Green Maternity Challenge 2024
As part of CSH’s larger project ‘Taking collective action to deliver low carbon, equitable maternity care’, The Green Maternity Challenge will be delivered by CSH in partnership The Royal College of Obstetricians and Gynaecologists (RCOG), The Royal College of Midwives (RCM) and The Sustainable Healthcare Coalition (SHC).
This work was commissioned and funded by SBRI healthcare as an Accelerated Access Collaborative (AAC) initiative, in partnership with the Health Innovation Network. The views expressed in the publication are those of the author(s) and not necessarily those of SBRI Healthcare or its stakeholders.
Maternity services account for a significant portion of the NHS’s carbon footprint, contributing to the UK’s environmental crisis. With over 673,000 births in 2022, the impact of NHS services on the environment is substantial. Pregnant women and infants are particularly vulnerable to climate change, which exacerbates health complications. Furthermore, significant health inequalities persist, disproportionately affecting women from ethnic minorities and disadvantaged backgrounds. Addressing both the environmental impact and healthcare inequalities is crucial to improving outcomes and creating a more sustainable, equitable healthcare system.
In the Green Maternity Challenge, CSH helped nine clinical teams in NHS trusts across the UK make a huge positive impact on sustainable and equitable maternity care.
The impact of this challenge has been significant, with an estimated £860,669 saved annually, 101,263 kgCO2e reduced, and emissions equivalent to 778,978 disposable nappies prevented.
Read about how we achieved these goals and more on each of the individual teams projects below.
What is the Green Maternity Challenge?
The Green Maternity Challenge is a maternity focused project based on CSH’s groundbreaking Green Specialty Challenge.
In the Green Maternity Challenge, nine clinical teams in the UK were selected to receive training and mentoring from CSH to develop, plan, run, and measure the impact of a sustainable quality improvement (SusQI) project. Projects will focus on identified target areas for reducing environmental harm and health inequalities.
Key target areas
We believe that by focusing Quality Improvement and service re-design projects around these target areas, maternity care can become more equitable and sustainable. These target areas overlap and many projects will tackle several at the same time.For all improvement work the outcome and experience of the people using the services is key. These should be maintained or improved in particular for people who are underserved by the status quo.
- Valuing people’s time:
Streamlining services and systems to avoid waste
Examples: Tackling delayed discharge, efficient scheduling of appointments, decreasing travel to appointments
Example links to environmental impact: Appointments, hospital bed stays and travel all contribute to carbon emissions and environmental harm.
- Supporting informed choices:
Providing relevant information and support so that people can successfully access/implement the choices that are best for them and the planet
Examples: Linking into local voluntary provision, access to pain relief, better access to translation services, culturally relevant support, being explicit about sustainability choices e.g. bounty packs
Example links to environmental impact: Appropriate and personalised care can reduce inefficiency in systems and use of resources that are of low-value to women and birthing people – which can save carbon and waste.
- Listening to women:
Reducing waste and improving outcomes by involving people in their own care, co-designing services and utilising third sector support
Examples: More say for people in how and where they access care, processes that value the voices of women
Example links to environmental impact: Personalised care can be more efficient, reducing healthcare activity that is of low value to women and birthing people. Leveraging third sector support can reduce the need for hospital-based care by providing community-based solutions, which typically have a smaller environmental impact compared to traditional healthcare settings.
- Access and experience for people who experience worse maternity outcomes:
Focusing resource and/or re-designing systems to cater for those that the system has underserved before
Examples: Improvement of services for people living in deprived communities, black and asian women and young mothers and birthing people
Example links to environmental impact: Reducing health inequalities leads to better outcomes for wider populations which long term reduces healthcare activity and resource use which contribute to carbon emissions
- Complex pregnancies:
Improved systems for those with additional care needs or complications
Examples: hypertension pathway improvements, new ways of monitoring, reducing travel to appointments
Example links to environmental impact: Optimising health by reducing complications and streamlining care for complications reduces inefficiencies in healthcare activity and resource use (e.g. appointments, medicines and avoidable emergency care) which contribute to carbon emissions.
- Infant feeding:
Meeting the unmet need of those who want to breastfeed but lack appropriate support
Examples: improved systems for supporting women in their feeding choices including peer support and culturally relevant nutritional support
Example links to environmental impact: Streamlined support and improved feeding outcomes reduces need for additional appointments and resources which contribute to carbon emissions and waste.
- Pelvic health and continence:
Tackling the long-lasting effects of poor continence following childbirth
Examples: Promotion of ante-natal pelvic health guidance, access to specialist services, improvement to perineal tear care.
Example links to environmental impact: Improving continence may prevent life-long need for continence products and associated care which contribute to carbon emissions and waste.
Why we need a green maternity challenge
Maternity services are one of the NHS’s high-volume services, with over 673,000 births in the UK in 2022. Each of these will have been preceded by approximately 30 weeks of regular antenatal care and followed up with postnatal care.
The NHS is responsible for 4% of the UKs carbon footprint – equivalent to the entire emissions of Croatia. NHS services and resource use is therefore contributing to the environmental and ecological crisis. Pregnant women and infants are some of the most vulnerable to the effects of climate change, such as extreme heat, air pollution, and natural disasters, which can exacerbate health issues, leading to complications such as preterm birth, low birth weight, and respiratory problems.
Significant inequalities persist in maternal services across the UK, disproportionately affecting women and birthing people from ethnic minorities and socio-economically disadvantaged backgrounds. Black women are four times more likely to die in pregnancy or childbirth compared to white women, and Asian women face twice the risk. Additionally, women from the most deprived areas are more likely to experience stillbirth compared to those from the least deprived areas.
Climate change and healthcare inequalities are inextricably linked. Disadvantaged communities are often more exposed to environmental hazards, are less able to recover from these hazards, and often have reduced access to high-quality healthcare. This compounding effect exacerbates health disparities.
Addressing inequalities and environmental harm from healthcare services not only improves health outcomes and experiences of care, but contributes to a more just and sustainable healthcare system.
Key dates and activities:
This event is open to all – those working in maternity care services and members of the public with lived experience or an interest in sustainability within maternity care
Application period opened: 24th July 2024
Application period closed & shortlisting started: 20th September 2024
Successful teams were contacted by 30th September 2024
Workshops & start of project period: 14th-18th October 2024
Teams participated in a 90-minute virtual workshop on sustainable healthcare, SusQI methodology, and project development.
Project Phase: 14th October 2024 – 31st January 2025 (16 weeks)
Project work: Over 12 weeks, teams will set aims, plan and implement changes, collect data, and calculate the impact of their changes. The CSH environmental analyst team will assist in carbon footprinting the environmental outcomes of the project.
Reporting: Complete a SusQI Project report, reviewed and supported by the CSH team.
Showcase Event: Wednesday 5th March 2025, 09:00 – 12:30 GMT
Teams will present their projects to a judging panel and audience at an online event.
The judging panel will include:
- Dr Ranee Thakar, President of RCOG
- Fiona Gibb, Director, Professional Midwifery, RCM
- Emma Crookes, Lived Experience Representative
- Dr Frances Mortimer, Medical Director, CSH
Green Maternity Challenge launch event
The Green Maternity Challenge was launched in June 2024 to those working in maternity care services and members of the public with lived experience or an interest in sustainability within maternity care.
“Now is your time to point the way to a brighter future. It will be your ideas, collaborative working and innovative mindsets that will lay the path for all delivering maternity care to follow. Do not hold back, come together and submit your ideas and we will support you every step of the way to demonstrate how these ideas can achieve the change that is so evidently required.”
Dr Ranee Thakar, President of the Royal College of Obstetricians and Gynaecologists (RCOG)
Watch the recording to learn more about the carbon and equity target areas and the Green Maternity Challenge.
The teams
We were impressed by the number of applications we received and the quality of project ideas submitted. Initially, we planned to work with six teams for the Green Maternity Challenge, but thanks to the support of our sponsors, we have been able to expand our selection to nine teams.
The selected teams are:
- South Warwickshire University NHS Foundation Trust (SWUFT)
NHS South Warwickshire is promoting antenatal perineal massage to reduce birth-related trauma and improve pelvic health. By training staff to counsel women on this practice, the initiative aims to lower perineal tears, enhance recovery, and reduce long-term health complications, benefiting both patients and healthcare resources. - Imperial College Healthcare NHS Trust
NHS Imperial is optimising antenatal referrals by shifting unnecessary face-to-face appointments to virtual consultations. This will reduce travel, waiting times, and clinic overcrowding while ensuring in-person slots are reserved for women who need them most, improving efficiency and care quality. - NHS Orkney
NHS Orkney is developing a local newborn hip dysplasia screening service to reduce the need for stressful and costly travel to Aberdeen. Currently, 47% of families find the journey challenging, and 98% support local screening. By upskilling sonography-trained midwives in partnership with Aberdeen, the change will improve patient experience, job satisfaction, and sustainability while easing financial and environmental burdens. - Imperial College Healthcare NHS Trust
NHS Queen Charlotte and Chelsea is improving hypertension management in pregnancy by refining clinical guidelines and boosting staff confidence in treatment. This will enhance patient care, reduce hospital stays, and improve long-term health outcomes while minimising costs and resource use. - Norfolk and Norwich University NHS Hospital Trust
NHS Norfolk and Norwich is introducing a virtual ward for women with hyperemesis gravidarum, allowing them to receive timely care at home. This will improve patient experience, reduce hospital visits, and lessen the environmental and financial strain on healthcare services. - West Suffolk Hospital, West Suffolk NHS Foundation Trust
NHS West Suffolk is improving care for women with multiple pregnancies by enhancing appointment efficiency, reducing unnecessary tests, and offering virtual consultations to save time and improve patient experience. The changes aim to streamline care, improve satisfaction, and reduce the burden on both women and staff, with potential benefits for the wider antenatal population. - Great Western Hospital NHS Trust
NHS Great Western is enhancing breastfeeding support by introducing daily antenatal and postnatal group sessions led by maternity support workers. Reusable baby bottles will replace single-use alternatives to reduce waste and improve feeding consistency, benefiting both families and the environment. - Whittington Health NHS Trust
NHS Whittington is improving antenatal care by combining midwifery and virtual obstetric appointments to prevent unnecessary hospital visits and duplicate tests. This change will enhance continuity, trust, and convenience while lowering environmental and financial costs. - Kingston and Richmond NHS Foundation Trust
NHS Kingston is improving care for Albanian women by establishing a dedicated clinic with a safeguarding midwife and an Albanian-speaking Doula. This will enhance continuity, cultural sensitivity, and communication while reducing unnecessary interventions, improving maternal wellbeing, and supporting better birth outcomes.
We look forward working with these teams and to seeing their innovative contributions to sustainable maternity care.
The Green Maternity Showcase
The Green Maternity Showcase was an event held on the 5th March 2025, dedicated to highlighting the remarkable efforts of the nine project teams selected to take part in the Green Maternity Challenge who were dedicated to creating more sustainable and equitable maternity care.
The nine clinical teams chosen as part of the challenge presented their Sustainable Quality Improvement (SusQI) projects to the judging panel.
These projects focused on the key target areas identified through collaboration with challenge partners, carbon footprinting analysis and discussion with members of a lived experience group: valuing people’s time, supporting informed choices, listening to women, access and experience for people who experience worse maternity outcomes, complex pregnancies, infant feeding, and pelvic health and continence, with the ultimate aim of reducing environmental harm and health inequalities in maternity services.
Winning team
Norfolk and Norwich University Hospitals NHS Foundation Trust was announced as the winning team for their work on improving care for women with hyperemesis gravidarum, reducing hospital admissions and saving 6,462 kgCO2e annually. NHS Orkney and Imperial College Healthcare NHS Trust received Highly Commended awards for their outstanding contributions to rural hip dysplasia screening and streamlined antenatal care pathways respectively.
Showcase outcomes and learning
The Green Maternity Showcase was an event dedicated to highlighting the inspiring work of the nine project teams taking part in the Green Maternity Challenge. These teams are leading the way in creating more sustainable and equitable maternity care.
The event featured presentations from 9 clinical teams presenting their Sustainable Quality Improvement (SusQI) projects, focusing on key areas identified through collaboration with challenge partners, carbon footprinting analysis, and discussions with a lived experience group.
To see all the video presentations from the showcase and case studies reports from each team project, please head to our dedicated page.
“There is so much good work happening that we don’t usually hear about, and it was a privilege to witness such amazing projects today. I was pleased to see so many people involved and look forward to further collaboration with hospitals, trusts, and teams. I hope this challenge inspires more initiatives like it.”
Dr Frances Mortimer, medical director, Centre of Sustainable Healthcare
Green Maternity Conference
The Green Maternity Conference: Taking collective action to deliver low carbon, equitable maternity care is a joint, in person event from the The Royal College of Obstetricians and Gynaecologists (RCOG), The Royal College of Midwives (RCM), The Sustainable Healthcare Coalition (SHC) and CSH, and is an opportunity to join a collaborative effort to tackle the impact of the climate crisis in women’s health and help shape the direction of sustainability in O&G.
Join us on Wednesday 19 March 2025 in-person at the RCOG, London.
Join us at the College to hear from RCOG president Ranee Thakar and other speakers including CSH’s SusQI programme lead Rachel McLean who will share their joint vision for the future of sustainable maternity care. Learn Learn from the real-life experience of multidisciplinary teams across the UK as they share the successes and challenges of implementing carbon reduction projects run through the Green Maternity Challenge, leaving you empowered to improve your practice and positively influence your colleagues in women’s health.
There is still more you can do
The impact of this challenge has been huge, with an estimated £860,669 in cost and efficiency savings annually and 101,263 kgCO2e reduced annually, equivalent to the kgCO2e of 778,978 disposable nappies. But that doesn’t mean there isn’t more we can all do.
Please join the CSH Women’s Health Network – an online community of healthcare professionals committed to tackling the environmental impact of women’s health by sharing knowledge, ideas and examples of good practice. The Maternity Challenge case studies are shared here in our resource library, along with other case studies, research and resources related to women’s health.
Please contact Rachel McLean, CSH’s SusQI programme lead if you have any questions about the project.