Birthrights is joined in conversation by Dr Kate Whitehouse to talk about maternity care and her experiences as a doctor within both the US and the UK maternity systems
“Originally trained as an OB/GYN, I have spent the last decade working primarily in sexual and reproductive health (SRH). Abortion care is my specific area of expertise- as both a clinician and a researcher. I have worked in British independent sector abortion provider organisations for the last 7 years. Prior to that, I also worked internationally, including with the World Health Organization where I contributed to global abortion & family planning research and guideline development.”
What brought you into maternity care?
“I did all my training and worked as a consultant obstetrician-gynaecologist in the US where I provided the full spectrum of care-from delivering babies to performing laparoscopic surgery. My main clinical focus since moving to the UK has been SRH, but I have been very involved in research, evidence, and guideline development. Through my role at the British Society of Abortion Care Providers (BSACP), I’ve been a stakeholder in a nationwide initiative to address findings from the last MBRRACE report, specifically the maternal mortality from blood clots in pregnancy. Through this work, I began digging deeper into the MBRRACE findings.”
Was there anything that particularly stood out to you or surprised you when you started working on maternal mortality?
“What struck me most was how racial disparities dominate the data. It is clear that Black and Brown women have consistently been at a higher risk of dying during or after pregnancy for years. And while the MBRRACE report mentions this, it still feels like we are not addressing this reality head-on. Initiatives, like that one I have been contributing to, spend a lot of time addressing the medical fixes, like reducing risk of blood clots. While obviously this is important, I worry we are still glazing over the deeper problem. Unless we also directly tackle the systemic injustices that likely drive these disparities in mortality, I fear we will continue to see the same trends every year.”
How did your focus evolve from abortion care to recognising the deeper systemic issues in maternity, particularly systemic racism?
“In abortion care, we see firsthand how stigma, inequality, and systemic bias shape health outcomes. In the UK, abortion rates are highest in Black women—up to double the expected rate based on population. The rate of repeat abortion is also highest amongst Black women. I don’t believe we have data available to tell us whether women of colour have higher abortion complication rates, but I wouldn’t be surprised if we found similar patterns to what we see in overall maternity care regarding abortion morbidity and mortality.
“We have very similar issues with racial disparities in women’s health in the USA too. I can’t say the US has solved the problem yet either, but I do think there has been some really hopeful progress in women’s health spaces. I’ve been really inspired by the Society of Family Planning and other reproductive health organisations in the US that have evolved over time to truly centre social justice at the heart of their work. They name racism explicitly, integrate reproductive justice principles into research and education, and ensure representation and accountability across their structures. It shows that a professional society can be rigorous, evidence-based, and unapologetically justice-oriented at the same time.
“However, in the UK healthcare system, it feels like people often frame inequities through the language of “diversity” or “health inequalities” rather than directly addressing racism or colonial legacies. It also feels like we are behind in offering mandatory training and open dialogue on implicit bias and systemic racism that have been standard in the US system for years. Until we normalise these discussions and embed anti-racism into how we teach, research, and deliver care, I believe progress will remain incremental.”
The MBRRACE reports have consistently highlighted stark racial disparities in maternity outcomes, with Black and Brown women and birthing people facing disproportionate risks. Despite years of evidence, we’ve seen little real improvement, and in some cases worsening outcomes. How do you interpret this lack of progress? What do you think it reveals about the way the system is working?
“I think it shows that our system is more comfortable reporting disparities than tackling them. Year after year, the data highlights the same inequities, yet the response seems like it has been siloed—addressing different pieces of the puzzle rather than the common thread: systemic bias. I am not entirely sure why this isn’t being more tackled more directly. Is it because these conversations feel difficult and make people uncomfortable? Is it because medical organisations feel that addressing racism isn’t their scope, so they focus only on the “scientific” improvements? Perhaps it shows that the UK system hasn’t given clinicians and public health experts the tools they need to tackle racial injustice in medicine.”
From your perspective, what needs to change to address these disparities meaningfully? Are there particular priorities (in policy, clinical practice, or culture) that you see as urgent?
“I would like to see UK healthcare providers and organisations putting social justice at the heart of everything. We all need to look through the lens of anti-racism and decolonisation when we provide medical care, write guidelines, or build services. This could include:
- Embedding anti-racist practice throughout maternity care and training.
- Co-designing services with women/birthing people of colour and communities most affected.
- Making equity as important a safety target as mortality reduction.
- Addressing the social determinants—poverty, housing, education, access—that intersect with race.”