Bold action: tackling inequalities in maternity care

While most women have positive birth experiences with good outcomes, it is also true that for others it is a deeply distressing experience, with some births ending in preventable tragedies. Though the rates of stillbirth and neonatal deaths in England have fallen by 20% and 30% respectively between 2010 and 2023, the government is not currently on track to meet its ambition to halve the 2010 stillbirth and neonatal mortality rates for infants born at 24 weeks or over by 2025 (ONS, 2025). There remains a gulf to close in the quality of experience and outcomes that women, their babies and their families should be able to rely on.

As James Titcombe, chief executive of Patient Safety Watch, notes “birth is neither inherently safe nor dangerous – it is both until reality declares otherwise” (Titcombe, 2014).  Risk is highly dynamic in maternity care, and how services are operated, resourced and regulated needs to reflect this.

This includes addressing the health inequalities in maternity care that directly undermine safety and quality by contributing to poorer clinical outcomes and inconsistent care experiences. The mortality rate for infants living in the 10% most deprived areas of England and Wales is double compared to those in the least deprived areas (ONS, 2025). Black women are three times more likely to die in pregnancy and childbirth compared to white women (Brader, 2023). As FiveXMore’s 2022 report sets out, “disparities in maternal mortality between Black and white women were identified as long as a decade ago, and yet maternal outcomes are, today, still substantially worse for Black women” (FiveXMore, 2022).

NHS Resolution’s annual report and accounts for 2023/24 makes clear the scale of quality and safety issues in maternity care, setting out an annual cost of £1.5bn for clinical negligence in maternity (NHS Resolution, 2024). In addition to the positive impact for families and staff, better care costs the system less.

In this briefing, we have summarised the findings from a series of interviews with trust leaders where they described the barriers and enablers to improvement in maternity services, with a particular focus on health inequalities. Drawing on these conversations, and NHS Providers’ longer-term work in this area, we have set out a number of calls to action. These look across improving access and preventative care, developing the workforce, working with women and communities, addressing race inequalities, streamlining reporting requirements and unlocking resource. 

Issues in maternity care are arguably a ‘canary in the coalmine’ for wider system failures, revealing deep-rooted problems in access, equity, safety and resourcing. The 10-year health plan (10YHP) provides us with a crucial opportunity to address these systemic challenges. It is an opportunity too for the government not only to follow through on its commitment to “set an explicit target to close the Black and Asian maternal mortality gap”, but to close the gap (Labour Party, 2024).

Meaningful improvements in maternity services should be seen as a litmus test for broader health system reform. Getting it right for women, infants, children, and young people is both a moral imperative and fundamental to improving population health and outcomes.