Black Health, Women, Menopause: an intersect of protected characteristics

This year it has been great to see many topics being discussed in relation to black health and wellness. With mental health being a hot topic over the last few years and the slowly increasing awareness of the high black maternal death rates in the UK it is encouraging these themes are in the spotlight.

My mother is a mental health midwife so conversations surrounding black health and wellness have always had an important place in my household. This Black History Month in particular, there have been events dedicated to discussing these themes which is a good sign as it shows there is still work to be done in creating awareness and being proactive.

Menopause in particular has become a trending topic over the last few years, with MPs calling for it to be viewed as a protected characteristic under the Equality Act 2010. As today marks Menopause Day here in the UK and we are also in Black History month, I think it is important we briefly reflect on how the two are related and the work and discussions that needs to be done moving forward.

Menopause Research and the invisibility of Black British Women.

Conversations and discussions in past years have revealed that on average people from Black, Asian and other ethnic minorities are less likely to have conversations about health-related topics such as menopause and mental health in the home or within their communities.

However, especially in respect of menopause there is a distinct imbalance in the knowledge available when it comes to gender and race in relation to health. This is seen especially when looking into the research on black women & menopause where the significant gap of information available is very apparent.

In fact, the most recent study on Black women’s experiences of menopause in the UK was carried out in 2007 with a very small sample of just 22 women who fall under the umbrella of ‘BME’. Of this this small pool of women only 15 identified as Black women and 3 identified as Black British women.

There are a number of factors that also contribute to silence and stigma for Black women, including tired tropes such as ‘strong Black women’ to also cultural norms and approaches to the area. Typically, women from traditional African and Caribbean backgrounds will resort first to holistic and natural remedies for their menopausal symptoms before seeking any form of medical intervention, for example in the form of hormone replacement therapy (HRT).

With menopause currently in the headlines as MPs campaign for it to be a protected characteristic it is important to boost research in the area for all demographics of women in the UK, to better support and accurately defend ay form of discrimination that may arise from it.

Mental Health in black communities – Barriers to access?

Mental health being regarded as a ‘taboo’ topic has slowly started to shift with more organisations dedicated to change this narrative such as The Immigration Law Practitioners’ Association (ILPA). What is also important to highlight is that although initial internal discussions are not always happening, members of these communities still face barriers to getting help because of racial biases.

Mind UK reports that Black people are 40% more likely to access treatment through a police or criminal justice route, less likely to receive psychological therapies, more likely to be compulsorily admitted for treatment, more likely to be on a medium or high secure ward and be more likely to be subject to seclusion or restraint (56.2 per 100,000 population for Black Caribbean as against 16.2 per 100,000 population for white).[1]

Stereotypes and harm

Stereotypes, unfortunately play a large role in the health and wellness of black people. Though seemingly harmless there are negative tropes that affect both black men and women and cause serious harm, especially when related to issues of mental health.

“He must’ve been at least 7 feet tall!” Black men & racial stereotypes in health

Typically, black men are often stereotyped as being more aggressive and violent than their white counterparts and to the point that when even describing the physical appearances of black men people tend to perceive them as taller, more muscular, and heavier. This was revealed in the American Psychological Association’s Journal of Personality and Social Psychology, exploring stereotypes about perceptions of male bodies.

Adding inches to height and more weight to black men to over-emphasize their stature is problematic and very harmful as it feeds into the false perception that black men are inherently threatening and intimidating.

In relation to mental health in particular, the stereotype that Black men are prone to violence contributes to the misdiagnosis of paranoid schizophrenia. Racial stereotypes of violence often operate at the unconscious level in mental health clinicians’ diagnostic judgments about Black men.[2] This is dangerous and in fact shows why awareness and training to combat such unconscious biases is a necessity. This is further seen when looking at detentions under the Mental Health Act. On average, black people are 4 times as likely to be detained under the MHA and arrested under s. 136 twice as often and they are put on CTOS 8 times more frequently than white people.[3]

“Strong and independent” Black women & racial stereotypes in health

Another significant stereotype that causes harm in this area is the notion that black women are ‘strong and independent’. Whilst on the surface it may come across as a compliment to be seen as resilient, however there is a dark side to this trope that negatively impacts black women, especially in healthcare.  This stereotype feeds into the notion that they are incapable of feeling pain or stress. So, in some circumstances where black women are expressing their pain and it is not taken seriously by their health care professional, they feel dismissed.

This can also be seen in the 2019 US study published in the American Journal of Emergency Medicine where it found that that Black patients were 40% less likely to receive medication for acute pain compared to white patients.

A startling fact that has been repeated over the last year or so is that in the UK alone, Black women are five times more likely to die in childbirth than white women. An inquiry by the charity Birthrights found that black, brown and mixed ethnicity women reported feeling unsafe, their concerns being ignored or dismissed, denial of pain relief due to racial stereotypes, and pervasive microaggressions causing harm or distress.

The problem is skin deep: What can we do to help?

It is important that professionals and service personnel who interact with us on a day basis have adequate training to know how to properly identify both physical and mental health concerns on more than people with white or fair skin.  This goes for health care professionals, the police and teachers.

A memory that will always stick with me was when I was in secondary school in Essex. That day I was very much under the weather. I felt ill, but as I was not on my death bed it did not feel like it was an adequate reason to skip school. 

I had had several classes up until I sat in my French class. That day we had a substitute teacher who was South-Asian.  

Whilst addressing the class he looked at me, paused and asked “Frances, are you alright? You look pale”.  This question for some reason had caused my predominately white class to erupt in laughter before my teacher clarified himself by saying that my skin tone looked a lot duller than usual and that sometimes when black or brown people are unwell it is also present in their skin tone.

He asked that I go to the office, and I was sent home. After visiting the GP the following morning, it was confirmed that I had come down with a viral bug that had caused me to feel unwell. 

I often think about all the classes I sat through that day, and how many teachers did not notice the difference in my state. Teachers that had taught me for years.  Sadly there continues to be significant disparity in health outcomes for Black Women and clearly there is much work to be done in this area to push for equality and shift the boundaries.

 Written by Frances Onyinah, Paralegal Cole Khan Solicitors

[1] https://www.mind.org.uk/news-campaigns/legal-news/legal-newsletter-june-2019/discrimination-in-mental-health-services/

[2] Abreu JM. Conscious and nonconscious Black stereotypes: impact on first impression and diagnostic ratings by therapists. J Consult Clin Psychol. 1999;67:387–393

[3] https://www.ethnicity-facts-figures.service.gov.uk/health/mental-health/detentions-under-the-mental-health-act/latest