Our National Trailblazer session in June was entitled Decolonising Contraception. With a love of migrant health and women’s health I was intrigued and (rather naively) volunteered to write the blog based on the title alone. I was keen to hear practical tips on how to engage with my 14 year old Roma patient looking to get pregnant or another Roma lady, this time a 23 year old mum of 5 who after 2 months of a contraceptive implant wanted it removed this instant. Guilt flooded back of a patient who ‘I hadn’t managed to get onto contraception’ as recommended by gynaecology correspondence after her most recent second trimester miscarriage. A 42 year old East African lady P2+4 with poorly managed type 2 diabetes and brittle mental health. She became pregnant while on a cocktail of teratogenic drugs then suffered a PE followed by a miscarriage complicated by massive haemorrhage then an MI. She survived against the odds and then deflected my attempts to start contraception. These cases* stay with me. I’m left with the feeling that I’ve missed something, let these women down and failed to understand something. There seems be to a chasm between my medical knowledge, my background and beliefs on women’s health, contraception and childbearing and the ideology and beliefs of these women, families and cultures. Is cultural competence the simple answer? Further reading on forced sterilisation of Roma women in Europe in the last 50 years did inform me as a white non-Romani doctor to approach contraception more sensitively and intentionally allowing patients to lead the discussion.
So what answers did Dr Annabel Sowemimo, founder of Decolonising Contraception provide for my lingering cases? First take one giant step back! Look at history, look at colonialism, look at the history of healthcare and expose racism. I slowly began to feel very uncomfortable…Listening to stories of Saartjie Baartman, the Tuskegee Syphilis study, Francis Galton eugenics and racial superiority. Then more recent and specific to contraception the 1990 US newspaper editorial headline “Poverty and Norplant--Can Contraception Reduce the Underclass.” Arguing to reduce poverty and ‘dysfunctional families’ more black women should have the contraceptive implant.
Pause…“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” (Maya Angelou). A 3 hour workshop and do I remember much content than above? No. But I remember feeling sick to my stomach at much of what I heard, feeling uncomfortable and guilty for my lack of pigmentation and for being part of a health system which at least in parts is inherently structurally racist. I’m still processing the information and feelings as well as some of my own newly exposed prejudices. The system’s discrimination isn’t limited to patients. In June this year an employment Tribunal upheld the complaints made by a consultant urologist that he was discriminated against by the GMC on the grounds of his race. BME doctors are 29% of all UK doctors but 42% of complaints by employers are made against BME doctors. UK graduate BME doctors are 50% more likely to get a sanction or warning than white doctors.
I do believe that what happened to Saartjie Baartman would not happen today, in spite of the appalling racial abuses that still happen all too frequently, I am hopeful that movements like ‘Black Lives Matter’ are beginning to change the world for the better. However, looking back at history has pushed me to consider what practices are continuing unchallenged today that future generations will consider a grotesque abuse of human rights and dignity? We each need to actively look for the vulnerable and marginalised who, by nature tend to hide or be hidden by our society. Let’s give them back their dignity and a voice now, rather than waiting for future generations to expose our guilt.
Take home points. It’s not enough to believe we’re all the same no matter what our skin colour. Sometimes it’s easier not to see the health inequality because then you don’t have to feel uncomfortable and you aren’t challenged to do anything about it. It seems the same is true of racism, my challenge now is how to be anti-racist.
*some details have been changed to protect patient confidentiality