Diverse needs: supporting BAME families

20 November 2020

BAME people suffer racial discrimination throughout their lives, as highlighted recently by the Black Lives Matter protests. Journalist Linsey Wynton, a mother of three mixed-race children, asks how CPs can best help BAME families.

BAME families know that racism is widespread and can start even before birth. Black women are five times more likely than white women to die in labour in the UK, and mixed-race and Asian women twice as likely (Knight et al, 2018).

As Unicef stated in a recent blog post about the importance of talking to children about racism: ‘Babies notice physical differences, including skin colour, from as early as six months. Studies have shown that, by age five, children can show signs of racial bias, such as treating people from one racial group more favourably than the other’ (Unicef, 2020).

Key issues for CPs

During the Black Lives Matter protests this year, many people shared their stories on social media. They included mothers whose black and mixed-race children had been called the N-word at nursery and assaulted, and a black mother of a light-skinned mixed-race baby who’d been asked if she had stolen him.

There were also accounts of mothers describing a lack of racial awareness among their health visitors. A mixed-race mum with a white husband reported that her HV had asked if she was the nanny; a mother of mixed-race girls reported that her HV hadn’t been able to tell if they had jaundice because of their ‘funny’ skin tone; and a mixed-race mother of a daughter with a Mongolian blue spot reported that her HV had implied that there could have been abuse.

Racism in schools is ticking up as well. Primary school exclusions for racist bullying in the UK rose by 40% in 2006-17. In all schools there were 4590 exclusions for racial abuse in 2016 (McCamley, 2020; Marsh and Mohdin, 2018).

Obi Amadi, lead professional officer for strategy, policy and equalities at Unite in Health, says 
the training that community practitioners receive on race varies around the country and is focused mainly on illnesses to which BAME communities are more susceptible.

‘For a long time we have been calling for all health and care staff to have more training and development on cultural competency,’ she says.

Supporting people’s cultural needs

Elaine Baptiste, a member of the CPHVA Executive, agrees that CPs need to receive more training about the culture of the UK’s diverse BAME communities ‘to ensure that there’s equity of treatment’.

She explains: ‘Child rearing differs from one culture to another. If you give the same advice to a family from a completely different background, it will often create problems. The parents will not necessarily follow that advice because it’s alien to them.

‘I have worked with newly qualified HVs with gaps in their knowledge on race and cultural issues. They don’t know what they don’t know, so they’re in danger of practising badly – not deliberately, but because they’re not aware.’

Susann Savidge is chair of People in Harmony (PIH), a charity for mixed-race families. She is adamant that CPs must not be ‘colour-blind’. Instead, they need to ‘recognise difference and that in professional practice one size does not fit all’.

Val Hoskins, a PIH trustee, notes that British-born BAME families may have similar cultural needs to those of their British-born white neighbours. ‘People often make assumptions about someone’s culture – or they might project their own assumptions in offering support,’ she says. ‘You have to ensure what their cultural needs are to start with.’  

Health professionals also need to recognise the dual heritage of mixed-race children and families, says PIH’s vice-chair, Dinah Morley.

‘For mixed-race children, black is so often the default position,” she says. ‘It’s so important that they are allowed to be who they are and have both sides of their identity recognised. They can experience so much prejudice – “too white to be black; too black to be white” – leaving them on the outside of peer groups, especially in their teens.’

Obi urges CPs to ‘be culturally competent, compassionate and attentive. For instance, people in some cultures don’t make eye contact with professionals. This isn’t disrespect or a sign that they do not understand you. It’s the opposite.’

Obi’s advice to any CP who is unsure about the best information to give a family about a culture-related issue – diet, for instance – is simple: find it yourself. ‘You might assume that all Asian families don’t eat pork, but that’s not the case. Some don’t eat beef; others are vegetarian. You don’t need to know everything, as long as you know where to access the information and say so. That’s good enough for safe practice.’

‘People in some cultures don’t make eye contact with professionals. This isn’t disrespect or a sign that they do not understand you’

Mind your language

Experts agree that professionals must listen to how to pronounce clients’ names to be respectful.

‘Sometimes people don’t even try.’ Obi says. ‘They will say to a client: “I can’t pronounce that. I’ll just call you X or Y.” If a health professional isn’t bothering, it doesn’t help in establishing a relationship.’

She adds: ‘It’s not appropriate to use a child to translate and interpret for parents. If there are language issues, make use of interpreting services [such as Language Line].’

Val notes that some clients who can speak English may still ‘feel that they need support from a family member or friend if they have fears of having professionals involved, as there may be trust issues’.

Health issues facing BAME communities

People from the Romany Gypsy Traveller community are particularly likely to need such support from relatives and/or other community members, according to Susann.

‘It is our oldest BAME community and still the most vulnerable,” she says. “That community is not always trustful. It needs to have its traditions and cultures understood.’

Val recommends that health professionals read Mind the gap: a handbook of clinical signs in black and brown skin (Mukwende et al, 2020). Malone Mukwende, a medical student at St George’s, University of London, co-wrote the booklet to educate students and health professionals on ‘the importance of recognising that certain clinical signs do not present the same on darker skin’, because British medical textbooks have a ‘white skin bias’.

Experts agree that health professionals need to be aware that black and mixed-race children are among those at increased risk of sickle cell disease, while south Asians are among those at increased risk of thalassemia and diabetes.


Elaine says that CPs also need to be aware of certain safeguarding issues, including female genital mutilation, that affect certain cultures. ‘In some cultures it’s still OK to beat your child,’ she observes, adding: ‘It’s not what you say; it’s how you say it – and find the right opening. Otherwise, someone might think you’re being nosy and won’t open up. Under Covid-19 movement restrictions, it’s hard to detect such issues and have that conversation with the parents if you can’t visit and are having to communicate by phone or video call.’

Elaine notes that CPs may encounter families with cultures ‘where grandparents have told parents to lay babies on their tummies to make them more comfortable. So you need to be able to explain about cot death risks.’

Val adds that foster and adoptive families of black or mixed-race children should be asked if they need support on how best to care for their children’s skin and hair.

‘Complaints of racism are not always listened to when people behave in an emotional way. Try to stay cool, calm and collected’

Racist bullying

The Equality Act (2010) states that schools must not discriminate between pupils on the basis of factors such as race and religion. It prohibits harassment of pupils on the basis of race, and victimisation of pupils who complain of discrimination.

A report by Family Lives (2020) states: ‘The complaints we’ve had include a girl aged six being told by a classmate that she cannot take the school mouse home because he doesn’t like people with brown faces… [and] incidents involving teenage gangs and weapons, one of which meant a boy was too frightened to return to school.’

The National Bullying Helpline (NBH) has called for all schools to have a safeguarding officer to deal with bullying cases and for these to be recorded by Ofsted (NBH, 2020).

The Runnymede Trust report Race and racism in English secondary schools (Joseph-Salisbury, 2020) highlights a lack of BAME teachers, particularly in senior positions, as a key issue.Citing cases including the murder of 12-year-old Shukri Abdi and the attempted suicide of 10-year-old Caleb Hills, both of whom had suffered racist bullying at school, the report calls on all teachers to improve their ‘racial literacy’.

It states: ‘By their own admission, many teachers are ill prepared to teach in ways that promote anti-racism – and this can include BME teachers’ (Joseph-Salisbury, 2020).

Val says that schools must ensure that they have books representing all BAME communities, including some emphasising the importance to students of talking to a trusted person if they suffer racist bullying. She adds that it’s vital that children are believed when they talk to professionals about the racism they have faced – and that their experiences are recorded accurately.

‘Children’s mental health is important,’ Obi stresses. ‘Imagine that a child is suffering through being bullied because they are racially or culturally different, plus they have a health condition or something else that makes them seem different. Intersectionality affects children too – school nurses need to be looking out for that as well.’

Susann says that families who have had negative experiences with schools or the police may prefer to seek help from a BAME support group initially, or find advocacy support.

Professionals should look out for young people who’ve been victims of racism and are ‘presenting with aggression – an outcome of being frustrated, confused and stressed’, she says. ‘We know that to be a problem in secondary schools, particularly those with hidden areas where unacceptable behaviour can occur.’

Susann adds that CPs should advise families whose children have experienced racism at nursery or school – by children, parents, staff or contractors – to gather evidence.

‘Write down the date and time and what was said, take photos and/or note registration numbers,’ she says.

Elaine moved her daughter from one primary school to another after she had faced racist bullying.

She says: ‘I normally advise parents to talk to the school, but also put it in writing so that you have concrete evidence of the conversation. Teachers can’t then go into denial and say they weren’t aware. Then you have to ask what is going to be done – and when – and check that it happens. If the person you report it to doesn’t do anything, you need to know who is the next person in charge to go to. Complaints of racism are not always listened to when people behave in an emotional way. Try to stay calm, cool and collected about what is happening.’



Supporting victims

Susann suggests that CPs could encourage BAME parents to get involved in parent-teacher associations and become school governors. This should give them a platform to effect change and stress the importance of getting all parents to talk to their children about racism.

As Unicef says: ‘Ignoring or avoiding the topic [of racism] isn’t protecting children; it’s leaving them exposed to bias that exists wherever we live’ (Unicef, 2020).

The resources cited in this article offer useful guidance. They include examples of inclusive books for young people, tips for parents on how talk to their children about racism, and health information.

‘It’s vital to effect change,’ Susann says. ‘Otherwise, it’s a whitewash – and people from BAME communities won’t have the recognition or the inclusivity they need.’ 

Image credit | iStock


Advice on racism and bullying  

Support organisations  

  • People in Harmony, a charity that provides guidance and assistance for mixed-race individuals and families: pih.org.uk    
  • Mind, the mental heath charity: mind.org.uk

Health information  


Anthony Walker Foundation. (2020) Hate crime is a serious concern and poses a threat to cohesive and strong local communities. See: https://anthonywalkerfoundation.com/services/ (accessed 17 September 2020).

Family Lives. (2020) What to do about racist bullying. See: https://www.bullying.co.uk/advice-for-parents/what-to-do-about-racist-bullying (accessed 8 October 2020).

Joseph-Salisbury R. (2020) Race and racism in English secondary schools. See: https://www.runnymedetrust.org/projects-and-publications/education/racism-in-secondary-schools.html (accessed 8 October 2020).

Knight M, Bunch K, Tuffnell D, Jayakody H, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ (eds) onbehalf of MBRRACE-UK. (2018) Saving Lives, improving mothers’ care: lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014-16. National Perinatal Epidemiology Unit, University of Oxford: Oxford. See: https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202018%20-%20Web%20Version.pdf (accessed 8 October 2020).

McCamley, F. (2020) Exclusions for racism in primary school in England up more than 40%. See: https://www.bbc.co.uk/news/education-50331687(accessed 17 September 2020)

Marsh S, Mohdin A. (2018). Record number of UK children excluded for racist bullying. The Guardian. See: https://www.theguardian.com/education/2018/nov/30/record-number-of-uk-children-excluded-for-racist-bullying (accessed 8 October 2020)

Mukwende M, Tamony P, Turner M. (2020) Mind the gap: a handbook of clinical signs on black and brown skin. See: https://www.blackandbrownskin.co.uk/mindthegap (accessed 8 October 2020).

National Bullying Helpline. (2020) What can we do to stop bullying in schools. See: https://www.nationalbullyinghelpline.co.uk/kids.html#stopbullying (accessed 8 October 2020).

Unicef. (2020) Talking to your kids about racism. See: https://www.unicef.org/parenting/talking-to-your-kids-about-racism (accessed 8 October 2020).

Social media references: private group.



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