Features
Black maternal health: why addressing inequity must be a “collective effort”
Black mothers are three times more likely to die from a pregnancy-related cause than white mothers, with over 80 per cent of these cases thought to be preventable. We speak to Dr Ndidiamaka Amutah-Onukagha, founder of the Center of Black Maternal Health and Reproductive Justice at Tufts University, about what’s driving these disparities, why she has dedicated her career addressing them, and how this can—and should—be a collective effort.
Dr Ndidiamaka Amutah-Onukagha, the Julia A. Okoro Professor of Black Maternal Health at Tufts University School of Medicine, believes we are facing a “maternal health crisis”.
Even with its vast resources, in the US, Black women are two to three times more likely to die during childbirth than their white peers. It’s no better in the UK, where maternal mortality for Black women is currently almost four times higher than for white women.
“Structural racism, inadequate healthcare access, and the dismissal of Black women’s pain and concerns continue to fuel these disparities, making it critical to push for systemic change in policy, clinical care, and community support,” Dr Amutah-Onukagha who has spent her career addressing these disparities, tells Femtech World.
For Dr Amutah-Onukagha, who has dedicated decades to researching Black women’s experiences of maternal health, infant mortality, reproductive health and HIV/AIDS, Black maternal health and mortality is a social justice issue.
Culturally-rooted and community-based
Aged 16 she lost a close friend —someone she describes as “more like a sister”— to childbirth complications, igniting a passion for addressing health disparities among women. This tragic loss would be the catalyst for her career, but maternal health was always in her roots.
Her grandmother, Julia Okoro, was a traditional birth attendant who delivered hundreds of babies, in Imo State, Nigeria, saving the lives of many women and children in the process.
“As a Nigerian immigrant, my background has given me a deep understanding of how culture, systemic barriers, and community impact maternal health, ” says Dr Amutah-Onukagha.
“Growing up in a society where midwifery and traditional birthing practices are central, I advocate for integrating culturally rooted, community-based solutions into US healthcare to improve Black maternal outcomes.”
She adds: “Here in the United States, my lived experience navigating bias and inequities fuels my commitment to ensuring that Black women receive respectful, quality maternal care, regardless of background or status. I have witnessed firsthand how discriminatory practices in healthcare, including under-diagnosis, overt racism, and biased treatment, hinder equitable access to necessary services.”
Creating the blueprint for maternal health equity
This was the basis on which Dr Amutah-Onukagha founded the Center of Black Maternal Health and Reproductive Justice (CBMHRJ) at Tufts University to serve as a catalyst for maternal health research, policy, and workforce advancement through “cross-disciplinary partnerships, thought leadership, and community engagement”.
The centre is focused on advancing maternal and postpartum care, strengthening maternal mortality data, and addressing structural issues in severe maternal mortality, she explains. Its approach advocates for supportive policies, expanding birthing options and insurance coverage, and improving data reporting.
In August 2024 this worked played a key role in the passing of the Massachusetts Maternal Health Momnibus legislation, which is thought to be one of the most comprehensive maternal health bills nationwide.
Dr Amutah-Onukagha says this legislation has the potential to “become a blueprint” for the rest of the country on how best to address maternal health inequities.
“The most impactful initiatives have been those that place access to non-clinical and community health workers at the forefront, initiatives that embrace and aim to increase birthing centres, as maternity care deserts and OB-GYN shortages continue to exacerbate our system,” she says.
“We need initiatives that allow us to access and analyse clinically accurate data in real-time to capture disparities in maternal health outcomes and better understand the underlying factors contributing to these disparities.”
Prioritising marginalised voices in research
Prioritising research that centres the voices and lived experiences of marginalised communities is also “critical.”
The Maternal Outcomes of Translational Health Equity Research (MOTHER) Lab, a student-run unit founded by Dr Amutah-Onukagha, conducted research advocating for increased multilingual accessibility of doula care in Massachusetts.
This was then used to provide informed recommendations to the State, healthcare systems, and doula organisations to expand linguistic access and diversity in services.
“We have people here, living, who can provide us with the information we need,” she says. “Women shouldn’t have to die for us to change the systems that are failing them.”
Through grant and foundational funding, the centre has also developed an interactive toolkit to support doulas and MassHealth members in becoming Medicaid reimbursable. The content of this is guided by its Community Advisory Board, composed of doula stakeholders, guides the toolkit’s content, intuitive design, and information dissemination.
Dr Amutah-Onukagha adds: “This is not just an ordinary advisory board; they don’t simply check a box to fulfil a role. They hold real decision-making power over what is shared and how we best provide trained doulas to local birthers who want them.”
Addressing Black maternal health disparities as a ‘collective effort’
Fresh off the back of hosting the eighth annual conference on Black maternal health, held from 4-5 April, Dr Amutah-Onukagha’s, is now focused on creating the right partnerships and securing resources to continue the work of the centre moving forward.
It is self-funded and relies on federal grants and strategic partnerships, something which she describes as an “ongoing hurdle”, particularly as the US “shifts its health focus and redefines research, policies, and public health”. In his first days in office, President Donald Trump issued a series of executive orders targeting diversity, equity, and inclusion programmes.
Perhaps now more than ever, addressing Black maternal health disparities requires a “collective effort” in which the private sector also has a “crucial role to play”.
“Companies can invest in research, advocate for equitable healthcare policies, fund community-based initiatives, and implement workplace protections such as paid parental leave, flexible schedules, and culturally competent healthcare that extends to full-spectrum pregnancy care and mental health support,” Dr Amutah-Onukagha explains.
“It will take all of us healthcare providers, policymakers, businesses, and communities—to drive meaningful and lasting change. Our work is not done until equity for all Black mothers, before, during, and after pregnancy, is achieved.”
Find out more about Dr Amutah-Onukagha’s work here.
In honour of Black Maternal Health Week (11-17 April), we also asked Dr Amutah-Onukagha what Femtech World readers can do to help address disparities in Black maternal health?
“Be intentional, start with small efforts, where you are, and build upon those actions. In what ways can you help raise awareness of the crisis in your community? What current efforts are in place that you can lend your expertise to? What policies are being implemented in your state? Is it time to call your state representative or congressperson?
“If you’re a business owner or a leader at your company, take a look at your parental leave policies—are they inclusive? If you’re in the office, stop by the lactation room, does it have everything needed for nursing parents? Review your healthcare plans, are they based on an income scale? Do they support the lowest earners as much as they do the highest earners? What remote offerings do you have for expecting families? Are they flexible?
“And finally, share what you learn! Whether it’s with colleagues, communities, or leaders, sharing knowledge is a powerful step toward achieving maternal health equity.”
Elation Health has acquired Aster, a women’s health EHR startup created by sisters Fifi Kara and Dr Lailah Kara-Newton.
The deal, announced on 3 June 2026, will see Aster’s team join Elation Health as the company expands development of what it describes as the first agentic operating system for primary care.
An EHR, or electronic health record, is a digital system used by healthcare providers to store and manage patient information.
Aster was founded by Kara and Kara-Newton as an AI-native EHR platform for women’s health providers.
Elation Health said the acquisition would allow Aster to learn from its expertise in AI agents and support development of its agentic operating system for primary care.
Kyna Fong, co-founder and chief executive of Elation Health, said: “The Aster team impressed us with their vision and creative inventions to support independent practices.”
Fong said Elation, like Aster, was founded by siblings who wanted to change the healthcare system.
She added: “That shared north star means they understand what we’re building and why it matters. It was clear right away they would significantly add to our capabilities.”
Kara has spent 10 years creating consumer and business-to-business products across the UK, Europe and the US, and recently supported Meta’s Health & Fitness team, according to Aster’s website.
Kara-Newton previously worked as a hospital doctor in the NHS across medical and surgical specialties, including breast surgery, general surgery, emergency medicine and obstetrics and gynaecology.
Aster launched in 2023 after raising US$2.8m from Zeal Capital Partners, Cornerstone Ventures, Octopus Ventures and others.
Kara, Kara-Newton and Aster’s chief technology officer, Nacho Vazquez, will all join Elation.
Kara said: “From the moment we met Kyna Fong, Ashley Rogers, and the Elation leadership team, it was clear we were aligned on what matters most: that clinicians deserve truly incredible software that brings joy back to their practice. Together, we can now bring that vision to millions of primary care patients across the country.”
The sisters said their work was shaped by Kara-Newton’s first pregnancy, when undiagnosed pre-eclampsia led to an emergency caesarean section and neonatal intensive care admission for her son.
The founders said they wanted to build technology that could help prevent similar outcomes for other women.
The acquisition comes amid continued concern over maternal health inequalities in the US.
In the US, Black maternal mortality remains alarmingly high, with rates nearly double those of white women, and experts point to unequal access to care, implicit bias and fragmented approaches to care.
Article produced in association with Spital Clinic
Both the copper coil and the Mirena are more than 99 per cent effective as contraceptives — but they work in completely different ways, have opposite effects on periods, and suit very different people.
With the FSRH’s May 2024 licence extension for the Mirena now in effect, this guide covers the five key differences using up-to-date UK evidence, not the older guidance that many sources still repeat.
How Each Device Works
The FSRH March 2023 guideline set out the terminology now used across UK clinical practice: the copper intrauterine device (Cu-IUD) and the levonorgestrel intrauterine system (LNG-IUD).
The copper coil works by releasing copper ions that are toxic to sperm, preventing fertilisation. It contains no hormones at all, making it a strong option for women who cannot or do not want hormonal contraception.
The Mirena — the most widely prescribed 52mg LNG-IUD in the UK — thickens cervical mucus to block sperm, thins the uterine lining, and may suppress ovulation, though most users continue to ovulate normally.
According to Hull University Teaching Hospitals NHS Trust, the hormone levels it produces are lower than those from the combined contraceptive pill — relevant for women advised to avoid higher-dose hormonal methods.
The hormone-free nature of the Cu-IUD is its defining advantage for some; the localised hormonal action of the LNG-IUD is its defining advantage for others.
According to NHS guidance on the copper coil, neither device interacts with medicines or herbal remedies, and both can be fitted in women who have never been pregnant.
The way each device works also determines what it does to periods — often the deciding factor.
Effectiveness and Duration
The NHS confirms both devices prevent pregnancy in more than 99 per cent of users. When it comes to contraceptive effectiveness, there is no meaningful difference between them.
Where they differ significantly is duration. The copper coil lasts up to 10 years, and one fitted in a woman aged 40 or over can remain in place until menopause under FSRH March 2023 guidance.
For the Mirena, the picture changed in May 2024: the FSRH CEU statement on extended LNG-IUD use confirmed that all 52mg LNG-IUDs — including the Mirena, Levosert, and Benilexa — are now licensed for eight years of contraceptive use, up from five under previous guidance.
When the Mirena is used as part of HRT, it protects the uterine lining for up to five years before requiring replacement. Smaller-dose devices such as Kyleena (20mcg) are licensed for five years, and Jaydess for three.
Both are long-acting reversible contraceptives — fertility returns immediately after removal, with no delay or washout period. Both are available without a GP referral through the coil insertion and removal service at Spital Clinic.
What Each Device Does to Periods
The most important practical difference is what each device does to periods — and they go in opposite directions.
The copper coil typically makes periods heavier, longer, and more painful; the NHS notes this may ease after a few months, but heavier bleeding is one of the most common reasons for early removal.
Both devices can cause irregular spotting in the first three to six months after fitting.
The Mirena does the opposite.
According to Hull University Teaching Hospitals NHS Trust, it reduces monthly blood loss by 86 per cent at three months and by 97 per cent at twelve months.
Nine in ten women who use it for heavy periods see a significant reduction; around 20 per cent have no bleeding at all; and 80 per cent report meaningful pain relief.
NHS information on the hormonal coil confirms that periods often become lighter, shorter, and less painful — with many users finding they stop entirely after the initial settling-in period.
For women whose choice of contraception is being shaped by troublesome periods, those statistics make the direction of the decision clear.
For women with already disrupted cycles, it is worth booking a private specialist assessment before deciding — for this group, the choice of coil is as much a treatment decision as a contraceptive one.
Unlike the copper coil, the Mirena is licensed as a first-line treatment for menorrhagia — heavy or prolonged bleeding defined as losing more than 80ml per cycle or periods lasting longer than seven days.
In around half of cases, heavy periods have no identifiable structural cause, making the Mirena’s targeted local action particularly useful: it reduces bleeding at the endometrial level without surgery, general anaesthesia, or high-dose systemic hormones, and offers a non-surgical alternative to procedures such as endometrial ablation.
Side Effects, Risks, and Who Cannot Use Each Device
Both devices carry the same procedural risks. Pelvic infection affects around 1 in 100 women in the first three weeks; expulsion happens in roughly 1 in 20; and uterine perforation occurs in approximately 2 in 1,000 fittings — slightly higher in women breastfeeding within six months of delivery. Ectopic pregnancy, though rare, is a risk if either device fails.
The side-effect profiles diverge beyond those shared risks.
The copper coil carries no hormonal side effects — heavier periods are its main downside. The
Mirena may cause acne, headaches, mood changes, breast tenderness, and ovarian cysts; most resolve without treatment, but they are worth considering for anyone sensitive to progestogen.
The Mirena is also unaffected by vomiting, diarrhoea, or most drug interactions.
Each device has its own contraindications. Neither should be fitted in the presence of an active sexually transmitted infection or unexplained uterine bleeding.
The Mirena is not suitable for women with a history of breast cancer, certain liver conditions, serious cardiovascular disease, or certain uterine abnormalities.
The copper coil, meanwhile, can be used as emergency contraception if fitted within five days of unprotected sex — the only intrauterine option for post-coital protection.
The Fitting Procedure and What to Expect
The fitting procedure is the same for both devices: a 10 to 15 minute clinical appointment, ideally towards the end of a period, though it can happen at any point in the cycle.
The full appointment takes around 30 minutes. Local anaesthetic gel or spray is used to manage discomfort, and the NHS advises taking ibuprofen or paracetamol about an hour beforehand.
No surgery or general anaesthetic is needed. Some cramping and light spotting in the days after fitting is normal and usually settles within a week. Neither device requires you to have had children previously.
Fertility returns immediately after removal of either device — there is no waiting period before trying to conceive.
For most women, the choice between the copper coil and the Mirena comes down to one question: are hormones acceptable or not?
The copper coil suits women who want hormone-free contraception, those who cannot use progestogen, and those who need emergency post-coital protection.
The Mirena suits women who want lighter or absent periods, those managing menorrhagia, and those using it as the progestogen component of HRT.
Both offer equivalent contraceptive effectiveness and full reversibility.
The FSRH’s May 2024 extension of the Mirena’s licence to eight years makes it a stronger long-term option than many comparisons suggest — worth knowing if the information you have found is based on older guidance.
This article is produced for informational purposes only and does not constitute medical advice, diagnosis or treatment. Clinical guidance referenced reflects published NHS and FSRH standards as at March 2025. Individual circumstances vary; readers are advised to consult a qualified healthcare professional before acting on any information in this article.
This piece was produced in association with Spital Clinic, which provided background clinical information for editorial purposes. Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.
Article produced in association with Spital Clinic
Each year in England, approximately three million women take part in cervical screening.
While the majority receive a reassuring result, a proportion are referred for further investigation following an abnormal finding or a positive human papillomavirus (HPV) test.
For these women, the next step is a colposcopy.
Despite being a widely performed procedure, colposcopy remains poorly understood by many of the women referred for one, often because they receive limited information between the letter of referral and the appointment itself.
What Is a Colposcopy?
A colposcopy is a close examination of the cervix carried out by a specialist gynaecologist or colposcopist.
It uses an instrument called a colposcope, a magnifying device that remains outside the body and allows the clinician to view the surface of the cervix in detail.
Unlike a cervical smear, which takes a cell sample for laboratory analysis, a colposcopy is a direct, real-time visual assessment.
The procedure is explained in detail on the NHS colposcopy page, which covers what to expect before, during and after the appointment.
Colposcopy is most commonly recommended following an abnormal smear result, a positive HPV test, or unexplained symptoms such as irregular or post-coital bleeding.
It may also be used to monitor previously treated cervical cell changes.
Why Colposcopy Is Central to Cervical Cancer Prevention
Cervical cancer is the fourth most common cancer in women globally.
According to Cancer Research UK cervical cancer data, around 3,200 women are diagnosed with cervical cancer in the UK each year.
The vast majority of cases are linked to persistent infection with high-risk HPV strains.
Critically, cervical cancer develops slowly, typically over 10 to 15 years from normal tissue through progressive cell changes classified as cervical intraepithelial neoplasia (CIN) to invasive cancer.
Colposcopy allows clinicians to identify and classify these changes before cancer develops.
The grading system for CIN runs from CIN1 (mild cell changes, often resolving without treatment) through CIN2 (moderate) to CIN3 (severe, high risk of progression). Identifying the grade accurately determines whether monitoring or active treatment is recommended.
What Happens During a Colposcopy Appointment
The procedure typically takes between 15 and 20 minutes and is carried out as an outpatient appointment without general anaesthetic.
The patient lies on a couch with their feet in supports, in a position similar to a smear test. A speculum is gently inserted to allow the clinician to view the cervix.
A solution of diluted acetic acid is applied to the cervical surface, which temporarily turns any abnormal cells white, making them visible against the surrounding tissue. Iodine solution may also be used.
If abnormal areas are identified, the colposcopist may take a small tissue sample, called a biopsy, for laboratory analysis.
This is a brief procedure and may cause a momentary sensation of pressure or cramping. Biopsy results are usually available within two to three weeks.
NHS vs Private Colposcopy
NHS colposcopy services are available following GP referral or cervical screening notification. Waiting times, however, can vary significantly by region and current service demand.
For women seeking faster access, private colposcopy is available through specialist clinics. According to RCOG guidance on cervical screening and colposcopy, timely assessment and follow-up are important components of cervical health management.
Spital Clinic, based in Spital Square in the City of London, offers private colposcopy with appointments available on short notice, including morning, afternoon and evening slots throughout the week.
The clinic also offers cervical smear testing and gynaecological consultations, allowing women to manage their complete cervical health pathway in a single setting.
After the Colposcopy: Possible Outcomes
There are several possible outcomes following a colposcopy. If no abnormality is found, the patient is typically returned to routine cervical screening.
If low-grade changes are identified, monitoring with a follow-up appointment in 6 to 12 months is usually recommended. High-grade changes, classified as CIN2 or CIN3, usually lead to treatment.
Treatment for high-grade CIN is most commonly carried out using large loop excision of the transformation zone (LLETZ), a procedure performed under local anaesthetic as an outpatient.
LLETZ has a high success rate and most women return to their usual activities within a few days.
Who Should Consider a Private Colposcopy Referral
- Women who have received an abnormal cervical screening result or HPV-positive test and want prompt specialist assessment
- Those awaiting an NHS colposcopy appointment and experiencing significant anxiety about the delay
- Women with unexplained vaginal bleeding, persistent discharge or post-coital bleeding
- Those with a personal or family history of cervical disease who want regular specialist monitoring
A colposcopy referral is not a diagnosis. It is the next step in a well-established clinical pathway that has been responsible for reducing cervical cancer rates in the UK.
The earlier abnormal changes are identified, the more straightforward the management options.
Disclaimer: This article is produced for informational purposes only and does not constitute medical advice, diagnosis or treatment.
Clinical guidance referenced reflects published NHS, NICE and RCOG standards as at March 2026.
Individual circumstances vary; readers are advised to consult a qualified healthcare professional before acting on any information in this article.
This piece was produced in association with Spital Clinic, which provided background clinical information for editorial purposes.
Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.
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