Racializing prenatal technology: exploring ethnic minority engagement with fetal ultrasound and MRI. KATE REED, UNIVERSITY OF SHEFFIELD

Background  Marginalisation of BME women and partners  Sociological studies have highlighted the continued marginalization of minority ethnic groups in prenatal screening services in the UK (Dyson 1999).  Stereotyped views of health professionals  Research on gender, ethnicity and prenatal care highlights stereotypical views of health professionals towards BME women and their partners (Puthussery et al 2008).  Fear of invasive screening  According to existing research, BME women are less likely to opt for screening and testing- especially invasive types of testing (Babay 2004).

Reasons for low service take-up  Cultural differences in attitudes towards the body and disability (Kupperman et al., 1996).  Religion is often cited as a key factor in ethnic minority women’s refusal of prenatal technology. For example certain understandings of the Quran may suggest that abortion is possible within the first 120 days of pregnancy if the mothers’ health is endangered (Panter-Brick 1991).  However focusing only religion and culture can lead to a racialization of health whereby ethnicity becomes an isolated variable in understanding patterns of inequality (Ahmad and Bradby 2007).  Therefore there is also a need to include a focus on racial discrimination and socio-economic factors. Racial harassment and discrimination are known factors in explaining health disparities between ethnic groups (Nazroo 2003).

Primary Research  Qualitative study on gender and prenatal blood screening (Welcome Trust )  Two small scale research projects conducted by 2 nd year medical students. Data collected from a local maternity hospital offering fetal MRI ( )  Qualitative study exploring professional and parent experience of fetal MRI (British Academy )

Research Questions  Who currently uses /accesses prenatal blood screening and ultrasound?  How are new technologies such as MRI being adapted and adopted in the prenatal realm?  How do professionals and parents feel about their access to and use of prenatal technology?

The subtleties of race and racism 1 (WT) Well, I wouldn’t say that the midwives were racist. I felt like they certainly weren’t surprised when I tested positive for sickle cell. It’s almost like with me being a black African they expect it. On the whole though I’ve got no complaints about my treatment. (Jameela, 37, Student accountant) I was treated really well during screening, especially when my blood tests showed up positive (for thalssaemia). The midwives couldn’t have been nicer to me or my husband but then we are both British born, I don’t know, when I look at some of the Muslim women in clinic, the Somalis that don’t speak English, I wonder just how well they get treated? (Pinky, 30, Bank clerk) 

Race and racism 2 (WT) The midwives were brilliant when I went for my tests. They did keep asking me to repeat things, because I am Czech English is not my first language. This was a bit annoying because I think I speak English pretty well! (Katarina, 28, Self-employed) Well, I was outraged. There was this black woman in clinic. Actually I think she had come in for diabetes testing. Anyway, the midwife calls her name and comes up to her, speaks really slowly as if she’s stupid and says, ‘do you speak English’. I felt like bloody shouting, of course she bloody speaks English, she is British. She has obviously lived here all her life. Honestly, I was so embarrassed I didn’t know whether to ignore it or whether to say something. My partners was a bit worried I was going to march over a give em a piece of my mind. (Sarah, 33, Teacher)

Challenging ‘culturalist’ assumptions (medical student projects)  Use of fetal MRI among particular women more pronounced e.g. among Pakistani and African women. Use by white British lower than expected.  Positive attitudes and high acceptability of the procedure among women. Parents liked being given images, receiving results on the same day.  Muslim women less likely to terminate therefore more likely to engage with prenatal services to gain better prognostic information about their child’s future.  This contradicts the theory put forward in existing literature -that BME women underuse PN services.

Religion and termination (BA) Nasra: Like, is it really very…I mean, such a serious thing that my baby has, that I should terminate my pregnancy? Interviewer: Right. So, you would have never done it under any circumstances? Nasra: No, I wouldn’t have done it anyhow. Actually, according to our religion, I mean, terminating the pregnancy, I mean, this kind of termination when you come to…when you have some problems with your baby or stuff, it’s a kind of murder

Religion and technology (BA) Interviewer: Okay. So you don’t have any strong reservations against it? Nasra: No, no, nothing like that. If I need to go, then yes I will. If the doctor says that yes, you need to have an MRI scan, then I will obviously. Interviewer: Okay. So it’s accepted to have this scan, religiously as well? Nasra: Yes. Interviewer: There’s no confrontation there? Nasra: Yeah. No, nothing like that.

Conclusion  Some evidence of ethnic stereotyping in WT data.  However, findings of all three studies challenge the assumptions often made in the literature about low-take up of services by women from minority ethnic groups.  Although religion influenced women’s attitude towards termination, it did not influence their attitude towards prenatal screening. They wanted more prognostic information.  Need to ensure universal access to prenatal screening care. Professionals involved In PN care also need to be more culturally sensitive to women and their partners.  We need however to avoid a further racialization of health in this context whereby ethnicity becomes an isolated variable in relation to the use of such technology (Ahmad and Bradby 2007).