Read standard 2: Reducing inequalities

Maternity standards
Healthcare Improvement Scotland

Standard statement

NHS boards actively work to reduce health inequalities and improve outcomes for women
and their babies

Rationale

Evidence consistently demonstrates the impact of health inequalities on maternity outcomes, including the health of women/birthing people and their babies. These inequalities affect a woman’s ability to access and receive equitable maternity care.5, 7, 8, 13 The main factors that impact health inequalities in Scotland’s maternity care include ethnicity and language, migration background, age and family status, mental health
and socioeconomic status.10, 14


National strategies are in place to address health inequalities in healthcare including maternity services. This includes the Race Equality Immediate Priorities Plan, the Women’s health plan and The Best Start framework. NHS boards should identify and implement actions to address inequalities and improve maternity outcomes in their local populations. This may include the use of impact assessments and the gathering, analysing and responding to feedback and data on experiences and outcomes from women, staff and services


Active listening, maintaining open communication and being responsive to the individual needs of women (including language, social and cultural needs) supports meaningful engagement with all underserved groups.6 This approach helps build trust and supports women to uphold their rights (see Standard 1). Staff should be enabled to deliver responsive and culturally-appropriate services. Staff should also be equipped to recognise how factors such as cultural background and beliefs, socioeconomic status and neurodiversity may
impact on people’s engagement and experiences.2, 3


Women under the age of 18 years have rights protected under the United Nations Convention on the Rights of the Child. Young people should be supported by staff who have the skills and confidence to identify and respond to their individual maternity care needs. Staff should be trained to identify safeguarding concerns, such as exploitation and abuse, and take appropriate action including referral to relevant support or protection services. Continuity of carer enables a relationship-based and person-centred approach to maternity care.15 The emphasis on participation, supported decision making and upholding rights is important for young people, particularly those made vulnerable by their circumstances, including care experienced young people.


Women affected by gender-based violence are at increased risk of harm during pregnancy, birth and the postnatal period. Trauma-informed and person-centred maternity care helps ensure safety, dignity and choice, while avoiding re-traumatisation. Integrating inequalities policies is essential because social and structural factors, such as poverty, ethnicity, disability, gender identity, migration status and other protected characteristics can influence both exposure to gender-based violence and access to support. An inequalities-sensitive approach promotes equitable and culturally-responsive care. NHS boards should ensure staff can access specialist expertise and clear referral pathways for child and adult protection, sexual exploitation, and gender-based violence. This enables timely, appropriate intervention and coordinated support, improving outcomes for women and their babies.2, 3

Criteria

2.1

NHS boards address health inequalities and provide equitable access to maternity care for all women and their babies by:


• offering responsive and personalised information, support and care, including access to translation and interpreter services, when required
• addressing all forms of prejudice and discrimination, including systemic racism
• working in partnership with women with lived experience and with third-sector agencies and support services.

2.2

Women can be confident that their culture, beliefs and personal preferences will be respected by staff who are nonjudgemental and compassionate.

2.3

NHS boards have systems and processes in place to implement national frameworks, guidance and strategies to tackle prejudice and inequalities across the maternity care pathway.

2.4

NHS boards routinely undertake comprehensive population health needs and impact assessments and use the data to:


• understand their local populations and identify underserved groups
• understand the impact of intersectionality and health inequalities on women’s and baby’s experiences and outcomes
• improve access to maternity care for all
• inform maternity care service provision
• benchmark progress and improvements

2.5

NHS boards use local population demographic data to take an evidence-based
approach to reducing health inequalities in:


• clinical and health outcomes, including morbidity and mortality
• quality of care.

2.6

NHS boards ensure staff undertake appropriate education and training to
deliver maternity care that:


• recognises differences in experiences and outcomes that may be influenced by factors such as cultural background and beliefs or socioeconomic status
• reduces the impact of health inequalities, intersectionality and protected characteristics on women’s experiences and outcomes
• addresses and mitigates the risk of bias (including racial bias) or stereotyping in clinical practice and communication
• is respectful, nonjudgemental, compassionate, culturally sensitive and
equitable

2.7

NHS boards deliver maternity care for women under the age of 18 that upholds their rights and meets their individual needs by ensuring:


• staff have the skills and confidence to identify and respond to the specific rights and maternity care needs of young people
• appropriate referral pathways are in place for relevant support and services, including where safeguarding concerns are identified
• participation, supported decision making and the upholding of rights are central to care, particularly for young people who may be vulnerable due to their circumstances, including those who are care experienced.

2.8

NHS boards ensure that women who have experienced gender-based violence receive trauma-informed and person-centred maternity care. This includes ensuring staff can access specialist expertise and clear referral pathways for:


• child and adult protection and safeguarding
• sexual exploitation
• gender-based violence.

2.9

NHS boards deliver maternity care for LGBTQIA+ people that ensures they feel
welcomed, safe and visible because they are:
• supported by staff who have appropriate knowledge and training in
LGBTQIA+ inclusive maternity care and use appropriate and inclusive
language
• asked for their preferred form of address, including pronouns
• asked how they wish their relevant personal information to be shared
with the wider maternity care team
• are supported to involve their care partners.

What does this standard mean for...

What does the standard mean for women and their babies?

  • You can be confident that your care will be fair, equitable and nondiscriminatory.
  • You will be able to access the translation and interpreter support you need.
  • Your personal circumstances, preferences, culture and beliefs will be respected at
    all times.
  • If you have experienced gender-based violence, staff will help you to access the
    care and support you need

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting:

  • take a person-centred and trauma-informed approach to maternity care that facilitates informed decision making
  • listen and actively engage with women to understand their needs and preferences
  • put women’s rights to non-discrimination at the centre of their work and support women to uphold their rights
  • can access and uptake education and training to deliver responsive maternity care
  • signpost to current information and support appropriate to individual needs.

What does the standard mean for the NHS board?

NHS boards:

  • ensure staff undertake inequalities training and programmes
  • ensure equitable access to high-quality, evidence-based maternity care for women in all circumstances and in all areas, including remote and rural communities
  • understand, monitor and plan services to improve health outcomes in underserved populations
  • identify local population groups who face barriers to accessing maternity care and take action to address these barriers
  • ensure women can access translation and interpreter services, when required
  • take an intersectional approach to reducing health inequalities and supporting women to uphold their rights
  • ensure that young people and adults at risk of harm receive tailored advice and
    support, with appropriate referrals to specialist services when required.

Benchmarking and measuring performance

 

Criteria

Examples of what meeting this standard might look like

Please note this list is not exhaustive and examples may vary according to the
size and scale of the service or NHS board or delivery model

2.1

Development and implementation of anti-racism and anti-discrimination policies.

2.2

Feedback from women on being supported by non-judgemental and compassionate staff.

2.3

Strategies, policies and action plans to tackle health inequalities.

2.4

Audit of maternal and neonatal mortality, including MBRRACE-UK collaborative activities.

2.5

Improvement work focused on understanding local health inequality data and maternity outcomes, including feedback from women, staff and students.

2.6

Training plans to support staff to understand the impact of health inequalities and intersectionality on women’s experiences and to improve the outcomes of all women.

2.7

Development of policies informed by UNCRC policies and Child Rights and Wellbeing Impact Assessments.

2.8

Referrals for specialist gender-based violence support.

2.9

Documented process for recording pronouns, preferred names and care partners in clinical systems

 

Editorial Information

Last reviewed: 23/03/2026

Next review date: 23/03/2031

Author(s): Maternity standards development group.

Author email(s): his.standardsandindicators@nhs.scot.

Approved By: Maternity standards development group

Reviewer name(s): Maternity standards project group.