New training reforms target disparities in maternal outcomes
Midwives across England are set to receive enhanced anti-racism training as part of sweeping reforms to university courses and professional education, following growing evidence that racial inequalities are contributing to higher maternal mortality rates among Black and Asian women.
The changes, backed by NHS England and professional regulators, aim to embed cultural competence and anti-discrimination practices into midwifery education. Universities delivering midwifery degrees are expected to update curricula to include training on recognising bias, addressing structural inequalities and improving communication with diverse patient groups.
The move follows repeated warnings from national reviews that disparities in maternity outcomes are not solely explained by clinical factors, but are also influenced by systemic issues within healthcare delivery.
Persistent gap in maternal mortality rates
Data from the MBRRACE-UK programme continues to show stark inequalities in maternal outcomes. Recent reports indicate that Black women in the UK are still around three times more likely to die during pregnancy or shortly after childbirth than white women, while Asian women face a significantly elevated risk compared with the national average.
These disparities have remained consistent over several years, despite broader improvements in maternity safety. Experts highlight a combination of factors contributing to the gap, including differences in access to care, underlying health conditions and socioeconomic status. However, there is increasing recognition that experiences of discrimination and bias within the healthcare system also play a role.
Reports have documented cases where women from minority ethnic backgrounds felt their concerns were not taken seriously or that symptoms were overlooked, issues that can delay diagnosis and treatment.
Overhaul of midwifery education and standards
The new measures will see anti-racism principles embedded throughout midwifery training, rather than treated as an optional or standalone topic. This includes teaching on culturally sensitive care, effective communication and the impact of unconscious bias on clinical decision-making. The Nursing and Midwifery Council is expected to play a key role in updating professional standards, ensuring that newly qualified midwives are equipped to deliver equitable care across diverse populations.
Universities will also be required to demonstrate how they are addressing inequalities within their programmes, including through assessment methods and clinical placements. In parallel, NHS trusts are being encouraged to provide ongoing professional development for existing staff, ensuring that improvements are not limited to new entrants into the workforce.
Wider NHS strategy to tackle inequality
The initiative forms part of a broader NHS strategy to reduce health inequalities, which has become a central policy priority in recent years. Programmes such as NHS England’s maternity equity and equality action plans aim to improve outcomes for underserved groups by addressing both clinical and non-clinical factors.
These efforts include targeted support for high-risk populations, improved data collection and the expansion of continuity of care models, where women are supported by the same midwife or team throughout pregnancy and postnatal care.
Digital tools are also playing an increasing role. Enhanced data systems are being used to identify disparities in real time, allowing services to intervene earlier and tailor care more effectively. However, experts caution that technology alone cannot resolve deeply rooted inequalities. Cultural change within organisations remains essential to ensure that all patients receive consistent and respectful care.
Balancing training with workforce pressures
While the introduction of anti-racism training has been widely welcomed, it comes at a time of significant pressure on the maternity workforce. Midwifery services across England continue to face staffing shortages, high workloads and rising demand. Some professionals have expressed concern about how additional training requirements will be delivered without exacerbating these pressures.
Health leaders argue that investing in training is essential to improving outcomes and reducing long-term demand on services. By addressing inequalities early, the NHS may be able to prevent complications and reduce the need for more intensive interventions later.
A critical step towards safer maternity care
The introduction of mandatory anti-racism training represents a significant shift in how the NHS approaches maternity safety. By recognising the role of systemic bias and discrimination, policymakers are moving beyond purely clinical solutions to address a more complex set of challenges. For patients, the changes aim to build trust and ensure that concerns are heard and acted upon, a crucial factor in achieving safe and positive maternity experiences.
While the reforms are unlikely to deliver immediate results, they mark an important step towards reducing longstanding inequalities in maternal outcomes. As implementation progresses, the effectiveness of the training and the NHS’s ability to embed lasting cultural change, will be closely watched. For many, the success of these efforts will be measured not only in improved statistics, but in the experiences of women receiving care across the health system.
