- Disparities arise from interaction of sociocultural, clinical, and systemic factors, not any single cause, requiring coordinated multi-level interventions.
- Sociocultural factors: experiences of discrimination and not being listened to erode trust and delay care-seeking among Black women.
- Clinical and systemic failures include higher rates of hypertensive disorders, pre-eclampsia, gestational diabetes, postpartum haemorrhage, inadequate escalation, workforce underrepresentation, postcode variation.
Cureus. 2026 Aug 13;18(8):e114480. doi: 10.7759/cureus.114480. eCollection 2026 Aug.
ABSTRACT
Despite overall low maternal mortality rates in the United Kingdom, Black women are approximately four times more likely to die during pregnancy, childbirth, or the postnatal period than White women. This disparity has persisted for over a decade despite national initiatives. This systematic review aimed to synthesize evidence from 2010-2025 on sociocultural, clinical, and systemic factors contributing to maternal health disparities between Black and White women in the United Kingdom (UK). Databases such as MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Web of Science (January 2010-December 2025) were searched along with grey literature sources including EthOS, OpenGrey, Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK), Birthrights, and NHS Race and Health Observatory. We included primary research studies (quantitative, qualitative, or mixed-methods) published in English that examined maternal health outcomes, experiences, or carer processes for Black and White women in the UK and analyzed at least one sociocultural, clinical, or systemic factor associated with disparities. Two reviewers independently screened titles/abstracts and full texts in Rayyan, extracted data using a piloted form, and assessed quality using Joanna Briggs Institute (JBI) checklists, Critical Appraisal Skills Programme (CASP), and Mixed Methods Appraisal Tool (MMAT). Narrative synthesis was conducted. Thirty-six studies were included, with 66.7% published post-2020. Sociocultural factors centered on experiences of discrimination and “not being listened to,” which eroded trust and delayed care-seeking. Clinical factors confirmed higher prevalence of hypertensive disorders, pre-eclampsia, gestational diabetes, and postpartum hemorrhage in Black women; however, disparities in escalation and response persisted after adjusting for comorbidities. Systemic issues included inconsistent continuity of care implementation, workforce underrepresentation, and a “postcode lottery” in service provision. The evidence demonstrates that disparities arise from the interaction of all three domains rather than any single factor. Multi-level interventions addressing sociocultural, clinical, and systemic factors simultaneously are essential. Future priorities include continuity of carer models, discrimination-focused longitudinal studies, and implementation science research. The persistence of these disparities requires sustained commitment from clinicians, policymakers, and researchers to translate evidence into meaningful action.
PMID:42732354 | PMC:PMC13570726 | DOI:10.7759/cureus.114480
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