In the UK, despite clear policy commitments to personalised and equitable care, we are sad to see significant gaps in outcomes and experience of maternity care. Black and Brown women are still several times more likely to die during pregnancy and childbirth and are more likely to report poorer experiences of care. These inequalities are not simply clinical, nor are they a reflection on the strong values and behaviour of maternity staff. They are rooted in structural and relational issues, including inconsistent implementation of policy, implicit and systemic bias, and a lack of trust between women and services. 

We are not short of data. Reports from MBRRACE-UK and national programmes led by NHS England have repeatedly highlighted these disparities. The challenge is no longer identifying the problem, it is embedding sustained, measurable change. Mandatory and meaningful collection of ethnicity data remains critical to monitoring progress, but data alone is not enough without accountability for action. 

Workforce knowledge is also key. Cultural competence and cultural safety must be consistently embedded across education and practice, not as optional training, but as a core component of safe, effective care. This requires a shift beyond surface-level approaches towards embedding anti-racist and anti-colonial principles within pre-registration education and ongoing professional development. 

So, what needs to happen next? 

We must move beyond “one-size-fits-all” models of care and genuinely implement culturally safe, individualised approaches. This is not just about recognising difference, but actively addressing power imbalances and ensuring that women feel heard, respected, and believed. These imbalances exist not only in clinical encounters but within organisational hierarchies and the continued lack of diversity in leadership. 

Listening to Black and Brown women is essential but listening alone is not enough. Their voices must be central to the co-design and delivery of services, ensuring that care reflects the needs of the populations served. 

At the same time, maternity services are operating under significant pressure. Numerous inquiries and investigations have highlighted failings, often following unacceptable harm. We know that staff are overworked and services are stretched too thin. Services need the time, resources, and space to implement evidence-based recommendations effectively. Maternity care needs the staffing and investment to improve for everyone. Without this, the cycle of reporting without resolution will continue. 

Progress has been made in acknowledging the problem. The next phase must be defined by execution and accountability. This includes stronger, more transparent leadership from the top of organisations, with equity treated as a core measure of quality and safety and not an adjunct.

• Black Maternal Health Week is held annually from 11-17 April.