During the second half of 2022, an anti-racist training programme was delivered to midwives and maternity support workers from North Bristol NHS Trust and University Hospitals Bristol and Weston NHS Foundation Trust. Fourteen individuals participated in the pilot of ‘Black Maternity Matters’, which consisted of six facilitated sessions with two specialist trainers from the independent sector. The training programme included topics such as unconscious bias and the role of the individual in perpetuating unsafe systems of care, developing participant understanding of racism and the way it can create risks to people’s health and wellbeing.
Black Maternity Matters has been codeveloped by the West of England AHSN, Representation Matters, BCohCo and Black Mothers Matter, with the support of local maternity and neonatal networks and service providers. It is funded by the Health Foundation through its Q Supporting local learning funding programme.
The evaluation sought to understand the impact of the pilot programme upon participants, the perceived value of the training and learnings that could inform further spread of the programme.
The evaluation team (a collaboration between WE AHSN and Unity Insights) delivered two surveys and conducted twelve semi-structured interviews (including two dyad interviews) with training participants and project stakeholders, (including the trainers and senior representatives from participating organisations). Unity Insights helped by designing a themed coding framework, while supporting the design of surveys and interview questions, and through the analysis of interview transcripts and survey results.
Health outcomes for black women and their children during pregnancy and the post-natal period highlight a significant disparity compared to other groups. Black women are four times more likely to die during pregnancy or in the postnatal period than white women (MBRRACE-UK, 2019), while stillbirth rates of black babies are over twice those for white babies (Muglu et al, 2019). It is hoped that anti-racist training can equip staff to recognise attitudes and structures that negatively impact black mothers and their babies as well as support quality improvement in this domain.
Feedback regarding the course was overwhelmingly positive, with responses to the survey suggesting improvement across all questions following the training programme. Responses also highlighted the Dunning-Kruger effect was present amongst participants prior to training. On a series of questions participants ranked their understanding and cultural awareness before training began. At the end of the training course, all respondents were asked to re-assess their understanding prior to training before then remarking on their position at the end of the project. These results suggested that prior to training staff were likely to over-estimate their awareness, and that the course had resulted in knowledge increase and self-reflection.
“I didn’t know how to put it into words, just the most eye opening, transformative training ever; it’s the best training I’ve ever been on. Hands down… It weaves its way into everything.”Training participant
“So, looking at how we look after women with disabilities or gender identity, a lot of the stuff you’re learning is actually just basic kindness and think about listening and the way we talk and the way we speak. So, it there’s a lot of transferable information there as well.”Training participant
The branding of the training programme as ‘anti-racist’ was considered a key part of this process, it was noted that while some participants had some initial discomfort with this approach, the facilitators had provided space for open discussion, providing a safe space to discuss uncomfortable topics to foster learning and growth.
“Ultimately, [racism is] a very uncomfortable topic and one that’s difficult to talk about and I think my feeling is that you need a course like that.”Training participant
The training led to a clear will to drive change in the workplace, and it is hoped that further phases of the project can build on this. Stakeholder’s input also highlighted the role of the AHSN in establishing and supporting the project, stating that they had struggled to reach organisations before the AHSN got involved.
Informed by the evaluation of the pilot phase, the Black Maternity Matters collaborative will deliver two further programmes of the Black Maternity Matters training in Bath and North East Somerset, Swindon and Wiltshire, and in Gloucestershire, as well as another programme in Bristol, North Somerset and South Gloucestershire.