By: 27 October 2022
Consultant in focus – Q&A with Benjamin Black

An obstetrician and gynaecologist, and a specialist advisor to humanitarian organisations, Benjamin holds a specific interest in how to respond to the sexual and reproductive health needs of populations living in remote, resource-poor and humanitarian-emergency settings.

Benjamin studied medicine in London, following which he pursued a career in obstetrics and gynaecology. He has also completed further training in sexual health, family planning and abortion care. Benjamin’s first book, Belly Woman, was published in October 2022, a timely book centring on the effects of global health crisis on maternal health.


OGMN: What drove you to choose obs and gynae as a career?

BB: In my mid-twenties I was working on the Thai-Myanmar border with refugees and forced migrants, seeing the maternal, sexual and reproductive health consequences of conflict, poverty and displacement drew me to pursuing obstetrics and gynaecology training. I found the mix of surgical, medical and public health skills made it highly applicable to the humanitarian context, furthermore meeting the health needs of affected populations resonated closely with my own career ambitions.


OGMN: It is clear that the healthcare industry has been greatly impacted by the pandemic, what has been the greatest impact for you within maternity care?

BB: Loss of trust in the system. Decisions to restrict the presence of birth partners were harmful and will have a lasting impact, it also came at a time when maternity services are already under immense pressure and scrutiny. Moving forward, through Ockenden, the enquiries into racial disparities and other maternity reports, it feels that listening to the population served, with their concerns at the centre of decision-making, will be an expectation which must be honoured. This is vital if we are to regain trust.


OGMN: What’s the best part of your job?

BB: As an advisor to Médecins Sans Frontières I’m often contacted by teams in remote locations (such as from a refugee camp clinic) for help in managing complex obstetric cases. Thanks to modern technology, the world is a small place. Using email, phone and video I’ve supported critical clinical decisions and procedures that have been life-saving in some of the world’s most hostile locations. Nothing beats that feeling.


OGMN: … and the worst?

BB: Bureaucracy – in the humanitarian sector and the NHS


OGMN: What has been the highlight of your career so far?

BB: Designing ways to care for Ebola-infected pregnant women. At the start of the West African Ebola epidemic it was though around 90% of infected pregnant women would die. With simple interventions and supporting teams the numbers dying fell to the same level as for non-pregnant women of the same age, about 50%. Still a very high mortality, but it proved pregnant women could survive and deserved specialist medical attention.


OGMN: Please can you tell us more about the research you are currently working on and what it could mean to patient experience and outcomes?

BB: I’m developing a surveillance and quality improvement system for responding to maternal deaths for use in multiple countries. In my book, Belly Woman, I follow the journeys of women who were harmed by pregnancy complications – what’s clear is the underlying factors extend far beyond the biomedical causes. The hope for this system is we will identify these causes and implement actions to prevent the same happening again.


OGMN: You have recently published your first book, Belly Woman. Congratulations! Can you tell us more about your experiences in Sierra Leone and how it inspired you to report on your struggles and lessons within the book?

BB: Thank you, I’m so happy the book is available to read, it shares an incredible story and sheds light on issues often overlooked.

I arrived in Sierra Leone in 2014, to work for Médecins Sans Frontières (MSF) in a referral centre for pregnancy complications. At the time Sierra Leone was considered the country with the highest maternal mortality rate in the world. Soon after arriving the Ebola epidemic swept through the country. As we struggled to tell the infected from the uninfected our work to save lives and stay safe became almost impossible. Belly Woman tells the story of what happened to my colleagues and the population around us.

I wrote the book to document the shocking disparity in maternal health just a six-hour flight away from London. The Ebola epidemic was a tragic and historic global health crisis, and as a frontline witness I felt a responsibility ensure those times, the errors and the human stories were recorded.

Having all lived through the Covid pandemic people reading Belly Woman will be struck by how many similarities there are, and how we missed opportunities to apply these experiences from the recent past.


OGMN: Are you planning to attend any medical conferences or events in the next year?

BB: Yes, I just attended the British Association of Abortion Care Providers (BSACP) conference, it was great to be among such incredible advocates for reproductive healthcare. Next year I hope to join colleagues at the Women Deliver conference where the intersection of medical and social science come together.


OGMN: If you weren’t an obstetrician and gynaecologist, what would you be?

BB: A journalist.


OGMN: What would you tell your 21-year-old self?

BB: Trust your moral compass. If you know something should be done, do it.


OGMN: If you were Health Minister for the day what changes would you implement?

BB: I’d resign. Without sustained genuine political, economic and social commitment the health service won’t have meaningful improvement.


OGMN: Away from the clinic – what do you do to relax?

BB: Read, write, let my cat curl up next to me. If I have the energy, go for a run.


OGMN: How do you think the future looks in the field of obs and gynae care and what are your predictions for 2023 and the next decade?

BB: In the short term I think we have tough times ahead. The health service is fatigued, inefficient and under-resourced. Retention of older, experienced, staff is poor; as we lose their skills, knowledge and wisdom we lose the foundations under our specialty. But I also see hopeful signs; better engagement with service users, listening and responding to their needs and more integrated working between disciplines.

In the humanitarian sector I hope we’ll see a stronger shift towards supporting local providers to take the lead in clinical care, management and governance. Moving beyond counting numbers of maternal deaths, but meaningful efforts to prevent the deaths from happening at all. Emergencies are becoming more common and it’s vital for the people in the most affected areas to have the skills.


You can order your copy of Belly Woman here