Tackling race inequalities in maternity care: our research and advice

Collecting and using equality data, and complying with the Public Sector Equality Duty (PSED), can help health bodies tackle health inequalities and race disparities, and promote patient safety and service improvements in maternity and neonatal care.

We have published guidance on the effective use of data in maternity care, including practical examples and recommendations to help health bodies develop their data collection capability and use data insights to improve services. 

We have also carried out research with Integrated Care Boards (ICBs) to understand what they are doing to tackle race disparities in maternity care. We used our findings to create recommended actions for ICBs and other health bodies. Read our research findings and recommended actions.

This information will be useful for health bodies, including:

• maternity and neonatal services
• Integrated Care Boards
• GP practices
• regulators and ombudsmen

It will be informative for policy makers. It is also intended to help practitioners and managers to identify relevant steps and take appropriate action.

Concerns about safety in maternity care

Wide-ranging safety concerns have been raised about maternity and neonatal care in recent years. This includes concerns raised by an inquiry by the All-Party Parliamentary Group for Birth Trauma in 2024 on traumatic births. They included evidence about differences in the standard of care provided to women and their babies.

Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) investigate the causes of maternal deaths, stillbirths and infant deaths. They have reported that maternal mortality rates grew by 15% between 2009 to 2011 and 2019 to 2021 in the UK. Furthermore, peri-natal mortality rates in the UK increased in 2021, after 7 years of year-on-year reduction. The peri-natal period for mothers refers to the time between conception and a year after birth.

As well as overarching concerns about maternity care, there are differences (disparities) in access, experiences and outcomes for women from different ethnic groups. For example, as found by MBRRACE-UK, maternal mortality rates are four times higher for Black women and twice as high for Asian women, compared to White women. There are also disparities between babies with different ethnicities. A range of organisations, including Birthrights, Fivexmore and Birth Companions, have published detailed evidence about this issue.

There has been an increase in awareness of these disparities in recent years. Change will require long-term commitment and action by a range of bodies to eliminate discrimination and advance equality. There is a need for a focus by the NHS on training, recruitment, confident leadership, better use of data, and increased investment in maternity and neonatal services. Other bodies with a key role to play in improving health outcomes are mentioned in Fair Society Healthy Lives (The Marmot Review).

An important recent step has been the publication of guidance for local maternity and neonatal systems by NHS England, which asked local systems to co-produce and publish equity and equality action plans. This was published in 2021 (during the pandemic), so it will take time to embed and have impact. Implementation of the Workforce Race Equality Standard by NHS commissioners and healthcare providers will be an important lever for change.

Further actions have included:

• the establishment of a Maternity Disparities Taskforce under the previous UK government
• inquiries by parliamentary committees
   

The public sector equality duty (PSED)

The PSED covers nine protected characteristics, including race. It requires public authorities, including ICBs, to actively consider how they can promote equality throughout every aspect of their work. This includes in:

• policies or practices
• decision-making
• criteria
• service delivery
• procurement
• employment

The PSED also applies to organisations delivering public functions, such as GP practices (read our guidance for GP practices about compliance with the PSED). It requires them to meet the general duty to ‘have due regard’ to the need to:

• eliminate unlawful discrimination, harassment and victimisation
• advance equality of opportunity (removing or minimising disadvantages, meeting needs, encouraging participation)
• foster good relations (tackling prejudice, promoting understanding between different groups) 

Complying with the PSED involves assessing the impact (positive or negative) of decisions, policies and practices on people with protected characteristics. This is often referred to as conducting an equality impact assessment (EIA).

We published a 10-step guide on considering equality in policy making to help public bodies and organisations delivering a public function understand how to conduct robust EIAs. This includes gathering and using evidence about the impact that policies are having, or are likely to have, on people with different protected characteristics. This applies to potential and actual service users. Such evidence is an important part of the equality information that listed bodies (including ICBs) need to publish under the PSED specific duties for England. This information must be accessible and show how the public body is complying with the general duty. Listed bodies in England also need to publish specific and measurable equality objectives.