Ethnic disparities in UK obstetric anaesthetic care

2 March 2023

A study funded by the OAA and just published in Anaesthesia has reported that compared to white women, Caribbean (Black or Black British) women were 58% more likely to be given a general anaesthetic for an elective caesarean section whilst African (Black or Black British) women were 35% more likely.
 
For women who had unassisted vaginal births, Bangladeshi (Asian or Asian British), Pakistani (Asian or Asian British), and Caribbean (Black or Black British) women were respectively 24%, 15% and 8% less likely to receive neuraxial anaesthesia during labour and delivery.
 
The researchers analysed 6,032,425 childbirth records between March 2011 and February 2021 belonging to 4,180,887 women aged under 55 who lived in England. Variables such as differences in age, geographical area, deprivation levels, admission year, previous births and comorbidities, including obesity, were accounted for during the analysis.
 
Co-author Marian Knight, Professor of Maternal and Child Population Health at Oxford, whilst acknowledging the study was observational said: "The findings clearly demonstrate a need for further research to investigate factors that may be driving the disparities, such as inequality of access to appropriate obstetric anaesthetic care.
 
"To ensure that obstetric anaesthetic care is equitable, information of anaesthetic choices needs to be easily accessible. Women from ethnic minorities must be listened to better to avoid misconceptions and presumptions about their expectations and experiences of perinatal care."
 
In an accompanying editorial in the same journal, two US researchers, Professors Allison Lee and Arvind Palanisamy, compared these disparities found in the NHS to similar disparities in the US healthcare system and concluded that: “Although the healthcare models, racial composition, social structure and political traditions of the USA and the UK appear to be quite different, there are striking parallels at many levels. The patterns of racial and ethnic disparities in health outcomes suggest that these may be mediated by similar factors, requiring similar solutions."

The authors stated that this study, like similar others, should provoke action at the hospital level and inspire anaesthetists to strive for institutional transformation.