What we learned about equity in perinatal mental health
When we looked closely at who was accessing our perinatal mental health services, and who was not, the numbers told only part of the story. Listening to women, communities and staff showed us that improving equity is less about quick fixes and more about sustained, practical change over time.
This work began when our team reviewed access data and saw clear disparities that the numbers alone could not explain. Conversations with women, staff and community partners highlighted gaps in trust, visibility and representation. It became clear that we needed to shift from analysing the problem to taking small, practical steps that could build relationships and confidence over time. That realisation shaped the direction of the project and grounded the changes that followed.
Small actions, meaningful shifts
The changes we made were not one big intervention, but lots of smaller, practical steps. We increased our presence at Black women’s antenatal groups, built stronger links with community and voluntary organisations, translated key information into the most widely spoken local languages, and delivered maternal mental-health and equity training to over 100 GPs.
We created space for regular reflection, using two weekly meetings to track progress, celebrate successes and acknowledge challenges. This helped build a culture of continuous learning where equity became part of everyday discussion rather than a separate project.
Women with lived experience played a central role. We involved them in steering groups, decision-making conversations and utilised an existing service user placement scheme at East London NHS Foundation Trust (ELFT). Two mothers participated in year-long roles with the project focused on equity, and were supported through regular check-ins, remuneration, flexible hours to accommodate childcare, and individualised plans for accessing structured support if needed.
We also built meaningful relationships with local stakeholders and delivered targeted workshops within the community for professionals and services users supporting mothers. These workshops brought together GPs, health professionals, voluntary, community and social enterprise (VCSE) sector representatives, and community members.
These sessions provided valuable networking for all participants; the ELFT team gained insights into the service offer and experiences of the VCSE sector and learned new approaches that have since influenced practice and decision-making within the Trust.
Within teams, we reviewed leaflets and communications with an anti-racism lens, looked more closely at waiting-time data by ethnicity, and talked more openly about representation in our workforce. Setting up a Perinatal Equity Board helped give this work a structure so it wouldn’t stop when the NHS Race and Health Observatory’s Learning Action Network (LAN) ended.
One of our most important learnings, though, was that it was hard to show a clear, direct change in access within the timeframe of the project. Perinatal services often deal with small numbers, and referral patterns do not shift overnight. That was uncomfortable at times, but also realistic. It reminded us that some impact is longer-term and not always immediately visible in the data. We saw clearer movement in conversations, confidence and relationships than we did in the numbers, and both matter.
Resource implications and enablers
Much of this work was delivered through existing staff capacity, but it did require dedicated time for relationship building, regular reflective meetings, community workshops and lived experience involvement. Additional resources were needed for translation of materials, remuneration for service user placements, and commissioning anti‑racism training. These investments helped ensure the work was not only meaningful but sustainable.
Using the IMPACT-AR tool, a framework designed to support teams to decolonise policies and ensure service improvements are actively anti-racism rather than neutral, alongside the Model for Improvement provided a practical and psychologically safe framework for teams to examine policies and practice through an anti-racism lens, supporting consistent decision-making and helping the work to be sustained beyond the life of the project.
The main enablers were our relationships built with women with lived experience, strong partnerships with VCSE organisations, psychological safety within teams, and a clear governance structure through the Perinatal Equity Board.
What we learned
A few things stand out. Data is important, but it only tells part of the story. Listening to women and community partners gives it meaning. Psychological safety is not just a “nice to have”; without it, staff do not feel able to raise concerns or question systems. Genuine partnership with communities cannot be an add-on, it has to sit at the centre of service design.
We also learned that impact is rarely quick or linear. Measuring access proved more complex than we expected, and that in itself was a useful insight. What did shift visibly was staff confidence to talk about race and inequity, and stronger connections with organisations doing similar work.
One of the most practical outcomes came through the relationships we built during the LAN. As part of this, we were involved in a pilot with White Ribbon Alliance to help develop the IMPACT-AR tool.
Through these conversations it became clear that goodwill alone was not enough, we needed shared language and structured approaches. As a direct result, we commissioned dedicated anti-racism training through Black Maternity Matters. This felt like an important step, moving from reflection into investing in skills and capability for the longer term.
Finally, we learned the value of starting small. Focusing on one borough and a clearly defined population allowed us to go deeper, test ideas properly and build trust. Over time, the learning has been useful well beyond that initial focus.
Justine Cawley is the trust–wide lead for perinatal mental health at East London NHS Foundation Trust.