Policy position: Racial and ethnic equality in women’s health

Across many aspects of women’s health in the UK, Black, Asian and minority ethnic women are found to have worse outcomes and experiences than white women. These health inequalities – avoidable and unfair differences in health across the population, and between different groups  – can have significant repercussions for women’s lives, influence health across the life course, and shape future interactions with health services.
Examples of racial and ethnic inequalities in women’s health outcomes in the UK today include:  

• Gynaecology – Evidence shows significant racial and ethnic inequalities in access to, and experience of, gynaecological care. The RCOG’s 2026 report New Year: Still Waiting for a Way Forward found that gynaecology waiting lists have risen most sharply among women from Black and Asian backgrounds, and incomplete ethnicity data suggests the true scale may be underestimated.  Inequalities are also evident in diagnosis and prevalence. Conditions, such as uterine fibroids, have a higher incidence in Black and Asian women compared to white women.  Women from minority ethnic backgrounds wait, on average, 11 years for an endometriosis diagnosis in the UK, compared with an overall UK average of 9 years and 4 months.  Structural and cultural barriers further contribute to these inequalities, including stigma and barriers to discussing gynaecological symptoms, which may delay help-seeking and access to care.  
• Sexual and reproductive healthcare – fragmented commissioning between the NHS and local authorities, and real-terms cuts to sexual and reproductive healthcare (SRH) services, are likely to disproportionately impact women from some ethnic minority backgrounds.
• Pregnancy – continuing a decades-long disparity, compared to white women, Asian women are 1.3 times more likely, and Black women 2.3 times more likely, to die from pregnancy-related causes during childbirth or within six months postpartum.  Racial and ethnic inequalities have been evidenced in rates of miscarriage, emergency caesarean birth, pregnancy-related complications such as hypertension in pregnancy and gestational diabetes, and pre-existing conditions associated with adverse pregnancy outcomes.  Significant variation by ethnicity has been found in access to perinatal mental health services in England.
• Neonatal outcomes – babies from Black and Asian ethnic groups are more likely to be born prematurely, and stillbirths among babies from Black and Asian ethnic groups are consistently higher than their white counterparts.  
• Fertility treatment – IVF birth rates are consistently lower for ethnic minority women at all ages compared to white women, and lowest for women from Black ethnic groups.  Black women are typically older when starting fertility treatment than other ethnic groups, are least likely to access NHS funded IVF cycles, and are most likely to experience multiple birth, which comes with increased risks of health problems.  There is a shortage of egg donors from minority ethnic communities in the UK, driven by a combination of low awareness, cultural and religious considerations, and stigma around infertility.  Evidence to the Women and Equalities Select Committee suggests this may limit access to ethnically matched donors and lead some patients to seek treatment overseas, where regulatory standards may vary.  
• Gynaecological cancers – South Asian women and women from Caribbean and African backgrounds have been found to be more likely to be diagnosed with breast or ovarian cancer at a later stage, when treatment is less likely to be effective.  Black women are more likely to be diagnosed with uterine cancer at a later stage, and have higher mortality rates than other ethnic groups.  Black and Asian women have been found to wait on average five to six days longer from referral to treatment for ovarian cancer than white women.  Women from some ethnic minority backgrounds are less likely to attend cervical screening appointments.
• Menstrual problems - Women from minority ethnic backgrounds are more likely to report heavy or severely painful periods.  Menstrual and menopausal symptoms can also contribute to financial insecurity, for example through impacts on employment and daily activities, which disproportionately affect ethnic minority women. 

The causes of racial and ethnic inequalities across women’s life course are multifactorial and complex. Taking an intersectional, life course approach is essential to understanding and addressing specific health outcomes, as outcomes are shaped by health and wellbeing throughout our lives, as well as the wider determinants of health.

Recognising and naming racism
It is important to recognise and name racism as a factor that can influence women’s health services and health outcomes, and an explicitly anti-racist approach should be taken in all efforts to improve outcomes.
Racism, whether structural, institutional or interpersonal,  can be identified in many of the factors that shape women’s health outcomes, including those set out below. Experiencing racism and discrimination over the life course can also directly contribute to chronic stress and the development of metabolic disease.  Recent research suggests that chronic stress linked to systemic racism may also contribute to adverse pregnancy outcomes through measurable physiological pathways, including inflammation and vascular changes, reinforcing the importance of addressing both clinical and structural determinants of maternal health. 
Governments and health services must be confident in recognising and addressing racism. The RCOG has also set out its work to confront racism and cultural bias in O&G.  
The impact of wider inequalities in society
The wider contexts of women’s lives, such as access to good quality housing, healthy, affordable food, good quality work and a robust social security system, significantly influence health outcomes.  
Racial discrimination can play a role in shaping people’s living and working conditions, and can also intersect with and compound gender inequalities.  Poverty, which can have a significant health impact across women’s lives and creates barriers to accessing healthcare, is much more likely to affect women from some ethnic minority groups compared to white women. 
The impact of poverty and deprivation is just one potential factor of many in shaping health outcomes, and inequalities can persist across all deprivation levels.  Nonetheless, sustainable progress towards equality in women’s health has to be supported by changes to every part of society which shape our health outcomes, as the RCOG has set out in its position statement on poverty, deprivation and women’s health.  
Racial discrimination has been shown to have significant economic impacts on the NHS, individuals, and the wider economy.  It leads to avoidable ill health through delayed care, poorer quality care, and unequal access to early intervention, resulting in more advanced disease, complications, and longer-term health conditions.  For example, untreated or poorly managed gynaecological conditions, such as uterine fibroids, further contribute to lost productivity, increased mental health needs, and wider societal costs. 
Access to and experiences of healthcare services
Many recent reports have illustrated poor care experienced by ethnic minority women, particularly in maternity settings. This includes care which is influenced by racial stereotypes held by healthcare professionals, women not being listened to when they present with pain or concerns about their health, and staff being less confident recognising symptoms on darker skin tones.  This reflects an unmet need for better training of healthcare professionals in cultural awareness, identifying and counteracting bias in their practice, and clinical skills suitable for service users of all ethnicities.
Poor past experiences can contribute to distrust and avoidance of health services,  as can historical discriminatory practices in medical research or within the O&G specialty in the UK or elsewhere, such as forced sterilisation, eugenics or the involvement of ethnic minority groups in research without informed consent. 
Problems with interpreting services and translated materials can impact the care and experiences of women from ethnic minority backgrounds with limited English proficiency.  National policies and laws can also lead to barriers which disproportionately affect ethnic minority women. For example, NHS overseas charging regulations, particularly in England, can deter women from accessing maternity care.  These issues are further explored in the RCOG’s position statement on equitable access to maternity care for refugee, asylum seeking and undocumented migrant women.  
Research, guidelines and healthcare technology designed for the whole population
The evidence base underpinning medical research, guidelines and technology is not yet equitable. This can ultimately influence care and outcomes and contribute to health inequalities, for example through treatments that are less effective or not appropriate for some populations or contributing to distrust of services and treatments. 
People who are female, from ethnic minority backgrounds, older or pregnant are often still under-represented in clinical studies, including in major disease areas like cancer and cardiovascular disease.  In addition, some women’s health conditions, and effective interventions to address inequalities, are under-researched, as are the barriers to participation in research.  UK guidelines for neonatal assessment have been found to be less relevant to babies with darker skin tones,  and a recent independent review of equity in medical devices noted that trials of new devices often do not include representative proportions of women or ethnic minorities.  
Supporting the women’s health workforce
An inclusive, well-supported and anti-racist O&G workforce is crucial to delivering equitable health outcomes and ensuring the women and people they care for feel safe and listened to.  The Workforce Race Equality Standard has highlighted that more must be done to address existing discrimination. For example, white applicants are still more likely to be appointed from shortlisting across all roles, with staff from ethnic minorities less likely to feel that their employer provides equal opportunities for promotion. 

The RCOG 2025 Workforce Census found that 65% of obstetricians and gynaecologists are at risk of burnout.  Of the 20% of respondents who indicated that they intend to leave the speciality within the next five years, 20% cited racism from patients and 27% cited racism from colleagues as contributing factors.  Poor workplace experiences for ethnic minority workers have a direct impact on staff morale, retention, and recruitment, adding to higher costs through turnover, sick-pay, agency use, and tribunals.  Addressing the significant pressures on the O&G workforce is therefore fundamental, through tackling high levels of burnout, protected time for training, retaining existing staff, and boosting workforce numbers.  

The RCOG has set out its work to advance racial equality in the specialty.  This includes developing Race Equity in the Workforce eLearning resources to support healthcare professionals to address racism in the workplace.  This free online package offers practical tools to promote inclusive training, challenges bias, improve communication and empower the workforce to deliver equity across clinical practice.   

We welcome the UK Government’s manifesto commitment to set an explicit target to close the Black and Asian maternal mortality gap, which the RCOG has recommended for several years. Ambitious targets must be developed without delay. To support this ambition, we urge the UK Government to consider also setting a target to end the higher risk of maternal mortality for women living in more deprived areas.

Suitable targets must be:

• Supported by substantial ring-fenced funding to support urgent investment, meaningful co-production, and cross-departmental innovation.
• Co-produced with ethnic minority women and communities.
• Supported by evidence on expected impact, a plan for evaluation and reporting to ensure transparency and trust.
• Linked with a cross-government focus on health inequalities, including an ongoing focus on tackling health inequalities as part of the Women’s Health Strategy.
• Backed by clear lines of accountability for delivery within the DHSC.

Targets must be reinforced by wider investment in the NHS and public health services, both of which play a crucial role in ensuring women can maintain good health throughout their lives and make decisions about their reproductive, preconception and pregnancy health. Long-term funding commitments are needed to promote lasting change in services given the entrenched nature of ethnic inequalities, alongside investment in NHS digital infrastructure to improve the flow of information between services and support data collection.

Investment in the maternity workforce is fundamental to achieving these targets. It is vital that services are safely staffed to levels which are reflective of their local populations and that healthcare professionals have the time to provide personalised care, undertake training, and implement quality improvement programmes designed to reduce health inequalities. The RCOG has set out further recommendations on investment in maternity,[i] and gynaecology services,[ii] as well as on increasing the public health grant.[iii] 

A whole-Government strategic approach is required across women’s life course to sustainably prevent health inequalities and to address the wider determinants of their health. It is also central to any policies seeking to achieve racial and ethnic equality in women’s health outcomes. The UK Government must therefore:

• Maintain a focus on implementing the Women’s Health Strategy, supported by long-term funding and a commitment to retaining tackling health inequalities as a core ambition.
• Ensure all government initiatives to improve women’s health or end inequalities in maternity outcomes make explicit connections across all relevant departments to achieve long-term improvements.
• Focus on specific interventions for groups of women at greatest risk of poorer outcomes or who face more significant barriers to care within and beyond the health system. For example, this may include tackling racism and discrimination in the workplace, the causes of poverty and deprivation, or the disproportionate impact of air pollution on ethnic minority communities. You can read more about our recommendations for tackling women’s health inequalities driven by poverty and deprivation here.

The Government must ensure equity is a standing concern of decision-making structures at every level of the health service, from the NHS England Board and Integrated Care Boards to the boards of all NHS providers. This must be supported by ongoing efforts to develop leaders at all levels who are able to drive cultural change and support the workforce to end racism in the workplace. In the context of ongoing NHS England and Integrated Care Board budget reductions and reforms, this commitment to equity must be maintained.[i]

Within the O&G workforce, it is vital that doctors are supported with their wellbeing and ability to escalate concerns, and that there are mechanisms in place to ensure fairness in opportunities and career progression. Psychological safety must be championed, and an environment where people are accepted and respected and feel to challenge when they have concerns or questions must be built.[ii] The RCOG is committed to improving workplace culture for the benefit of both the wellbeing of doctors and ultimately to improve patient care.[iii]   

Where the MWRES and WRES identify racial inequalities in workforce experiences or progression within NHS organisations, there must be accountability for change, with targets and timelines set out to deliver equitable outcomes for doctors from all ethnic backgrounds.

At the local level, Local Maternity and Neonatal Systems (LMNS) be supported by their ICB, with a clear framework on roles and responsibilities between the two structures. There must also be opportunities for LMNS staff to share best practices and take up leadership roles within ICBs. LMNSs also need to be supported with the tools to robustly track and evaluate maternal and neonatal outcomes to ensure comprehensive oversight.[iv]

The NHS has committed to providing convenient, easy access services that meet the needs of communities, in a way that does not discriminate.  Health services must, therefore, have the structures in place to strive towards equity in outcomes and overcome the barriers that prevent women from accessing care.
Listening to women and their families is fundamental to providing person-centred care, and so co-production of services with women must be implemented wherever possible.  This includes involving service users from all backgrounds in all aspects of care, including co-production of services, training of the multi-professional team and investigations following adverse events. Innovation and outreach should be used to engage with women who are underrepresented, and services need to be financially supported to deliver this.
NHS commissioners must consider how local funding or eligibility criteria may have unequal impacts on women from ethnic minority backgrounds, and where services need to respond to the needs of particular groups. For example, making sure the cervical screening programme responds to lower attendance by women and people from some groups,  or giving regard to how eligibility criteria for NHS fertility services can have unequal impacts on women from some ethnic groups. 
The RCOG has set out further recommendations on these issues in its joint position statement on gynaecological cancers with the British Gynaecological Cancer Society  and its call to action on ethnic disparities in fertility treatment with the Human Fertilisation and Embryology Authority, British Fertility Society and Fertility Network UK.  
Current NHS England equity programmes and initiatives relevant to reducing women’s healthcare inequalities, such as the Equity and Equality guidance for local maternity systems and the Core20PLUS5 approach,  should be co-ordinated and aligned to reflect the life course approach and to support ICBs to collaborate on budgets. Equity initiatives should also be regularly evaluated and adapted to ensure they are suitable tools for improvement.

The UK Government can also support women’s access to services and pre-conception health through facilitating better integration of women’s SRH services and by ensuring women can access care in their local communities, in line with the Government’s commitment to shifting care from hospitals into community settings.[i]

Women’s Health Hubs are a proven example of the benefits of bringing together healthcare professionals to provide integrated women’s health services in the community,[ii] including sexual and reproductive healthcare services, preconception care and cervical screening.[iii] Hubs can reduce unnecessary referrals into secondary care, bring down elective waiting lists, and provide care closer to home for women waiting.[iv] As outlined in the renewed Women’s Health Strategy for England,[v] where high quality Women’s Health Hubs exist, they should continue to play a central role in service delivery. Where they are not yet in place, services should ensure equivalent integrated women’s health provision within Neighbourhood Health models, to avoid a postcode lottery in access to essential care closer to home.[vi]

Services need an accurate understanding of the ethnicities of those they serve to best identify inequalities, design appropriate services, and support research on effective interventions. One of the key recommendations of the RCOG’s Waiting for a Way Forward report was for the Government to improve the collection and publication of data on health inequalities in elective gynaecology waiting times.[i] The RCOG therefore welcomes the Government’s decision to publish monthly data from the Waiting List Minimum Dataset (WLMDS), providing information on the demographics of people waiting for NHS treatment in England and waiting times.[ii]

However, the WLMDS has significant limitations. Missing data and reporting issues are likely to mask the full extent of inequalities, and there remains a lack of qualitative research to understand the drivers of disparities in gynaecology care.[iii] Data collection on ethnicity and healthcare outcomes, particularly in gynaecology, must be improved to ensure accuracy and consistency, so that inequalities can be effectively measured, monitored, and used to inform the design of effective interventions and strategies.[iv]

In addition, data on inequalities in access and outcomes have only been published for England; equivalent data must be made available across all UK nations to enable a comprehensive understanding of the scale of inequalities.[v]

All services should make sure that women’s self-reported ethnicity is asked and accurately recorded, using agreed ethnic group coding systems that should be updated regularly in accordance with the most current census groups.[vi] Healthcare staff should be aware of and able to explain to service users the reasons for ethnicity data collection, how it can be used, and why it is so important for health, as recommended by the Race Equality Foundation.[vii]

Ethnicity data should also be incorporated into safety and quality metrics, with regular reporting required to monitor progress and identify areas needing improvement. This requires data and research support, and training to support staff to collect data appropriately.

Governments and health services should consider how to improve the availability and quality of information about choices during pregnancy and labour, with particular attention to the development of evidence based shared decision making tools for place, mode and timing of birth and pain relief options.  
Provision and use of good interpreting services and translated materials are crucial to support women and people using O&G services in making informed decisions about their care. However, RCOG members have reported variation in provision between and within healthcare providers, unreliable, slow interpreting services that take up valuable clinical time, and a lack of funding allocated to protect this essential service. Deficiencies with interpretation or translation provision have also been raised in MBRRACE-UK confidential enquiries into maternal deaths and by a BBC investigation. 
Every maternity service must provide access to a high quality interpreting service and consider ways to improve the availability and usage of appropriate interpreters. Services should be supported by additional funding to deliver this where needed. Commissioners of maternity services must take into account the cost of interpreting requirements, including NICE recommendations for professional interpreters and the need for longer appointments, when commissioning and funding services.
NHS England should ensure that interpreters supporting maternity care are trained to provide high quality services in this specific context, setting out minimum competencies in a nationally agreed standard, as the RCOG has highlighted previously in its position statement on equitable access to maternity care for refugee, asylum seeking and undocumented migrant women.  

Services must ensure equitable access to pre-pregnancy and post-pregnancy counselling for women and people planning a pregnancy who have medical conditions or a previous complicated pregnancy. There should also be continuous and protected support for NHS Maternal Medicine Networks, which have an important role in reducing maternal mortality and morbidity from medical problems in pregnancy. We also support developing and implementing tools that can help assess and identify risk early.

The RCOG has made specific recommendations for improving access for women seeking asylum or with insecure migration status, who are often at higher risk of poor outcomes.[i] NHS Trusts have an important role in minimising the impact of NHS overseas visitors charging regulations on maternity outcomes, and should implement the RCOG, RCM and Maternity Action Guidance on improving access to maternity care for women affected by charging.[ii]

It is vital that services are set up to learn when things go wrong, and that the potential relevance of race and ethnicity as contributing factors are fully and confidently explored. This includes ensuring complaints processes are accessible for all service users, working with those with lived experience. Maternity care providers should ensure oversight and monitoring of complaints to identify patterns and learning. Ethnicity should be a mandatory field on local incident reviews and tools, supported by adequate time for staff to create a psychologically safe space to encourage dialogue and confidently identify where racism, stereotypes or bias may have affected a woman’s care.

A continued focus on addressing bias and knowledge gaps in care is important to ensuring women feel comfortable accessing care. We welcome dedicated investment across the health system in anti-racist and culturally safe education, training and practice, backed by regular evaluation. 

A robust evidence base is fundamental to healthcare interventions and policies which are equitable and effective across diverse populations. When looking to address maternity inequalities, building the evidence base for effective interventions and delivering an anti-racist service must be the focus. A substantial piece of research is needed to understand and develop practical solutions to the mechanisms behind poorer care and outcomes in maternity services, and to evaluate existing interventions. Mechanisms should be in place to rapidly escalate learning across the system to shape service delivery and clinical recommendations where required.

We also urge the UK Government to deliver a review of equity in the medical devices encountered during pregnancy and the neonatal period, as recommended by the recent independent review into equity in medical devices.[i]  While the commissioning of NIHR research into disparities in the use of medical devices in pregnancy and the neonatal period is welcome, its findings must be followed by urgent and decisive Government action to address inequalities in outcomes associated with medical devices.[ii]

The renewed Women’s Health Strategy includes measures to improve investment in women’s health research and participation in clinical research.[iii] These include new funding for innovation, including partnerships with FemTech developers, the creation of a Women in Tech taskforce, commitments from the National Institute for Health and Care Research (NIHR) to better account for sex-based differences in research, and action to improve participation in clinical studies through initiatives such as the Be Part of Research service within the NHS App.

While the RCOG welcomes these developments, which reflect longstanding calls for greater investment and inclusivity in women’s health research, sustained implementation and robust evaluation will be essential to ensure they reduce inequalities in research participation and outcomes.

It is vital that research funders and journals support proportionate representation of ethnicities in clinical studies, such as by specifying the use of the NIHR-INCLUDE frameworks and requiring studies to be co-designed with representative groups of women. Further research into understanding and addressing the factors that lead to less diverse recruitment to clinical studies should also be considered.

• Read more about the College’s ambition for race equality
• Policy position: Poverty, deprivation and women’s health
• Policy position: Equitable access to maternity care for refugee, asylum seeking and undocumented migrant women
• Maternity safety resource hub
• Tackling racism eLearning
• Workforce Behaviour Toolkit
• Blog: Understanding and addressing the influence of colonialism on Obstetrics and Gynaecology specialty training in the UK