by Fatimah Mohamied – Midwife and editorial board member of ‘The Student Midwife Journal’, contributor of ‘all4maternity’ and contributor to the ‘Association of South Asian Midwives’.
Midwifery is a profession that not only cares for the physical health of its clientele, but has also a deep and lasting impact on the mental and social health of a family. In this way, midwives are as much political forces for justice, as they are protectors of physical well-being. This political nature of our profession should not be underestimated, much of the shape of society has changed over the decades due to the activism of midwives. We should therefore not be guarded when advocating for human rights and dignity, this is particularly needed for marginalised and underprivileged groups; namely people of colour, whose battles with racism are still unbelieved by both ordinary and powerful establishments (Hirsch, 2018). But in order to battle racism, we need to address the ills in our own institutions and systems, which have largely stemmed from colonialism and empire.
Winston Churchill’s asymmetric face, saliently staring up from every five pound note in the country, is a marker of the glorious nostalgia that contemporary Britain views its past empire and colonial history (Akala 2018). Churchill was among many who believed in the disposability of the colonised, his policies of heavily taxing the Indians resulted in the tragedy of the Bengal famine, where up to 3 million ethnic Bengalis were killed. In this way the new five pound note is a symbol of Slavery, genocide, dehumanisation, rape, pillage, famine, brutality and inhumanity, being automatically swept under a rug of selective amnesia (Andrews, 2018). If we are carrying around such an insult to people of colour in our pockets, and reflect upon the British Empire as a lost romantic notion (Akala, 2018), then it is naiive to think our institutions, including our hospitals, whose hierarchies and systems have significantly large holes primed for inequality, can generate justice and dignity for its service users (Eddo-Lodge, 2018).
Sands detailed the trauma of a Jewish woman labouring and birthing her child at gunpoint by Nazi soldiers (2018), she had her mother at her side, who witnessed her grandchild be shot moments after it was born, and then her daughter before being killed herself. The tragedy of these inhumanities has not be denied by contemporary Germans. On the contrary, German education strenuously emphasises its past atrocities, which is why its institutions (though by no means perfect) have an anti-racist awareness and development towards justice. There is no such reflection of the British Empire in British education, not even in GCSE history, but we all know about Henry VIII.
An example of how colonial history has seeped into our healthcare system is by the notorious work of James Marion Sims, well known as the father of modern gynaecology, but less known as a cruel slave owner and experimenter. He conducted 30 experimentally gynaecological surgeries on a black enslaved woman called Enarcha and 11 other enslaved women without pain relief, though it was available at the time (Washington, 2007). This was due to a common perception that black people do not experience a sensation that can be creditably called pain, which was a method to actively create a culture of dehumanisation among melanated peoples (Washington, 2007). A shadow of this can be observed in our modern maternity units, where women of colour are often mistreated when complaining of pain (Thalassis, 2013), which is also not believed to be sincere by healthcare professionals. Sims, meanwhile, was celebrated for the knowledge he usurped from Enarcha, particularly for a speculum, which he designed and named after himself (Washington, 2007). It is still in use, and can be found in operating theatre store rooms; a silent testament to its sinister origin.
Uncomfortable truths are not safely contained across the Atlantic. When Britain entered both World Wars, it was the Empire, and not just the natives that fought for Britain. Many Indian soldiers during World War 1 were treated for their injuries in Brighton, but were ignored when they complained of shell shock and psychological disturbances. Unlike the white soldiers who were believed and treated compassionately, the Indians were promptly sent back to the front line to fight for Britain, this action was rationalised by a poor excuse that the Indians came from a warrior lineage and so did not suffer from mental health concerns (Buxton, 2018). Furthermore, this correlation of people of colour dying for Britain can be seen in the current covid19 pandemic, where the majority of healthcare workers who have died from covid19 are people of colour (Farah, 2020).
A known feature of the British Empire, was a belief in their own superiority and intellectual capacity over the people they ruled. This culminated in a popular belief that the colonised did not know what was good for them, and that the British influences would result in their improvement. This attitude of dominance can be seen in the well intentioned work of medical charities. When the only psychiatric hospital in Sierra Leone received a poster from an organisation about not chaining their patients to their beds, they were very frustrated. Crippled after a civil war on top of managing their own wounds from French colonialism, the hospital had no running water, electricity, medicine or staff to care for their patients. Chaining patients to their beds was the only feasible method of protecting aggressive patients from themselves and others. The hospital received a donated generator, which was too powerful and fused all the appliances, this was because the charity did not communicate with the hospital about its needs. Partnership, on a footing of humane equality, not transacting on a giver and receiver dynamic, holds more impact for health and justice.
The attitude of British superiority has filtered down in history to our contemporary healthcare systems. This is evidenced in the slower rate of promotion for people of colour in comparison to their white peers, the higher attrition rates among students of colour, and the woeful lack of minority representation among senior management. Especially when people from the commonwealth were recruited to fill a labour shortage in the NHS since the 1960s. These were not decisions made by one unfortunately racist person, but by a racist system scripted by powerful people (most white) who were not adequately educated about their country’s racist history.
After World War 2 Britain found its empire too costly to run, and subsequently handed over independence to many of its colonies. But in the interests of capitalism and personal gain, dictatorial authoritarian leaders were intentionally installed to create division and destabilisation (Akala, 2018). This is why the highest maternal mortality rate in the world, (1 in 17 women) in Sierra Leone, cannot be unlinked from colonial history and our collective consciousness.
But we can look closer to home for racial disparities in maternal care (MMBRACE), where black women are 5 times more likely, and Asian women 2 times more likely than white women to die in the perinatal period; an inhospitable statistic. A need for discussion and reflection from both the women of colour and staff of colour are needed in addition to an investigative report, as this statistic is unlikely to accrue from purely physiological roots. However, we can start off with that necessary ugly look at our history, and its relevance to contemporary healthcare.
Educating the young is an excellent step in shifting societies towards dignity and justice. However, our Universities need to change too. Education around cultural safety should not focus on how much of another’s culture a student knows, but around the White default that medical education has been tuned to (Burnett et al, 2020). Pre-registration healthcare education should rotate to learning about our biases and how those biases stemmed from colonisation. We should take pains to analyse our own behaviour to those who are different to us, by acknowledging that the environment we were born into was founded upon principles of racism and dehumanisation. Education should start with ourselves in recognising and acting upon our privileges, so that we can move into a culture of kindness and safety.
“We are all racists” is a healthy place to start, because Enarcha and the countless people who have suffered at the hands of intentional dehumanisation, deserve it.
- Akala, 2018, Natives: Race and Class in the Ruins of Empire, Two Roads, London
- Andrews K, 2018, Back to Black, Retelling black Radicalism for the 21st Century, Zed Books, London
- Burnett A, Moorley C, Grant J, Kahin M, Sagoo R et al, 2020, Dismantling racism in education: In 2020, the year of the nurse and midwife “it’s time”, Nurse Education Tday, Volume 93, October 2020, 104532, available online at: http://www.irr.org.uk/news/institutional-racism-in-the-nhs-intensifies-in-times-of-crisis/ (Accessed on 24/7/2020)
- Buxton, 2018, Imperial Amnesia: Race, Trauma and Indian Troops in the First World War, Past & Present, 241(1), Pages 221–258.
- Eddo-Lodge R, 2017, Why I’m no Longer talking to White people about Race, Bloomsbury, London,
- Farah W, 2020, Institutional racism in the NHS intensifies at a time of Crisis, The Institute of Race relations, available at:
- MMBRACE report 2019, Saving Lives, Improving mothers’ Care,
- Sands P, 2016, East West Street: on the Origins of Genocide and Crimes against Humanity, Widenfeld and Nicolson, London.
- Thalassis N, 2013, A study into the experiences of Black and Minority Ethnic Maternity Service Users at Imperial College Healthcare NHS Trust April 2011-March 2013, BME Health Forum,
- Washington HA, 2007, Medical Apartheid, the Dark history of Medical Experimentation on Black Americans from Colonial times to the present, Doubleday, New York
- https://www.pih.org/article/celebrating-new-possibilities-sierra-leones-only-psychiatric-hospital
Fatimah Mohamied is a newly qualified midwife passionate about delivering dignity and justice for the woman and families in her care, she is also passionate about history, politics and intersectional feminism. She is a member of the Student Leadership Program Advisory Board by the Council of Deans of Health, an editorial board member for The Student Midwife Journal, and a contributor of the newly erected Association of South Asian Midwives. She is also a new mother and aspiring fiction writer.