Women’s accounts of their own symptoms and experiences in maternity care are systematically dismissed because of deep-seated gender and racial prejudices, according to research into formal reports on poor care. The findings, highlighted in a letter from academics at the University of Manchester and the University of Sheffield, point to what they describe as a form of “epistemic injustice” in which women’s “testimonial knowledge” – what they say about themselves and their bodies – is routinely devalued. This pattern, they argue, reflects a broader “medical misogyny” that has devastating consequences for mothers and babies, and is compounded for Black and other ethnically non-white women by racial stereotypes about pain tolerance that lead to inaccurate or missed pain relief in labour.
The researchers, Professor Sarah Devaney, Dr Victoria Moore, Professor Alexandra Mullock of the University of Manchester, and Dr Laura O’Donovan of the University of Sheffield, said gender-based prejudices carry “disturbing echoes of historical patriarchal assumptions and myths about the mysteries of female bodies.” Women are frequently perceived as anxious, hysterical or irrational, and their physical symptoms are dismissed as psychological. For Black women, these biases are exacerbated by entrenched racial stereotypes, including the false belief that women from particular ethnic groups have higher or lower pain thresholds. The result, the academics warned, is that women’s voices are seen as unreliable and are routinely ignored, leaving them without the compassionate, safe care they deserve.
Prejudice and misogyny at the heart of maternity failings
The recent Ockenden Review into maternity services at Nottingham University Hospitals NHS Trust laid bare the human cost of such systemic failures. Examining more than 2,500 cases between 2012 and 2025, the review found that over 500 mothers and babies died or suffered potentially avoidable harm. It identified a culture in which staff did not listen to mothers and fathers, and where concerns raised by patients were minimised or reframed. The review’s findings echo a long pattern of women’s voices being dismissed not just due to a lack of understanding but also a lack of empathy, with research highlighting that women’s pain is frequently ignored. Black women in the UK face disproportionately poor outcomes: studies indicate they are between 2.3 and four times more likely to die during pregnancy, childbirth or the postnatal period compared with White women, and twice as likely to experience severe pregnancy complications. The campaigning organisation Five X More has documented how Black women continue to face racism and poorer care, including unjustified high-risk categorisation, racist comments and a lack of empathy around pain management, forcing many to “fight for everything” and advocate for themselves.
These disparities are driven by systemic failings in leadership, training, data collection and accountability, with racism identified as a core driver. The Ockenden Review itself reported a “bullying and toxic culture” where junior staff were too intimidated to escalate clinical concerns or challenge unsafe decisions. It found a persistent failure to investigate mistakes and learn from them, alongside insufficient staffing and funding. The academics behind the research on epistemic injustice argue that the only way to end this cycle is to implement regulation for safer care within a learning healthcare system that genuinely values women’s contributions.
Leadership failures and toxic culture
The failings in Nottingham are not new. More than a decade after the Francis Inquiry into failings at Mid Staffordshire NHS Foundation Trust made 290 recommendations – including a statutory duty of candour – concerns persist that lessons have not been learned. Simon Gillespie, a former NHS regulator who spent his career in health regulation and leadership roles, said he was “not surprised” by the Ockenden findings. He pointed to “deep and enduring flaws” in the leadership of midwifery and nursing at the most senior levels in health trusts, boards and government departments. “Organisations established to improve nursing and midwifery leadership, and those which represent these professions more generally, have failed to recognise the clear challenges, learn from them and deal with them,” he wrote. He criticised leaders who “accepted poor care, not dealt with the many tragedies, prioritised protecting the reputation of the professions and organisations over patient care, lacked vision and grip to make the system better for patients, and individually and collectively not protected or stood up for their patients.”
The Ockenden Review also highlighted the refusal of over half of the 66 executives and 10 out of 14 commissioners to take part in the investigation. Lorin Lakasing, a consultant in obstetrics and fetal medicine, noted that these are the same people who “preach transparency and promise to undertake thorough investigations so that lessons will be learned, yet they shy away when the spotlight is turned on them.” She argued that even a statutory public inquiry would provide few answers because those involved would simply claim they were carrying out orders from the Department of Health and Social Care or NHS England, most would have been promoted, and all would point to being part of “a much wider team structured specifically to dilute accountability.” David Lewis, a psychologist and neuroscientist, called for senior managers to be made personally criminally liable for allowing a toxic situation that inhibits whistleblowing. He noted that the Francis report on Freedom to Speak Up had been published over a decade ago, yet the Ockenden Review still found a “culture of fear” in which staff were intimidated and patients’ concerns ignored.
Chronic understaffing and the paradox of unfilled posts
Underpinning many of these failings is a severe shortage of midwives and doctors. Dr M Tariq Ali, who has almost 40 years of NHS experience, said toxic behaviour in staff is the manifestation of severe stress caused by understaffing. He described how his daughter, a trainee midwife, arrived at work to find only six midwives instead of the planned 11 – a situation he called “normal.” She was dreading her day. The Ockenden Review itself reports “chronic understaffing … where midwives and doctors were overstretched, exhausted and unable to respond promptly to requests for help.” A report in February highlighted “inadequate staffing and resources at every level of maternity care,” yet perversely, 31% of midwifery graduates are unable to find jobs. Dr Ali noted that he had pointed out the dangers of understaffing more than 12 years ago. “It is so sad that we have walked with our eyes open into this terrible state of affairs,” he wrote.