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Experts ‘not surprised’ by England’s stark maternal health disparities

Black women have historically faced racism and mistreatment at the hands of medical professionals, campaigners have said

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Experts have said they are not surprised by England’s “stark” maternal health disparities after a new report has shed light on the reality many Black mothers across the nation are facing.

An analysis conducted by the Guardian found that Black women are up to six times more likely to experience some of the most serious birth complications during hospital delivery across England than their white counterparts.

Black women made up 26 per cent of the women who experienced the birth complication preeclampsia superimposed on chronic hypertension during delivery, the report showed, despite making up just five per cent of all deliveries across England.

However, the findings have come as no surprise to experts who said Black women and women of colour had historically faced racism and mistreatment at the hands of medical professionals.

“The Guardian’s analysis, which starkly highlights the severe disparities in birth complications amongst Black women, is deeply concerning, yet sadly predictable,” Agnes Agyepong, maternal health advocate and founder of Global Black Maternal Health, told Femtech World.

“Systemic and structural issues, such as disparities in healthcare access, quality of care, and exacerbated underlying chronic conditions due to socio-economic and environmental factors, play a significant role. These barriers mean that when Black women voice their concerns early on, they are often not heard, leading to delayed or less effective antenatal care and poorer outcomes.”

Without tackling these structural inequities, and without taking a biopsychosocial approach to maternity care, any long-term structural change remains a distant hope, Agyepong said.

Emily Butterworth, lead midwife at Lansinoh, said the “unfortunate reality” is that across England women’s ethnic background and socioeconomic status are strongly related to their likelihood of experiencing birth complications.

“To make pregnancy and birth safer we need a multifaceted approach, not only by midwives and obstetricians but also by public health professionals and politicians,” she explained.

“It is vital that we are raising awareness and training not only midwives and maternity professionals, but any health professionals who are caring for women before pregnancy and after pregnancy on cultural competency, and looking at ways we can eliminate implicit bias racial stereotyping.”

As part of efforts to reduce birth complications for minority groups and improve maternity care for all, Butterworth said we must address the roles of racism and discrimination in healthcare.

“Making birth safer for all will only be realistically achieved if we address the disparities in maternal health across the spectra of socio-economic backgrounds,” she said.

Black women in the UK are almost four times more likely to die in pregnancy and childbirth than their white counterparts, while black babies are twice as likely to be stillborn.

Emma Jarvis, founder and CEO of pregnancy subscription service Dearbump, said this is due to the fact that Black women are less likely to seek support and less likely to be offered treatment.

“If you are treated poorly and your pain is not taken seriously you lose faith and trust in the system, and it’s hard to break that cycle.

“There needs to be a conscious effort from healthcare providers, policy makers and women’s health organisations, to proactively engage with and check in with Black mothers, and to be aware of any unconscious biases that might exist and recognise the heightened risk they face in maternal outcomes.”

Empowering Black and Brown women in healthcare settings should be a priority, said Wendy Powell, founder and CEO of maternal pelvic health platform MUTU System.

“Black and Brown women experience disproportionate adverse birth outcomes due to ingrained prejudices dictating their treatment and care levels,” Powell told Femtech World.

“However, it’s crucial to recognise the presence of implicit biases and systemic racism within healthcare systems and create environments where Black and Brown women’s voices are heard.

“By challenging bias and advocating for change, we can amplify the voices of marginalised communities and work towards a healthcare system that serves everyone.”

Dr Ranee Thakar, president of the Royal College of Obstetricians and Gynaecologists, called on the government to set a definitive target to eliminate racial disparities in maternal deaths.

“Whilst the college continues to deliver quality improvement programmes in maternity, it is crucial that the government commits to sufficient, long-term NHS investment for staff recruitment, retention and training, which underpins safe and compassionate care,” she said.

“We are also calling for the government to commit to a funded, time-limited target to end the higher risk of maternal mortality among Black, Asian and ethnic minority women, and for women living in more deprived area.”

Bliss, the UK’s charity for babies born premature or sick, called for more research into maternal morbidity and preterm birth.

“We know that the higher rates of birth complications for Black and Asian women are likely to be just one of the reasons they experience higher rates of preterm birth and are therefore more likely to have a baby admitted to neonatal care,” Caroline Lee-Davey, chief executive of Bliss, said.

“This is an unacceptable disparity, yet we still know so little about the reasons underlying these serious inequities in care. Bliss would like to see more research funded which specifically looks at these issues to inform improvements in care for both pregnant women and new-born babies from the Black and Asian community.

“We also urge health services and professional bodies to ensure that all maternity and neonatal health professionals have access to training and guidance that will specifically enable them to support Black and Asian parents and their babies, to stop them being unfairly and avoidably disadvantaged by current practice, and to ensure every baby has the best chance of survival and quality of life.”

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Mental health

Cosmetic procedures may become addictive for some women, researchers say

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Cosmetic procedures may become addiction-like for some women, with low body esteem and problematic social media use linked to higher risk, new research suggests.

A study of 1,614 women aged 25 to 71 found that one in five who had undergone treatments met the threshold for moderate to severe risk of addictive cosmetic procedure use.

Low body esteem and problematic social media use emerged as the strongest risk factors.

Researchers from the Hebrew University of Jerusalem and the Israel Center for Addiction and Mental Health examined what they described as addictive cosmetic procedure use, or ACPU, among Jewish Israeli women.

ACPU refers to repeated cosmetic treatment behaviour that may resemble addiction, including feeling unable to stop, continuing despite negative effects or craving further procedures.

The study was led by Vera Skvirsky alongside Uri Lifshin, Dvora Shmulewitz and Mario Mikulincer, from the department of psychology at the Hebrew University of Jerusalem and the Israel Center for Addiction and Mental Health.

The researchers surveyed women from the general population rather than focusing only on patients at cosmetic clinics.

Among women who had undergone cosmetic procedures, 20 per cent met the threshold for moderate to severe lifetime risk, while more than 15 per cent reported symptoms within the previous year.

Across the full sample, nearly nine per cent of women showed moderate to severe signs of problematic cosmetic procedure use.

The researchers adapted questions based on mental health criteria used to assess substance-related disorders.

Participants were asked whether they had tried unsuccessfully to stop having cosmetic procedures, felt compelled to continue despite negative consequences or experienced cravings linked to treatment.

Previous research has linked cosmetic procedures with body-image concerns and body dysmorphic disorder.

Body dysmorphic disorder is a mental health condition in which a person becomes highly distressed by perceived flaws in their appearance, often flaws that others may not notice.

The new study examined whether repeated cosmetic procedures may, in some cases, resemble a behavioural addiction.

Women with lower body esteem were more likely to report addiction-like patterns, particularly when this was combined with high levels of problematic social media use.

Participants who reported problematic or excessive social media behaviour appeared especially vulnerable when they also felt dissatisfied with their appearance.

The researchers also found smaller links between addictive cosmetic procedure use and lower feminist attitudes, lower attachment security and more negative attitudes towards ageing.

However, those links were less consistent when several factors were analysed together.

The findings come amid a sharp global rise in cosmetic procedures, with international estimates cited by the researchers suggesting interventions increased by around 40 per cent between 2019 and 2023.

The researchers stressed that the study does not suggest cosmetic procedures are inherently harmful.

Instead, they said repeated engagement may, for some people, take on characteristics similar to behavioural addictions already recognised in mental health research.

The researchers said: “Cosmetic procedures have become deeply normalised in many societies, and for many people they may be a positive experience.

“But our findings suggest that for a meaningful minority, the behaviour may begin to resemble other compulsive patterns we see in addiction research, especially when low body esteem and problematic social media use are involved.”

The study was cross-sectional, meaning it captured a single point in time and cannot prove cause and effect.

Researchers said it remains unclear whether problematic social media use contributes to addiction-like cosmetic procedure behaviour, whether treatments influence body image and online engagement, or whether other psychological factors drive both.

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Insight

New pregnancy treatment shows promise for at-risk twins

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A high-powered ultrasound treatment could help identical twins affected by a rare and serious condition during early pregnancy, an initial study suggests.

Twin-to-twin transfusion syndrome, or TTTS, causes uneven blood flow between identical twins who share a placenta.

The imbalance can leave one baby dangerously small and the other too large, putting both babies’ survival at risk.

 

Brioney Garrett’s daughters were in danger before doctors used the world-first treatment to seal the blood vessels causing the problem without an operation.

Nancy and Margo were born healthy and, now aged four, are due to start school.

Researchers from Queen Charlotte’s and Chelsea Hospital tested the non-invasive procedure in 10 women from the UK and elsewhere in Europe after scans detected TTTS during early pregnancy.

Five women needed further treatment, while 12 of the 20 babies survived following the procedure.

The researchers described having a treatment that did not require a needle or telescope to be inserted into the mother’s abdomen as “extremely exciting”.

However, they said larger studies involving more pregnant women were needed before the procedure could be offered more widely.

Garrett described her daughters as “my miracle twins”.

She said: “We were in a very dire situation and I don’t forget that.

“It stays with me always how things could have been. Every day I still count my blessings.”

TTTS affects between 10 and 15 per cent of identical twins who share a placenta, representing around 300 to 400 pregnancies in the UK each year.

The uneven blood flow causes excess fluid to build up around the larger recipient baby, while leaving dangerously little fluid around the smaller donor baby.

Treatment usually involves inserting a needle into the womb to drain some of the fluid or using a laser to seal the connecting blood vessels.

Garrett’s procedure took about 20 minutes. She lay flat while a specially designed machine directed high-powered ultrasound waves at small blood vessels in her placenta.

She said: “It was very quick and pretty painless.”

Christoph Lees, head of fetal medicine at Imperial College Healthcare NHS Trust and professor of obstetrics at Imperial College London, described the research as “very promising”.

He said: “If this could work in a fully-fledged study, it could give hope to a lot of women who otherwise might have to have quite invasive treatment.”

Ultrasound is commonly used during medical scans to produce images of the body, but this procedure uses much more focused waves.

Heat generated by the waves can seal blood vessels about 2mm in diameter and located around 5cm to 6cm beneath the skin.

The procedure blocked blood flow in 90 per cent of the vessels treated during the study, with no unwanted side-effects reported.

Twins Trust, which supported the study, said the approach could make a significant difference for families affected by TTTS.

Helen Peck, head of healthcare engagement and research, said: “Any procedure that is non-invasive and can potentially identify TTTS earlier and improve outcomes for our families with this life-threatening condition could be a turning point.”

Scans carried out weeks after Garrett’s procedure showed that blood flow between the babies had been rebalanced, although other problems developed during the pregnancy.

Garrett said Margo, who had too little fluid around her, “was in a much better position” and that “the strain on Nancy’s heart had eased”.

Nancy and Margo were born at nearly 34 weeks, weighing 3lb 7oz and 3lb 3oz respectively.

Garrett said: “They were both healthy, and Margo wasn’t as small as we worried she was going to be.”

The twins are due to start primary school in September.

Garrett said: “They’re funny, smart, energetic little girls that just fit right in with their age group.”

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Cancer

Breast cancer rising rapidly in Asian American women, study finds

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Breast cancer rates have risen rapidly among Asian American women over the past two decades, with some of the steepest increases among women under 50, new research has revealed.

Rates rose by more than three per cent a year in nearly every Asian American ethnic group studied, much faster than in any other US ethnic group.

The increase was particularly marked among women under 50 and in cases involving advanced-stage disease or certain aggressive subtypes of the cancer.

The study found even larger increases among Chinese and Vietnamese women.

Breast cancer rates among Native Hawaiian women were already among the highest recorded among US women, but rose by about one per cent a year, less than the increases seen in Asian American groups.

The researchers said increased screening was unlikely to explain the trend because screening would be expected to identify more cancers at an earlier stage.

Instead, cancers that had already spread increased at the fastest rate.

Triple-negative breast cancer, considered the most aggressive subtype, rose by more than six per cent a year among Chinese American women between 2017 and 2022.

Scarlett Lin Gomez, senior author and professor of epidemiology and biostatistics at the University of California, San Francisco, said: “These patterns are highly concerning from a disparities standpoint.

“They underscore why it is so important to move beyond treating Asian Americans, Native Hawaiians, and Pacific Islanders as a single population.”

Researchers analysed about 150,000 cases of invasive breast cancer diagnosed between 2000 and 2022 using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Programme.

The analysis covered nine Asian American, Native Hawaiian and Pacific Islander populations across 14 states. Together, these states account for about two-thirds of the US population within these groups.

Except for Native Hawaiian women, Asian American women have historically had lower breast cancer rates than non-Hispanic white women.

However, the gap has narrowed rapidly. By 2022, incidence among Asian American women under 50 was comparable with that recorded among white women.

The reasons for the increase among women under 50 remain unclear.

Changes in reproductive patterns, diet and other lifestyle factors may play a part, but researchers said they did not fully explain the findings.

They said previously unidentified risk factors may also be contributing to the rises in some Asian American communities.

Researchers hope two UCSF-based studies, the CRANE breast cancer study and the ASPIRE cohort study, will provide insights into these factors.

Gomez said: “Understanding why breast cancer is increasing so rapidly in these communities is critical.

“At the same time, we need to ensure that women across all Asian American, Native Hawaiian, and Pacific Islander communities have access to culturally appropriate education, screening, and timely follow-up care.”

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