pregnancy and have a healthy baby, and expect that you should be able to do the same. They don’t believe you when you say you’re in pain or that something doesn’t feel right. I can’t imagine seeing a father on a labour ward.

I wasn’t ready physically, financially or subconsciously. In my country, being a woman is a challenge. Pregnancy brings more challenges, and so does raising children. I envisage my eldest daughter becoming a doctor. Then maybe another woman won’t have to go through what I am going through.
• Seven weeks after Namisa was interviewed, her twins were stillborn at 32 weeks

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‘In Iceland, natural birth is encouraged, and I wanted that. Back in Venezuela, C-section is the norm’

Valenttina Griffin, 37, mechanical engineer and co-founder of Women In Tech Iceland, Reykjavik

It has been two decades since I left Venezuela for the first time. We initially moved to Norway, where I finished high school, then back to Venezuela for a short time before settling in Iceland. I had my first child here when I was 27; he’s nine now.

The maternity system here is one of the very best in the world, and I think that’s because it was developed to encourage population growth. You have to support pregnancies and childbirth to achieve that. The population has still not reached half a million. It’s both a historical and a cultural thing. Women used to give birth very young here to increase the chance of healthy babies. Now they are having children older, and in tandem with that there are improvements in care and other developments designed to decrease child mortality.

You see a midwife at three- or four-week intervals during your pregnancy, and there is a comprehensive online system where you can access every single detail related to your pregnancy. They even upload all of the photos from your scans free of charge.

In Iceland, natural birth is normal and encouraged, and that’s what I wanted; back in Venezuela, C-section is the norm and there is a stigma around natural birth. My first was difficult. As a child, I was told I was allergic to silicone, which is used to deliver an epidural, meaning I couldn’t have one. I was pushing for two hours, and when my son began to come out he was face up and got stuck, so I had to have an assisted birth with a ventouse. I recently met the head anaesthetist to discuss my upcoming birth, and his jaw dropped when I told him I hadn’t had an epidural.

When I had my 12-week appointment for this pregnancy, it finally hit me that I would have to give birth again: “Oh my God, I have to push this baby out!?” I knew then that the first birth was a more traumatic experience than I had realised, so I’ve been seeing a therapist. I had some bleeding in the first months, due to a low-lying placenta, but later scans have shown it has moved up, meaning I won’t have to have a C-section.

My grandfather was Black and my grandmother white, though I identify as Black. Living in Iceland, it doesn’t bother me that none of my healthcare professionals are Black. I did hear a story from a midwife who heard about colleagues who were unsure, and quite worried, about what a dark patch on the skin of a newborn mixed-race baby was. That’s very common in Venezuela; it’s just the colour the baby’s skin will become when they’re older, and nothing to worry about. But here they were stumped. I’ve never heard of anything serious being missed or overlooked because the baby isn’t white, though.

A big part of the reason I’ve had such a positive experience here is because I speak the language. I resisted learning it when I first arrived – “What would be the point in learning something only 300,000 people speak,” I thought. But there was a wall between us. I was lucky because I already spoke a Norwegian dialect that is similar to Icelandic, and being able to communicate has made all the difference in bringing that wall down. There is a subtle racism here, though. We need a foreign workforce to do the jobs locals don’t want to do, like cleaning and cutting fish, but these new immigrants are often segregated from the locals. I love Iceland, though. I know my baby will too.
• Valenttina had her baby in May 2022