Navigating silence and voice: South Asian women healthcare professionals in the UK NHS during COVID-19 and beyond - a qualitative study.

objectiveTo explore the experiences of South Asian female healthcare professionals in the UK National Health Service (NHS) during COVID-19, examining how the pandemic conditions exposed the ways in which race, gender and professional identity intersect to shape risk, silence and discrimination. STUDY

designA qualitative study using semi-structured interviews. SETTING AND

participants27 South Asian female doctors and nurses, employed across NHS trusts in London, Greater Manchester and Liverpool, were recruited through purposive snowball sampling between 2021 and 2022.

resultsThis study was conducted during the COVID-19 pandemic, a period when existing workplace inequality became more visible and consequential. Although the research was initially motivated by evidence of disproportionate COVID-19 risk among ethnic minority healthcare staff, participants consistently foregrounded experiences of voice, silence and power within the NHS. It was through these accounts, situated in the heightened pressures and uncertainties of the pandemic, that four key themes emerged: (1) how discrimination and ethnic bias suppress voice; (2) fear of retaliation and the consequences of speaking out; (3) internalised cultural norms and the emotional labour of adaptation; and (4) finding voice through experience and action. Participants reported microaggressions, disproportionate disciplinary scrutiny and informal silencing tactics that left them feeling vulnerable and voiceless. For many, cultural expectations around hierarchy and respect inhibited confrontation, even in the face of unfair treatment. Some women engaged in self-reflexive strategies, learning to interpret institutional codes, recalibrating their behaviour or selectively speaking out. For many, this process of adaptation-learning, recalibrating and navigating institutional expectations-was less a path to upholding their agency and more a survival mechanism within a system they perceived as structurally biased. While a few participants described finding ways to speak out and support others through union membership and legal awareness, most described adaptation as emotionally taxing and ineffectual in the face of structural barriers. Silence (eg, withdrawing, transferring departments, leaving their roles altogether) remained the dominant strategy.

conclusionCOVID-19 did not create these dynamics, but it did expose and intensify pre-existing constraints on voice in the NHS. Drawing on South Asian women's accounts, this study provides insight into how institutional and cultural dynamics constrain voice and inclusion, particularly under conditions of heightened organisational pressure. We argue that voice is not just a personal capacity but a structural condition that can either reinforce silence or enable change. Our study highlights the need for structural reforms that strengthen psychological safety, ensure clarity around rights and protections and address the persistent gap between inclusion rhetoric and lived experience.