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Midwifery Feature Articles

What We Need to Thrive?

In 2011, one of the Society of African and Caribbean Midwives (SoAC) leaders embarked on the journey of becoming a Mary Seacole Leadership.

In the words of Martin Luther King Jr ‘Take the first step. You don’t have to see the whole staircase, just take the first step.’

Embarking on this journey highlighted the stark and inhumane challenges Black and Asian midwives (ethnic minorities) face in the work environment. Often disheartening to know these things happen in the National Health Service (NHS) that is meant to care for others. Fast forward to 2021, the Covid-19 pandemic has shone a glaring light on the challenges faced both in the workplace but also in the communities that we live and serve.

The Association of South Asian Midwives (ASAM) and the Society of African and Caribbean Midwives (SoAC) have been activist fighting against what we call ‘ism and skisms’ supporting our colleagues that have been experiencing challenges in the workplace. We soon acknowledge that we are in the same storm in different boats experiencing the turbulence of incivility. We decided to collaborate, after we found out that many of the midwives from these two groups face the same type of discrimination and racism in the workplace.

We formally met just weeks prior to International Day of the Midwives (IDM 2021)…it dawned on us that the theme was ‘Follow the data; invest in midwives’. We organized two sessions for Black and Brown midwives and were advertise in our networks and on social media platforms; with the sole aim for colleagues to share their thoughts on what was needed for them to thrive as a profession. We were fully aware of the variation of the offerings but didn’t want to make any assumptions. It was emphasized that these sessions for Black and Brown student midwives and midwives would be a safe space for them to be able to talk freely without fear of any repercussions.

The model that was used for this exercise was the adaptive appreciative inquiry. This is a strength based positive approach to leadership development and organizational change. It helps people to move toward a shared vision for the future by engaging others in strategic innovation.

It was uncertain as to how many midwives would participate in the sessions. It is a well-known fact that healthcare professionals from culturally diverse groups are reluctant to speak out and share their experiences as they feel a lack of trust to be able to do so and that they will face dire consequences as a result. Studies have identified that healthcare professionals from culturally diverse groups are likely to face formal disciplinary processes.

However, the sessions were attended by just over 60 participants and the distribution of South Asian and Black African and Caribbean was representative of the national distribution of midwives from the two groups. Based on the feedback, it was believed the sessions were informative. Unsurprisingly to ASAM and SoAC the common thread highlighted the disparities that exist within the NHS workforce. When questioned about why there was a need to keep silent and tolerate the ongoing bombardment of negative behaviors, it was apparent that the midwives believed that by raising these concerns it would be like throwing away one’s career and that they would be labelled as being difficult and would have even more problems within the workplace. It was also mentioned that there are a large number of people that believe that racism does not exist and that the “race card” is used as a tool when things get tough or difficult.

The participants were asked to complete a questionnaire after the session. There was a response form 46 of the participants giving a response rate of 76%.

From the results of the survey the following themes were identified from the question that asked whether or not they had experienced unconscious bias in the workplace. 96% of the participants concluded that they had experienced unconscious bias in the workplace. We know that bias can be the biggest disabler of diversity. Tackling unconscious bias involves a willingness to alter one’s behaviour regardless of intent, when the impact of one’s unconscious biases is uncovered and addressed. Following a thematic analysis four emerging themes were identified.

  • How speaking English determines the type of care and attention received
  • Stereotyping and preconceived notions
  • Unfair treatment in the workplace
  • Racism and discrimination
  • Exclusion

The link between the treatment of staff and patient care is particularly well evidenced for culturally diverse staff in the NHS; this is an important issue for patient care, as well as for the workforce. The “business case” for workforce race equality in the NHS is now also a powerful one. Organisations with diverse workforce and leadership are more likely to be sensitive to local health needs, including those linked to reducing health inequalities linked to ethnicity.

These are clear facts which show the relationship of positive impact on patient satisfaction when there is a culturally diverse workforce, even so structural racism and discrimination is rife within the system.

When comments from the survey were analysed it was really shocking to see the extent of how blatant and direct the comments were. Many of the participants have never had the courage to voice the type of racism and microaggressions they experience within the workplace. The two sessions provided a safe environment for expressing these experiences, for many this would have been the first time they were enabled to share their lived experiences and be heard.

From the survey it was identified that if you are a culturally diverse member of staff, you are less likely to be treated favorably, have poorer experience and progression opportunities, which impacts on the patient experience.

It was evident that the majority of the participants had no guidance or support when it came to career progression.

The participants suggested that structures need to be in place for all staff that are equitable, open and transparent when it comes to career planning and development opportunities. Formal developmental pathways for staff from diverse backgrounds so that they are able to access programme and courses like their white British counterparts. Creation of hubs for career planning with support for interview practice, applications, coaching and leadership tools and being directed to the appropriate person for guidance. Programmes to be developed for midwives who are thinking of progressing in their careers to be able access leadership pathways and have protected time to attend courses and workshops that are available but when it comes to seeking approval to attend, barriers come into light which prevents culturally diverse staff from attending thereby unable to build their profiles for future job and career progression opportunities.

From the conversations it was evident that there are stark variations in organisations. Individual success stories are minimal and this includes being mentored and sponsored by individuals.

The recommendations that came to light from this event and the findings of the survey were to:

  • Support in the softer skills such as: how staff present themselves, writing personal statements, interview technique and skills.
  • A need for coaching, having a buddy system, mentoring including reverse mentoring, sponsorship, access to opportunities (shadowing, courses), managing conflict and general support for staff to feel confident in their work albeit for confidence in current role or seeking out career progression.
  • Provision for safe spaces for staff to be able to voice their concerns without worrying about repercussions that they may face as a consequence of raising concerns.

In ensuring this is achieved, clear and focused work is required to improve culturally diverse midwives’ experiences and career progression. This should be reflected in National Policy such as the People Plan and be monitored through local and regional systems as well as through regulatory mechanisms in ensuring accountability.

No member of an organisation in the first world should be scared about speaking out about the way they are treated in the workplace. Organisations need to be held accountable for inequity and unfair treatment to any staff member.

This report clearly highlights the theme for this year’s International Day of the Midwife

‘Follow the Data : Invest in Midwives’

ASAM and SoAC have shared the report with senior leaders and key stakeholders, with the hope we will see action along with accountability in enacting change for Black and Brown Midwives.

Authors: ASAM and SoAC Leadership teams
Edited by: Nafiza Anwar and Marsha Jones


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