Tackling inequalities in perinatal mental health

The Maternal Mental Health Alliance says that approximately 20% of Black mothers report not seeking professional help for low mood or depression during the perinatal period. This matters because MBRRACE-UK data shows mental health issues remain a leading cause of maternal deaths.

These women face extensive barriers accessing mental health care, including systemic racism and a lack of cultural competency from maternity staff, and can experience deep-rooted mistrust, fear and stigma that discourages them from seeking help.

The statistics are stark and highlight why closing the gaps in outcomes for pregnant women and people from different ethnic groups is one of the most pressing challenges in maternity care today. One that West and North London’s integrated care system is committed to meeting.

Joining a national network for change

In 2024, before its merger into West and North London, North Central London’s local maternity and neonatal system (LMNS) joined the NHS Race and Health Observatory’s Maternal and Neonatal Learning and Action Network (LAN).

The innovative peer-to-peer quality improvement programme brought together 10 teams across England with a shared aim of addressing ethnic inequalities in maternity and neonatal outcomes through an explicit anti-racism lens. North Central London was one of just two integrated care systems participating – the remaining teams were individual trusts.  

Our project team brought together partners from across the system, including clinicians from acute trusts (a director of midwifery, consultant obstetrician, digital midwife and a personalised care midwife), the ICB (executive sponsors, the assistant director for maternity and neonates and an analyst), and project management from Transformation Partners in Health and Care.

Identifying priority actions and first steps

We chose to focus on perinatal mental health. North Central London is an ethnically diverse, densely populated area, where more than half of the population lives in 40% of the most deprived areas nationally.

A system-wide strategic review had already suggested a higher prevalence of mental health conditions in North Central London than the London average: in 2019/20 9.2% of the population was diagnosed with depression compared to the London average of 8.2%, yet in 2021/22, the percentage of pregnant women and people accessing perinatal mental health services fell significantly short of the Long-Term Plan ambition of 8.6%, at just 4.9%. CQC Women’s Survey results from 2022 also reinforced this as a priority.

To understand how the challenge varied across ethnic groups, our project team reviewed maternity bookings data in two high-deprivation postcodes between 2022 – 2024. While 28% of White British women were being identified with mental health needs at booking (in line with the expected 27% prevalence) other ethnic groups were significantly under-identified. Only 8% of Black African women were being flagged with perinatal mental health needs.

Working with the Lavender Team

We partnered with the Lavender Team, a community midwifery team based at the Triangle Children’s Centre in Tottenham, serving women and pregnant people in the N15 and N17 postcodes. The goal was to increase referrals to perinatal mental health services by 15% among Black women and pregnant people in those areas. 

Working collaboratively with perinatal mental health specialists, we developed a crib sheet to help maternity staff open conversations about mental health during appointments. The local impact was meaningful. In 2024, staff reported greater confidence in raising mental health, and a deeper awareness of the specific challenges faced by Black women, including the influence of immigration status, language, racism and stigma.  

More personalised, supportive conversations about mental health and racism were held with women, their mental health challenges were better identified, and as a result they received more appropriate support. All Lavender Team members surveyed said they would recommend the crib sheet to others.

Lavender Team Leader Felicia Thompson captured the shift in approach: “You would never see a woman and not test her urine sample. So why would you miss an opportunity to ask her how she’s doing emotionally and mentally?”

Key learnings from the LAN

• Align your data infrastructure from the start. Early in the programme it became clear the data to track improvement needed to be strengthened. This has prompted a longer-term project to collate and monitor perinatal mental health challenges identified at booking alongside referral data, with all data segmented by ethnicity at postcode level. Having this visibility across providers builds a stronger case for change, will help target efforts where they are needed most and highlight the impact of changes.
• Start small but establish broad engagement to scale. The LAN team encouraged us to test initiatives in a small, targeted area. Working with a single community midwifery team in two postcodes was valuable for trialling ideas, but it limited data insights and broader system engagement. For an integrated care system, parallel testing across multiple providers would fast-track learning and adoption. To address systemic inequalities, this work must be sustained across years and through organisational change.
• Anti-racism principles make for better quality improvement. One of the most valuable outputs of the LAN has been the development of an Anti-Racism Model for Improvement by the Institute for Healthcare Improvement and the RHO. This gives teams a structured way to apply an anti-racism lens throughout their work, asking not just whether a change is effective, but whether it actively addresses racism as a determinant of health and centres communities in the design of interventions. We would encourage any team embarking on improvement work to adopt this framework from the outset.
• Peer learning accelerates progress. Being part of a network of teams grappling with the same challenges was one of the most energising aspects of the programme. Learning from colleagues across England through shared sessions, coaching and honest reflection shifted thinking in ways that formal guidance alone cannot achieve.

What needs to happen next

Maternity and neonatal systems have a critical role to play in sustaining and scaling this work. That means using system-level data to identify where inequalities are greatest, commissioning collaborative improvement work across providers using the Anti-Racism Model for Improvement, and ensuring progress is monitored and shared openly.  

Tackling ethnic health inequalities in maternity care is a long-term endeavour, but with the right infrastructure, tools and commitment, it is one we can make meaningful progress on together. 

Zoe Hooper is Senior Consultant at Transformation Partners in Health and Care, and is currently providing interim cover for the Assistant Director of Maternity and Neonatal Services at West and North London ICB.