UK Maternity Gap: Ethnic Minority Women less likely to receive Epidural

Women from Black and Asian backgrounds in the UK are less likely than their white counterparts to receive an epidural during childbirth, according to new research covering more than 2.7 million births.

The findings have fuelled warnings of an “ethnicity pain gap” in healthcare, where people of colour are more likely to experience unequal access to pain relief across medical settings.

The analysis, published in the journal Anaesthesia, examined a decade of maternity data up to 2021 and found consistent disparities in epidural use during vaginal births.

Women of Bangladeshi, Pakistani and Black Caribbean backgrounds were 24%, 15% and 8% less likely, respectively, to receive an epidural compared with white women.

The research follows a report by Labour peer and former diplomat Valerie Amos into UK maternity services, which documented widespread failings including women being ignored, delayed triage and systemic issues linked to institutional racism.

International research has echoed similar concerns, with studies in the US and Australia also documenting racial bias in pain treatment and clinical decision-making.

Bell Ribeiro-Addy, Labour MP and chair of the all-party parliamentary group on black maternal health, said:

“The disparities around pain relief identified in this report are shocking and indefensible, but sadly not surprising, given the way black people’s pain has historically been doubted, downplayed and dismissed.”

She added that the findings were “inseparable from the wider context of racism and racial tropes such as the ‘strong black woman’.”

Dr Nuala Lucas, president of the Obstetric Anaesthetists’ Association and co-author of the study, said:

“We know that women with ill health during pregnancy, or those who give birth prematurely, may particularly benefit from effective epidural pain relief.

“It is especially troubling if these are among the women least likely to receive it.”

The study also found further inequalities in anaesthesia during caesarean sections.

Black Caribbean-British women were 58% more likely than white women to be given general anaesthesia during elective caesareans, while Black African-British women were 35% more likely.

Most planned caesareans are carried out using regional anaesthesia, such as spinal or epidural, which allows mothers to remain awake and is generally considered safer and linked to quicker recovery. General anaesthesia is typically reserved for emergencies.

Researchers and clinicians say these disparities sit within a wider pattern of stereotyping and mistrust.

Previous studies have suggested Black women’s pain is more likely to be minimised, while Asian mothers are sometimes stereotyped as either overly demanding or less able to cope with pain.

Analysis from the University of Oxford found that many Black and Asian women reported feeling dismissed or ignored when discussing pain relief during labour, with some reluctant to speak up at all.

The study described an “atmosphere of systemic distrust between ethnic minority women and their healthcare practitioners”, with many participants saying they were not fully involved in decisions about their care.

Dr Lisa Hinton, lead author of the Oxford study, said:

“Maternity inequalities are well documented, but we urgently need to understand what lies behind the figures.

“Ethnic disparities in maternity care, including experiences of pain relief, are shaped as much by communication and trust as by access to treatment – women need dialogue, not just options.”

Fiona Gibb, director of midwifery at the Royal College of Midwives, said the findings were unacceptable and pointed to systemic issues in data and accountability:

“Any suggestion that women’s pain is not taken seriously, or that access to appropriate pain relief differs by ethnicity, is completely unacceptable.

“More consistent data collection is essential.

“Without robust data on pain relief, interventions and outcomes broken down by ethnicity, it is harder to identify where inequalities exist and to hold systems to account for addressing them.”

Ribeiro-Addy said addressing inequalities in maternity care required broader systemic reform:

“Report after report has outlined how black women experience discrimination, racism and unequal care in maternity settings.

“We must embed a stronger anti-racist culture in our healthcare institutions.”

“We must also ensure that the staffing and funding levels are there to provide every woman with the high standard of care she deserves.”

Kate Brintworth, chief midwifery officer for NHS England, added:

“Racism and discrimination have absolutely no place in the NHS, and every single pregnant woman should be listened to and involved in decisions about her pain relief.

“We know that this kind of behaviour can have a terrible impact on mothers and babies from ethnic minorities, and those from deprived communities resulting in poorer outcomes and experience.”

She said new measures would require trusts to roll out perinatal equality and anti-discrimination training by the end of 2026.