Are you listening? Black Voices on Contraception Choice and Access to Services

Posted 05 Apr 2022

Date: 05 Apr 2022

Author: Dr Shardia Briscoe-Palmer

Ten new videos launch this month as part of the Black Voices on Contraception Choice project, highlighting the views and experiences of Black people when accessing sexual and reproductive health services. In this month’s eFeature, Dr Shardia Briscoe-Palmer gives an overview of the project findings and shares steps to enhance the experiences of Black people when accessing services.

The videos are available on the Contraception Choices website.

The videos were produced by Dr Shardia Briscoe-Palmer (project researcher) in collaboration with Dr Julia Bailey from the University College London eHealth Unit, Dr Annabel Sowemimo from Decolonising Contraception, and the FSRH.

In the videos, Black men and women describe their experiences of using different contraception methods, and also of the racism which acts in a variety of ways to erode trust and informed choice.Dr Shardia Briscoe-Palmer

Black people experience some of the worst sexual and reproductive health outcomes in the UK (Ethnic Inequalities in Healthcare; Saving Lives, Improving Mothers’ Care) and inequalities have widened during the COVID-19 pandemic, showing that race and ethnicity continue to be at the centre of inequality and social injustice.

Accessing healthcare is increasingly difficult as a consequence of the Coronavirus pandemic on top of ongoing cuts to services (Strengthening Access to Contraception Beyond the Pandemic). Our Black Voices research project confirms there are extra barriers for Black people which are rooted in structural, institutional, and interpersonal racism.
Accessing, choosing, and using contraception is complicated and challenging at the best of times. People may be put off using contraception by concerns about side effects, the views of partners, friends, family and community, as well as anxiety about what will happen in healthcare services. Race-related discrimination adds an additional layer resulting in poor clinical service and restricted access (From race-based to race conscious medicine).

“Black people are people. We want to access services with support and without judgement.” 

Project participants discussed largely positive experiences of different contraceptive methods, but our research showed there is still much work to be done to ensure Black people have positive experiences of sexual and reproductive healthcare.

Participants talked about not feeling welcome, not feeling listened to, and negative stereotypes and assumptions, leading to a lack of trust and reluctance to attend services at all.

The feeling of not being listened to was a theme which came up frequently:

“I found that a lot of the time my pain has been dismissed or any side effects or symptoms haven't really been taken seriously.”  

Lack of acknowledgement of Black women’s pain, is an ongoing study exposed in areas such as pregnancy and childbirth (Ethnic differences in women's worries about labour and birth).
Biased, unprofessional attitudes shrouded in racialised stereotypes can surface in patient-doctor interactions:   

“The jokes about being Black and having a big willy...saying about having multiple women.”  

The cultural bias and racism placed onto Black people’s bodies is a legacy of stereotypes stretching far into history, which needs addressing across the sector.

Lack of visibility and representation was a recurrent thread. Better representation is needed in clinic staffing at all levels, as well as in research, on posters, websites and health promotion materials.

A patient-centered approach should be holistic, flexible and collaborative, and service users should receive timely, confidential, non-judgmental access to care that addresses their needs. Our research showed that Black people, as for all service users, want to feel welcomed, comfortable, listened to and supported to make decisions about their own sexual and reproductive health.

Participants also talked about the ways that they are educating themselves, and seeking to heal from collective and individual trauma.

Participants’ messages to clinicians: 

“Just remember that it takes courage for the person to come to you in the first place”

“I think first and foremost, you should believe your patient and listen to them. What may be insignificant to you can be very big deal to someone else”

“We want to access services not feeling judged. And being given the true advantages and disadvantages of all methods and being able to weigh up pros and cons, with support and without judgment.”

“We just want help in the same way that everybody else does - race, ethnicity and gender shouldn't be a barrier to receiving a really good level of service, especially for sexual health services. It's so important for our health and a really big part of our lives”

The Black Voices videos are available on the Contraception Choices website.

Published in the April 2022 edition of the Sexual Health, Reproductive Health and HIV Policy eBulletin.  The content of all eFeatures represents the views and opinions of the authors. FSRH and coalition partners do not necessarily share or endorse the views expressed within them.