Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3:77-101

Blencowe H, Chou VB, Lawn J, Bhutta Z. Modelling stillbirth mortality reduction with the Lives Saved Tool. BMC Public Health. 2017; 17

Cooper P. Strategies to reduce perinatal mortality. The Lancet Global Health. 2016; 4:(1)

The development of consciousness of self and the emergence of racial identification in negro preschool. 1939. (accessed 12 November 2021)

Draper ES, Gallimore ID, Smith LK MBRRACE-UK Perinatal Mortality Surveillance Report, UK Perinatal Deaths for Births from January to December 2019.Leicester: University of Leicester; 2021

Equality and Human Rights Commission. Public Sector Equality Duty. 2021. (accessed 3 December 2021)

Government Equalities Office. Equality Act 2010: guidance. 2015. (accessed 18 November 2021)

Healthcare Safety Investigation Branch. Recognition of the acutely ill infant. 2021. (accessed 15 December 2021)

Institute of Race Relations. What is institutional racism?. 1998. (accessed 12 November 2021)

Knight M, Bunch K, Tuffnell D Saving Lives, Improving Mothers' Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2016-18.Oxford: University of Oxford; 2020

Knight M, Bunch K, Tuffnell D Saving Lives, Improving Mothers' Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2017-19.Oxford: University of Oxford; 2021a

A national cohort study and confidential enquiry to investigate ethnic disparities in maternal mortality. 2021b. (accessed 16 December 2021)

Ledger S, Hindle G, McKee A, Smith T. Mind the Gap: An Investigation into maternity training for frontline professionals across the UK (2020/21).UK: Baby Lifeline; 2021

Limb M. Disparity in maternal deaths because of ethnicity is “unacceptable”. BMJ. 2021; 372

Mind the Gap — A handbook of clinical signs in Black and Brown skin. 2021. (accessed 8 December 2021)

NHS England. National Maternity Review: Better Births: Improving outcomes of maternity services in England. 2016. (accessed 8 December 2021)

NHS England. Saving babies lives care bundle version two. 2019. (accessed 8 December 2021)

Parker G, Cordon A, Heaton J. Experiences of and influences on continuity of care for service users and carers: synthesis of evidence from a research programme. Health Soc Care Community. 2011; 19:(6)576-601

Royal College of Midwives. RCM warns of midwife exodus as maternity staffing crisis grows. 2021. (accessed 8 December 2021)

How Implicit Bias Contributes to Racial Disparities in Maternal Morbidity and Mortality in the United States. 2021. (accessed 2 February 2022)

APGAR Score. 2021. (accessed 2 February 2022)

Sigurdson K, Mitchell B, Liu J Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review. Pediatrics. 2019; 144:(2)

Black Maternal Mortality: ‘It's not Race, it's Racism’. 2021. (accessed 12 November 2021)

Vincent C, Amalberti R. Safer Healthcare: strategies for the Real World.Oxford: Springer Open; 2016

Westerman J, Rosse J. Reducing the Threat of rater Nonparticipation in 360-degree feedback Systems: An Exploratory Examination of Antecdents tp Participation in Upward Ratings. Group & Organisation Management. 1997; 22:(2)288-309

Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary.Geneva: World Health Organization; 2019

Does training affect understanding of implicit bias and care of black, Asian and minority ethnic babies?

02 March 2022
12 min read
Volume 30 · Issue 3



In the UK, there are huge inequities in maternal and neonatal mortality, yet there appears to be very little training to address this for midwives. This quality improvement project aimed to address this by providing training on implicit bias, stereotyping and clinical assessment of babies from black, Asian and minority ethnic families.


A training package was created and delivered to 67 midwives and students on placement at the Yeovil District NHS Foundation Trust on implicit bias, structural racism and clinical assessment of babies from black, Asian and minority ethnic groups. Pre- and post-training surveys were completed and descriptive statistical analysis alongside thematic analysis was used to analyse the findings.


It was evident that midwives benefited from the training, as pre-session surveys noted that many midwives were unaware of the factors influencing the care of women and babies from black, Asian and minority ethnic families. After the training, they identified a wish to change their practice to be more inclusive.


The training package was well evaluated; however, more training and research is needed to improve the safety of mothers and babies from black, Asian and minority ethnic families.

Between 2000 and 2017, the worldwide maternal mortality rate fell by 38% (World Health Organization (WHO), 2019). Despite this welcome decline, it is not spread evenly across the world, with the maternal mortality ratio in low-income countries in 2017 being 462 per 100 000 women compared to 11 per 100 000 women in high-income countries (WHO, 2019). Between 2017 and 2019, the UK's maternal mortality ratio was 8.8 per 100 000 (Knight et al, 2021a). The difference in maternal mortality ratio between low- and high-income countries may be expected as a result of inadequate access to care and equipment (WHO, 2019). However, within the UK, there are huge disparities in maternal mortality rates. In 2016–2018, for every 100 000 black women who gave birth, 34 died. For every 100 000 Asian women who gave birth, 15 died. In comparison, eight white women per 100 000 died (Knight et al, 2020). In 2021, a UK report into maternal deaths revealed that there has been no statistically significant change in these disparities since 2014 (Knight et al, 2021b). In the USA, rates are similar, with maternal mortality being three times higher in black women than white women (Saluja and Bryant, 2021). Limb (2021) argued that maternity inequity was likely to increase as a result of the COVID-19 pandemic.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month