The problem

Black women are four times more likely to die during pregnancy or in the postnatal period than White women1, while stillbirth rates of Black and Black British babies are over twice those for White babies2.

It is also widely accepted that there are inevitable ‘near misses’, instances of poor care and psychological impact that have not yet been a focus of research, which add to the negative experience of many Black women during pregnancy and post-natal care.

While there are examples of excellent pockets of work happening around the country, there has been little action to develop a targeted, unified strategy to improve outcomes for Black pregnant women and their babies. Where training and education is offered, maternity staff are often left with no clear steps on how to introduce and test potential changes and improvements.

Action taken

Inspired by a shared vision that one day Black mothers will no longer be disproportionately at risk during pregnancy and the first year after birth, the West of England AHSN is working with partners on a new project called Black Maternity Matters.

The project partners include two local trusts (North Bristol NHS Trust and University Hospitals Bristol and Weston NHS Foundation Trust), and community organisations – Black Mothers Matter, Representation Matters and BCohCo.

This is one of nine projects around the country to be awarded funding from the Health Foundation through its Q Supporting local learning funding programme.

Through Black Maternity Matters 15 midwives from across the Bristol, North Somerset and South Gloucestershire Local Maternity System are taking part in a structured programme of peer support, education and training, and coaching in quality improvement (QI).

These maternity staff will form a supportive collaborative or community of practice, providing a psychologically safe and brave space in which to explore the issues facing Black mothers and develop practical changes in how we provide more equitable maternity services and care.

Next steps

Starting in May 2022, the members of the collaborative will take part in an innovative six-month education and training programme, led by Representation Matters and BCohCo alongside two Midwife Champions and input from local parent partners. This programme will focus on cultural competency and diversity fluency. Participants will examine unconscious biases and the role of the individual in perpetuating unsafe systems of care for Black women.

The training programme will increase capacity and embed learning through a ‘train the trainer’ approach, resourcing the participants to take back and share their learning with colleagues in their own maternity units.

Participants will also be supported to develop as quality improvement (QI) practitioners.

Using the learning and insights they gain and with ongoing support from the wider collaborative, they will receive training and coaching to help them design and implement QI projects in their own maternity services, running small tests of change aimed at improving experiences and outcomes for Black women.


This project is still at a very early stage. The West of England AHSN will carry out a qualitative and quantitative evaluation of the approach to identify both enablers and barriers in using QI to improve equity.

The learning will be shared regionally and nationally in late 2022 to inform the potential scale-up of this programme and to influence similar initiatives aimed at reducing inequity for other populations within and outside the maternity system.

Initial learning around establishing the project partnership and the collaborative of maternity staff include:

  • Working in a co-production model with the trusts, alongside subject matter specialists and people with lived experience has ensured the content and tone of the training is specialised, impactful and innovative.
  • Working collaboratively with the community (Black Mothers Matter, parent partners) allows the use of real time evidence, particularly valuable as the most recent MBRRACE report covers the period 2016-2018.
  • Our partners have expressed that this project is an important signal to Black communities that there is acknowledgment from health care professionals and Local Maternity Systems that action is needed to reduce harm.


Access more learning case studies – Diversity and Innovation Progress and Learning Report 2022


  1. Knight et al 2019 MBRRACE-UK
  2. Muglu et al 2019