Improving maternity outcomes through an anti-racism lens

When we first joined the NHS Race & Health Observatory (RHO) and Institute for Healthcare Improvement (IHI) Learning Action Network (LAN), we did not anticipate how much it would ask of us personally as healthcare professionals and as leaders of change.

As a predominantly White British core team, we had to direct our attention inwards first, to recognise our own position, to explore what we represented within the system, and to understand how important our role is when applying an anti-racismt lens to focused improvement work.

We could only do this alongside colleagues and, crucially, service users from the population group of focus. Looking closely at our data and listening to service users brought a previously hidden equity gap in maternity outcomes into view, and made the inequity impossible to ignore. It challenged us to move beyond acknowledgement and intention, toward practical, measurable change.

Sharing our learning more widely matters to us because anti-racism is not and should not be seen as a specialist strand of work; it has to be a way of improving care that any team can adopt, whatever their starting point.

Hidden Equity Gap

Our team at Lancashire Teaching Hospitals NHS Foundation Trust (LTHTR) started by bringing together quantitative data, service user insight and colleague reflections to understand opportunities to improve service user care.

This three-part data review highlighted a hidden equity gap in maternity outcomes, with postpartum haemorrhage (PPH ≥1000mL) affecting 12% of women from the focus population compared with 5% of white British women.

While we understood that the causes of this gap in outcomes were complex, and not all of the levers were within the sphere of our control, we recognised that there was much that we could control and influence. As a team we were determined to apply improvement science with rigour so that we could act on this and close the gap as much as possible.

Our aim was to reduce PPH ≥1000mL for Black & ethnic minority women & birthing people by 50% (from 12% to 6%) by a target date of 1 May 2026.

Impact to Date 

Participation in the LAN enabled us to take our initial impressions and build on them through the systematic application of continuous improvement methodology with a specific anti-racism lens.

We took a range of actions including staff training on anti-racism and managing PPH from a clinical perspective. We also reviewed our policies, including publishing a maternity exemptions policy with the addition of allowing midwives to administer ferrous sulphate.

To date, we have been able to deliver sustained reduction in PPH ≥1000mL from 12% to 9% since March 2024, alongside improvements in clinical processes, risk assessment and real‑time decision‑making. Being part of the LAN provided structure, challenge and peer learning.

Applying an anti‑racism lens increased confidence to talk about race and racism, influenced Trust-wide health inequalities strategy, and reshaped improvement across maternity pathways.

Beyond the initial process of data collection, service users were actively involved throughout the improvement journey. Women and birthing people from the population of focus contributed through in-depth interviews, were kept informed of progress and were invited to attend a national learning event that our trust hosted relating to this work.

This ongoing engagement helped ensure that improvement priorities, tests of change and learning remained grounded in lived experience.

Next steps and reflections 

Our focused improvement work continues to strengthen organisational capability to measure and address health inequalities, increasing confidence among clinical teams to engage with sensitive issues and use improvement science to support meaningful change in practice.

The work has been shared locally, regionally, nationally and internationally and recognised through the LTHTR Our People’s Award for Best Safety Initiative. Effective allyship in this work was externally recognised by the charity Bliss.

Along the way, we have learned that the effective application of improvement science is only part of the challenge. The greatest opportunity is creating time and psychological safety to have honest conversations about race, hearing feedback that may be uncomfortable, and staying committed when progress feels slow.

What helped us most was working in partnership, bringing together service user voice, frontline insight and leadership support, and treating each test of change as a chance to learn rather than to “prove” we had the answer.

We hope our experience encourages other teams to start where they are: be curious about variation, name inequity when you see it, involve the people most affected, and use improvement methods to turn values into action.

Jennifer Carroll is Continuous Improvement Clinical Fellow and a Specialist Physiotherapist at Lancashire Teaching Hospitals NHS Foundation Trust. 

With support from: Jennifer Barber, Consultant Obstetrician; GB, Information Technology Midwife; Jennifer Craddock, Team Leader (Midwife); Catherine Garratt, Specialist Practitioner (Midwife); Jo Goss, Consultant Midwife; Nicholas John, System Improvement Programme Manager; Joanne Lambert, Interim Divisional Nursing & Midwifery Director; Hassin Rasool, Digital Midwife; and executive sponsor Sarah Morrison, Deputy Chief Executive and Chief Nursing Officer.