COVID-19 and the risk to black, Asian and minority ethnic women during pregnancy
Black, Asian and minority ethnic (BAME) women in the UK have increased maternal mortality rates compared to other groups of women. Unfortunately, according to preliminary findings, the COVID-19 pandemic has contributed to mortality rates for BAME women, raising concerns that pregnant BAME women are facing greater health disparities during the pandemic. A review of 427 pregnant women admitted to hospital in the UK with confirmed COVID-19 infection found that over half (56%) were from black or other ethnic minority groups. How BAME women navigate maternity services during the COVID-19 pandemic requires a vigilant review of their needs on an individual basis. This is particularly relevant for hard-to-reach women, such as recent immigrants and asylum seekers, who may encounter difficulties accessing or engaging with maternity services. Therefore, it is imperative to reassess and highlight the challenges faced by pregnant BAME women during the pandemic. The disruption of maternity services and diversion of resources away from essential pregnancy care because of prioritising the COVID-19 response is expected to increase risks of maternal mortality.
Recently, concerns have been raised about a possible association between ethnicity and incidence and outcomes of COVID-19, following observational data released from the Intensive Care National Audit and Research Centre (ICNARC, 2020), published on 10 April 2020. The data showed that of 3883 patients with confirmed COVID-19, 14% (486) were Asian and 12% (402) were black, demonstrating a high prevalence in these ethnic minority groups (Abuelgasim et al, 2020).
The evidence of increased risks of COVID-19 in BAME groups is concerning. In a cohort study of UK biobank data including 415 582 participants with 2 886 tested and 1 039 positive for COVID-19, it was found that rates in England were higher in BAME communities and in those living in deprived areas (Prats-Uribe et al, 2020).
There is also startling evidence of the high risk of BAME individuals contracting COVID-19 because of pre-existing health conditions, which is the case for all individuals. However, BAME individuals are prone to higher rates of hypertension, cardiovascular disease and diabetes and are subject to adverse healthcare disparities, compared to their white counterparts (Abuelgasim et al, 2020). Multiple studies have confirmed that the most common comorbidities associated with severe cases of COVID-19 are hypertension, cardiovascular disease, diabetes (Wu et al, 2020) and obesity (Yates et al, 2020), establishing the link between underlying health conditions and COVID-19. In addition, BAME individuals are more likely to die after contracting COVID-19; as shown in the UK Institute for Fiscal Studies reports, which stated that the death rate for people of black African descent was 3.5 times higher than for white British people, while for those of black Caribbean and Pakistani descent, death rates were 1.7 and 2.7 times higher, respectively (Kirby, 2020).
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