Intended for healthcare professionals


Tackling racism in maternal health

BMJ 2023; 383 doi: (Published 24 October 2023) Cite this as: BMJ 2023;383:e076092

Linked Feature

Ethnic inequalities in health and care show diversity in need and disadvantage

  1. Raquel Catalao, NIHR clinical research fellow in psychiatry1,
  2. Laurie Zephyrin, senior vice president2,
  3. Lisa Richardson, chief impact officer3,
  4. Yvonne Coghill, director4,
  5. Janet Smylie, director and professor5 6,
  6. Stephani L Hatch, professor of sociology and epidemiology1 7
  1. 1Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  2. 2Advancing Health Equity, Commonwealth Fund, New York, NY, USA
  3. 3Institute of Women and Ethnic Studies, UNO Research and Technology Foundation, New Orleans, USA
  4. 4Excellence in Action, Workforce Race Equality, NHS London, UK
  5. 5Well Living House, Li Ka Shing Knowledge Institute, Unity Health, Toronto Canada
  6. 6Dalla Lana School of Public Health and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
  7. 7ESRC Centre for Society and Mental Health, King’s College London, UK
  1. Correspondence to: R Catalao raquel.catalao{at}

Approaches are needed that tackle the root causes, including the structural drivers of health, argue Raquel Catalao and colleagues

Inequalities in maternal health outcomes for ethnic minority and Indigenous populations across the globe are driven by cultural, structural, and interpersonal racism. Strategies to mitigate this racial injustice require government commitment, structural policy changes, and community led solutions. Biomedically driven interventions alone will not fix this, and novel systemic approaches are required to tackle the social determinants.

Maternity care provides a unique setting for understanding the links between social determinants and health inequity through its focus on the experiences at a critical transitional period of life. We focus here on high income countries, where our experiences mostly lie and where data tend to be more widely available. In this context, there is a clear and alarming pattern of people from racialised groups (that is, those who are disadvantaged based on their skin colour or indigeneity through the normalisation and legitimisation of an array of dynamics that favour white people1) experiencing worse maternal outcomes.2

Inequities in maternal mortality show how disparities in social determinants are shaped by racism and colonial legacies and give rise to inequalities in social conditions and health risk factors that cost women´s lives. Maternal mortality is a barometer of more widespread inequalities experienced by racialised and Indigenous populations, including adverse birth outcomes, morbidity, access to care, and experience of the services.34 Data driven technologies are increasingly used to identify inequalities in access, experience, and allocation of resources, but current health datasets lack consistency and completeness of ethnicity recording.5 In most high income countries the gulf of inequity is not decreasing, and it has been exacerbated by the covid-19 pandemic.67

Importance of structural determinants

Evidence shows that different pathways link racism to inequities in society and …

View Full Text

Log in

Log in through your institution


* For online subscription