Tisian Lynskey-Wilkie is the Prevent Lead for Cheshire and Merseyside’s Women’s and Children’s Services Partnership, which is also known as the Cheshire and Merseyside Local Maternity System (LMS). As well as being a qualified midwife, Tisian holds a master’s degree in Public Health Nutrition and is currently a PhD student at University Central Lancashire. She has recently launched the region’s Black Mum Magic project, which supports black mothers and gives the black community a voice in system design and configuration.
Can you tell us about your role?
As the Prevent Lead for Cheshire and Merseyside’s LMS, a big part of my role is coordinating and leading on key public health issues like substance misuse, weight management, infant feeding and some aspects of postnatal care like contraception and smoking in pregnancy. An important element of the LMS is also reducing inequalities, standardising service provision and improving the health of mums and their babies, which is why I started the Black Mum Project.
Is this something that you’ve always been interested in?
I’ve always had a passion for research and when I was a student midwife, I started to learn more about the complex social factors and social determinants that have an impact on health, which then gave me an interest in public health. So, when I went on to do my master’s and study maternal nutrition, I discovered that I loved the combination of maternity and public health.
How did the Black Mum Magic project start?
When I started this role last year I was working with migrant mothers and we held a fantastic study day for healthcare professionals and had some service users talking about their experiences, which prompted a lot of discussion and learning.
I wanted to do something similar for black mums, because I knew from the University of Oxford’s Mothers and Babies: Reducing Risk through adults and Confidential Enquiries across the UK (MBRRACE-UK) report that racial inequalities have resulted in poorer outcomes for black mothers, but no one seemed to be doing anything about that at the time.
How did you feel when you read the findings of that report?
It’s sad, it’s disappointing and it’s frustrating because there’s no genetic biomarker in black women that means that we’re more likely to die, what there is instead is systemic and institutionalised racism. What’s more, we knew this was happening in 2016 and in 2019 we’ve found the same thing again. Whilst it’s good that this conversation is happening now, it should have started a long time ago.
There’s a phenomenon called ‘weathering’, which is living in a state of chronic stress as a result this racism and that’s been highlighted as having a direct impact on babies and maternity. So, acknowledging that black women face, in their day to day lives, experiences and situations that negatively impacts their wellbeing and their children’s wellbeing should be enough for everyone to want to see change.
When did the project launch?
We launched the programme the day before Liverpool’s Black Lives Matters protest and I actually had the chance to speak about this work and some of the inequalities that black women face in society at the protest. Getting the word out there was really important to me as, whilst the protests were about the horrendous police brutality that is happening, they were also about the systemic racism that comes in many forms, including microaggressions and stereotypes. So I wanted to get the message across that we need a complete culture change and the disparities that black women and their babies face is a perfect example of that.
The project is primarily about listening to the experiences of black women and we heard about what it’s like accessing healthcare, what it’s like to have barriers in place as a black woman and we also talked about implicit bias and the fact that we all have it and that it’s time to acknowledge it, own it and address it. We also talked about stereotypes and microaggressions and how they can transpire in our healthcare and in particular we focused on how we can empower women to speak up when their healthcare is not up to standard because of racism.
We had several other sessions that looked at maternity, as well as neonatal mortality and how there’s a greater risk of black and brown babies suffering after they’re born with illness. We also looked at workforce representation, because we know that if we look at the top bands of NHS pay, there’s very few black people in those bands, and how there’s much more diversity in nursing than there is in midwifery. The latter is important because when I was a student midwife, I think there was only me and a small handful of Black, Asian and Minority Ethnic (BAME) students throughout the three years and we were expected to know everything about every cultural ethnicity and cultural practice. There were instances where I was expected to know about specific cultural beliefs or practices that women from African countries or the Caribbean had because I had ‘loads of black friends’, but even though I’m from England and I don’t have that perspective, because I’m black it’s assumed that I do. It should never be the responsibility of one person in the room to educate everyone else.
Could you share some of the experiences you’ve heard from black women as part of your work with Black Mum Magic?
Sometimes it’s the simple things – one mum talked about the assumptions that are made about the country that she’s from and being asked if she’s going to be taking her baby back to a particular country, even though she wasn’t actually from there. What should have happened is that the healthcare professional asked the question and opened the dialogue, but an assumption was made which then becomes a microaggression.
We also heard stories about women out there who have rejected healthcare and have decided to go alone and have a free birth, which is fine and their choice, but they’re sometimes not making that decision from an informed viewpoint, they’re doing because they don’t think they’re going to receive safe and culturally sensitive care.
What has it been like living and working in Cheshire and Merseyside as a black woman?
Personally, I’m from south-central Liverpool and I’ve grown up in a diverse community, but outside of that, I’ve realised that Cheshire and Merseyside is very white, and because the number of BAME people in the region is small, it’s seen as ‘out of sight, out of mind’. But that attitude is so counterproductive, because we know that those smaller pockets of communities are more isolated and have more barriers and really need more targeted support and intervention. But I’ve found that getting that message to healthcare providers is really hard.
As a female of colour, I always say that it’s not just a glass ceiling for me, I literally live in a glass box, and you have to break both the sides and the ceiling, which is really frustrating. Even growing up, I didn’t see anyone like me doing a PhD and I’m so proud to be in my community now and showing other people that it’s possible to break through, but it hasn’t been without challenge. For example, I’ve experienced racism in work, and I wasn’t supported, which meant that I had to develop an additional layer of resilience just to get through the working day.
As a professional, I know that when I apply for a job that, from my name, people will get an indication that I’m not a white person. I’ve been told in the past that my ‘background isn’t suitable’ for the job, but when I ask what that means, I don’t get a response or follow up.
I’m even conscious about my hair. My hair is usually curly, Afro hair but I would never go to an interview with my hair like that because I feel that I’d be putting myself at a disadvantage. That’s quite powerful – to feel that you cannot express yourself and express your roots and heritage if you want to excel and progress, but that’s the reality. I know colleagues and friends who use their middle name instead of their real name when they’re in work and that’s really sad. How can you be your authentic self and embrace your culture and heritage when you feel like you can’t even use your proper name?
I once even had a service user make an assumption and say: “You’re not white, your name must be Shaniqua”, which is so insensitive and stereotypical. People don’t realise the impact that this can have on a person, but it makes you feel massively uncomfortable and when you try and get support from your senior leaders, sometimes it’s not here.
In your opinion, what more needs to be done to ensure that health and care services are fully accessible and tailored for the black community?
I don’t believe that you can have true advocacy unless you have true representation. When you see that so many organisations do not have any black people in their top pay bands, how can they say that they are a true advocate for black people and BAME people? A lot of the BAME workers are in the lower banding and lower paid jobs, both inside and outside of medical roles. In my opinion it’s not as diverse as it should be.
As well as that, we also need to have implicit bias training for all staff at all levels and we need to keep coproducing our services and valuing the voice of the community that we’re trying to serve. We need to be coming from a ‘you said, we did’ place and listen to people.
What are some cultural resources that you’d recommend people take a look at during Black History Month?
The Museum of Liverpool has put together a powerful exhibition of placards from the recent Black Lives Matter protest, including mine, and is sharing the stories of the voices behind the placards.
I’d also recommend a book called ‘Killing the Black Body’ by Dorothy Roberts, which highlights some of the longstanding racial inequalities that black women have faced for years.