Exclusive: Analysis Reveals Racial Inequalities in Pain Relief Across Healthcare
Women from Black and Asian backgrounds in the UK are less likely than their white counterparts to receive an epidural during childbirth, according to new research. This extensive study, analyzing data from over 2.7 million births, has raised concerns among experts about an "ethnicity pain gap" that affects people of colour within medical settings.
's analysis highlights racial disparities in pain relief offered across various healthcare areas, ranging from children in accident and emergency departments to palliative care for cancer patients.
Four UK medical royal colleges—the professional bodies representing medical professions—have called for improved data collection to better understand how patients from ethnic minority backgrounds are more likely to have their pain dismissed by healthcare providers.
Study Findings on Epidural Use During Vaginal Births
The research, published in the journal Anaesthesia, reviewed data collected over a decade up to 2021. It found that women from Bangladeshi, Pakistani, and Black Caribbean backgrounds were respectively 24%, 15%, and 8% less likely than white women to receive an epidural during vaginal births.
This study follows a recent 181-page report by Labour peer and former diplomat Valerie Amos into UK maternity care, which documented widespread failings such as women being ignored and poor triage of expectant mothers. The report attributed these issues partly to systemic problems including institutional racism.
The findings align with reports from other countries that document racism in patient treatment and management.
Expert Reactions and Context
"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," said Bell Ribeiro-Addy, Labour MP and chair of the all-party parliamentary group on black maternal health. She added that the findings were "inseparable from the wider context of racism and racial tropes such as the ‘strong Black woman’."
Dr Nuala Lucas, president of the Obstetric Anaesthetists’ Association and co-author of the study, stated: "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."
Disparities in Anaesthesia During Caesarean Births
The analysis also revealed that Black Caribbean-British women are 58% more likely than white women to receive general anaesthesia instead of regional anaesthesia during elective caesarean sections. Black African-British women are 35% more likely to receive general anaesthesia in these circumstances.
Most caesarean births are performed with the mother awake under regional anaesthesia (spinal or epidural), which is considered safer and allows quicker recovery. General anaesthesia is typically reserved for emergency situations when there is insufficient time to administer regional anaesthesia.
Wider Research on Maternity Care Inequalities
This study contributes to a growing body of research highlighting inequalities in maternity care. Previous studies have reported that Black women are often stereotyped by maternity staff as having "thick skin" and being able to tolerate pain, while Asian mothers have been described as "princesses" who are "overly demanding" and unable to cope with pain.
Analysis from the University of Oxford, shared with , identified significant disparities in how Black and Asian women are supported in managing pain during labour.
Many women from Black and Asian backgrounds who participated in the research reported feeling dismissed or ignored by healthcare professionals when discussing pain relief options. Many also expressed fear of speaking up. According to the study, these women "often felt they were not involved in decisions around their pain relief" by healthcare providers.
The study concluded that multiple factors influence the experiences of ethnic minority women during labour, including an "atmosphere of systemic distrust between ethnic minority women and their healthcare practitioners."
"Maternity inequalities are well documented, but we urgently need to understand what lies behind the figures," said Dr Lisa Hinton, lead author of the study. "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 Collection
Fiona Gibb, director of midwifery at the Royal College of Midwives, said: "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. Without robust data on pain relief, interventions and outcomes broken down by ethnicity, it is harder to identify where inequalities exist and to hold systems to account for addressing them."
Dr Christine Ekechi, a gynaecology specialist from the Royal College of Obstetricians and Gynaecologists, stated: "We have 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 in maternal care "means looking at 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."
