RHO Learning and Action Network: Maternal and Neonatal Health Equity

An anti-racism quality improvement programme tackling ethnic inequalities in maternal and neonatal health outcomes across NHS England regions.

Introduction

The NHS Race and Health Observatory’s Maternal and Neonatal Health Equity Learning Action Network (LAN) was established in response to persistent ethnic inequalities in maternal and neonatal outcomes. At the time of mobilisation, Black mothers in the United Kingdom were up to four times more likely to die during or shortly after pregnancy than White mothers, while South Asian mothers faced up to twice the risk.

From January 2024, the NHS Race and Health Observatory and the Institute for Healthcare Improvement ran a 15-month Learning and Action Network (LAN): a peer-to-peer quality improvement programme across 10 teams, 8 Integrated Care Systems, and 4 NHS regions. Teams focused on one of four clinical areas where ethnic inequalities in outcomes are well evidenced: postpartum haemorrhage, gestational diabetes, perinatal mental health, and preterm birth.

The programme was explicitly anti-racist in its framing, naming racism as a cause of unequal outcomes rather than treating disparities as incidental. The change packages below are the direct output of that work, developed using the Anti-Racism Model For Improvement Framework. Each has been revised to retain the changes with the highest confidence for improvement, and each includes prioritisation guidance, measurement frameworks, and considerations for scaling across other NHS settings.

15
months (Jan 2024)
10
participating teams
8
Integrated Care Systems
4
NHS regions
4
clinical focus areas
Anti-racism change packages

Resources

Anti-racism change packages

Each package draws on 15 months of real-world learning across NHS teams. They are structured around five improvement drivers and include practical guidance on how to prioritise changes and measure progress.

Every package includes
  • Aim and driver diagram
  • Change concepts and ideas across all five pillars
  • Prioritisation guide: where to start
  • Measurement guidance — outcome, process, and balance measures
  • Considerations for spread and scale
Change package
Postpartum haemorrhage
Guides teams in applying anti-racism QI methods to reduce ethnic inequalities in PPH risk, recognition, and clinical response. Includes the highest-confidence changes from the LAN, refined after 15 months of implementation learning.
Download package
Change package
Gestational diabetes
Supports teams in closing the equity gap in gestational diabetes screening, diagnosis, and management for Black, Asian, and minority ethnic women. Incorporates debiasing of clinical protocols and stratified data use.
Download package
Change package
Perinatal mental health
Addresses ethnic inequalities in access to and experience of perinatal mental health services. Centres anti-racism principles to improve how teams identify, refer, and support women from ethnic minority backgrounds.
Download package

A fourth change package covering preterm birth is also part of this programme and will be uploaded once ready. Each package has been revised following completion of the LAN to highlight changes with the highest confidence for improvement. For further reading, see the Model for Improvement: Anti-Racism Framework Guidance at nhsrho.org.