Maternity care project
CSH has partnering with the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM) and the Sustainable Healthcare Coalition (SHC) to deliver the project “Taking collective action to deliver low carbon, equitable maternity care”.
Maternity care – sometimes called antenatal care or pregnancy care – is a large umbrella term that encompasses the wide range of clinical, medical and social interventions that accompany pregnancy and childbirth.
This year-long SBRI project aimed to engage the multi-disciplinary maternity community by studying maternity care pathways, highlighting carbon and health inequity hotspots, supporting maternity teams to run QI projects to address these areas, and bringing the wider community together to discuss how the findings could shape the future of maternity care.
How does global warming affect maternity care?
The impact of global warming not only on maternity care services but the health and wellbeing of the parent and the child is well documented. With increasing heatwaves, adverse weather events, air pollution and more all having significant negative effects.
Research into climate change and the potential effects on maternal and pregnancy outcomes has identified a clear link between negative maternal and pregnancy outcomes and a lack of food, safe drinking water and proper sanitation caused by climate induced migration; increased frequency of extreme weather events; changing patterns of disease and morbidity, especially with emerging tropical diseases such as Zika; and direct heat exposure through climate change. It is clear that the consequences of climate change for pregnant women and the unborn child can be substantial.
The lack of sustainability in maternity care
Maternity care is highlighted as one of the key clinical challenges in the Core20Plus5 equity strategy – NHS England’s approach to reducing health inequalities – yet it often receives limited attention in discussions on sustainable models of care. At the same time, inequities in maternity care delivery and experience remain significant.
The NHS has made strong progress in reducing its carbon footprint, cutting emissions by 30% since 2010 and exceeding its commitments under the Climate Change Act. However, healthcare still accounts for 4.4% of global emissions, with maternity care a major contributor. The pathway is high volume — caesarean sections are among the most common surgeries in the NHS — and certain practices have a disproportionate impact, such as the use of Entonox during childbirth, which is responsible for two-thirds of nitrous oxide emissions. Yet, despite these clear signals, maternity services have not been comprehensively carbon-footprinted.
Taking collective action to deliver low carbon, equitable maternity care
It is clear that inequity in healthcare is a key barrier to achieving the EU’s 2030 Agenda for Sustainable Development and the SDGs, and the inequity in women’s maternal health is a significant issue. According to the MBRRACE statistics, between 2019 and 2021 – the latest statistics available at the time of writing and statistically unchanged from the 2018 to 2019 period – women of Black ethnic backgrounds were four times more likely than white women to die in childbirth, and Asian women were almost twice as likely. This is compounded by socio-economic factors, with women living in the most economically deprived areas having a maternal mortality rate two-and-a-half times higher than women living in the least deprived areas.
One of the biggest disparities of maternity provision is in continuity of care. Seeing the same midwife and developing a supportive, trusting relationship between the service user and the care giver is widely known to bring about better outcomes for both mother and baby, so much so that the NHS Long Term Plan sees continuity of care as a priority and states that 75% of women from Black, Asian and other ethnic minorities and women from the most deprived areas should receive continuity of care by 2024. Unfortunately this target has never come close to being met thanks in large part to reported causes such as suboptimal staffing levels, which is just one of the many reasons that inequity in maternity care needs to be tackled as a matter of urgency.
But how exactly will making maternity care more sustainable help to reduce inequity of care? This is just one of the key questions this project aims to answer.
What did this project achieve?
To address inequity and the lack of sustainability in maternity care, a long-term, multidisciplinary approach was required. Working alongside SBRI Healthcare, the Centre for Sustainable Healthcare collaborated with the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, and the Sustainable Healthcare Coalition to deliver the project “Taking Collective Action to Deliver Low Carbon, Equitable Maternity Care.”
The project also engaged expert advisors from obstetrics and midwifery, as well as a panel organised by the RCOG representing people with lived experience of maternity care and their advocates. Over the course of the year, the maternity community studied care pathways to identify carbon and health inequity hotspots, supported teams to run Quality Improvement (QI) projects addressing these areas, and came together to discuss how the findings could shape the future of maternity care.
The project included:
- Mapping the maternity pathways to identify carbon and inequity hotspots
- Agreeing target areas where changes could affect carbon and equity at the same time
- A Green Maternity Challenge where maternity teams from across the UK co-design Sustainability in Quality Improvement (SusQI) projects with our lived-experience group to test changes in situ
- Events to feed back the learning to the maternity community including industry partners
How did the Centre of Sustainable Healthcare help reduce carbon and inequity in maternity care?
In collaboration with our partners and wider members of the multidisciplinary professions, the Centre for Sustainable Healthcare managed the year long project, bringing our carbon footprinting and practical SusQI expertise to help ensure the project delivers its potential benefits. We helped align net zero and equity actions with clinical and patient priorities, with the ultimate aim of improving outcomes and experiences while reducing health inequities.
Service-user and clinical engagement increased understanding of maternity sustainability and equity hotspots, and greater involvement in practice. By modelling cross-disciplinary collaboration and co-design with service users, the project promoted a culture of integration, teamwork, and shared ownership, leading to improvements in the experience of maternity service users.
The project also quantified environmental, social, and economic benefits at project level and scaled these to national level, providing robust measurement. This work highlighted key areas for industry innovation and created opportunities for clinical guidance, education, and national quality initiatives to embed net zero and equity learning.
Equally important, the project showcased the power of community action. The maternity community demonstrated energy, determination, creativity, and strong networks — qualities that drove the project forward and helped grow the Women’s Health Sustainability Network, bringing greater knowledge and momentum for delivering high-value, sustainable, and equitable care.
Project timeline
Launch and events
July 2024
The project launched alongside a series of events on the CSH Networks. These events engaged the maternity community — including clinical professionals and those with lived experience — to identify key target areas within the maternity care pathway for exploration.
Recruitment and workshops
July – October 2024
During this phase, specialist teams from across the maternity care community were recruited. Through a series of workshops, they developed individual projects for the Green Maternity Challenge 2024.
Projects
October 2024 – January 2025
Each team ran its SusQI project as part of the Green Maternity Challenge, focusing on sustainability and equity in maternity care.
Showcase event
March 2025
Teams presented their projects to a judging panel and wider audience. The results of these projects are now being used to inform improvements in the sustainability and equity of maternity care service pathways.
Identifying key target areas
CSH hosted a series of network events to identify key target areas within the maternity care pathway. By focusing Quality Improvement and service redesign projects on these areas, maternity care can become both more equitable and more sustainable. As the target areas often overlap, many projects address several at once.
Across all improvement work, the outcomes and experiences of people using the services remain central — with particular attention to ensuring that those currently underserved by the status quo see meaningful improvements.
- Valuing people’s time:
Aim: Streamline services and systems to reduce inefficiency and avoid waste.
Environmental impact: Every appointment, hospital bed day, and journey contributes to carbon emissions. Cutting unnecessary activity reduces environmental harm.
Examples: Tackling delayed discharge, improving appointment scheduling, reducing travel to appointments.
- Supporting informed choices:
Aim: Provide relevant information and support so people can make choices that work best for them and for the planet.
Examples: Access to pain relief, better translation services, culturally relevant support, signposting to voluntary services, being explicit about sustainable options (e.g. bounty packs).
Environmental impact: Personalised care reduces inefficiency and low-value interventions, saving both resources and carbon.
- Listening to women:
Aim: Improve outcomes and reduce waste by involving people in their care and co-designing services.
Examples: Giving people more say in how and where they access care, embedding women’s voices in service design, using third sector support.
Environmental impact: Personalised, co-designed care avoids unnecessary activity. Community-based solutions often have a lower environmental footprint than hospital-based care.
- Access and experience for people who experience worse maternity outcomes:
Aim: Focus resources and redesign systems to better meet the needs of groups historically underserved.
Environmental impact: Reducing inequalities improves outcomes across populations, lowering long-term demand for healthcare and associated carbon emissions.
Examples: Improving services for people in deprived communities, Black and Asian women, and young mothers and birthing people.
- Complex pregnancies:
Aim: Enhance systems of care for people with additional needs or complications.
Environmental impact: Streamlined, effective care prevents complications, avoids inefficient resource use, and reduces carbon emissions.
Examples: Improving hypertension pathways, developing new monitoring approaches, reducing unnecessary travel to appointments.
- Infant feeding:
Aim: Meet the unmet need for women who want to breastfeed but lack support.
Environmental impact: Effective feeding support reduces demand for additional appointments, interventions, and resources, lowering waste and emissions.
Examples: Better systems for infant feeding support, including peer networks and culturally appropriate nutrition support.
- Pelvic health and continence:
Aim: Address the long-term effects of poor continence following childbirth.
Environmental impact: Preventing chronic continence problems reduces lifelong reliance on continence products and care, significantly cutting waste and carbon impact.
Examples: Antenatal pelvic health guidance, improved perineal tear care, better access to specialist services.
Green Maternity Challenge 2024
As part of this larger maternity project, the Green Maternity Challenge was delivered by CSH in partnership with the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM) and the Sustainable Healthcare Coalition (SHC).
In the Green Maternity Challenge, six clinical teams from across 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. These projects focused on key target areas for reducing environmental harm and tackling health inequalities.
To read more about the Challenge and its impact, please visit our dedicated project page below.
Green Maternity Conference
“The Green Maternity Conference: Taking collective action to deliver low carbon, equitable maternity care” took place on Wednesday 19 March 2025. This in-person, collaborative event was jointly hosted by The Royal College of Obstetricians and Gynaecologists (RCOG), The Royal College of Midwives (RCM), The Sustainable Healthcare Coalition (SHC) and the Centre for Sustainable Healthcare (CSH). It offered a valuable opportunity to unite efforts in addressing the climate crisis and its impact on women’s health, while helping to shape the future of sustainability in obstetrics and gynaecology.
Attendees heard from RCOG President Ranee Thakar and other inspiring speakers, including Rachel McLean, SusQI Programme lead, who shared their collective vision for sustainable maternity care. Delegates also gained insight from multidisciplinary teams across the UK, who presented the successes and challenges of carbon-reduction initiatives delivered through the Green Maternity Challenge.
Participants left the conference with renewed energy, equipped to strengthen their own practice and inspire positive change across women’s health services.
The Green Maternity Report
The Green Maternity Report 2025 has been published, setting out eight initial priorities and a series of evidence-based recommendations for creating a more sustainable and equitable future for maternity care.
Drawing on case studies from the Green Maternity Challenge 2024, lived experience insights, and carbon modelling, the report provides a unique evidence base for reducing the environmental impact of maternity services while addressing health inequalities.
Developed through a year-long SBRI project, the maternity community has worked to:
- Map care pathways to identify carbon and health inequity hotspots
- Support maternity teams to deliver Quality Improvement (QI) projects targeting these areas
- Bring together professionals to explore how findings can shape the future of maternity care
Published by the Royal College of Obstetricians and Gynaecologists (RCOG), the report highlights practical, evidence-led actions to help ensure maternity services are fit for the future — delivering high-quality care that is low carbon, equitable, and centred on patients and families.
How can you help make maternity care more sustainable?
Join our Women’s Health Sustainability Network and make your voice count. This new and growing online hub will be our primary forum for the project and members run monthly events and share up to date research and sustainability news.
Through this project, we aim to demonstrate that maternity care can be both more sustainable and more equitable. By working collaboratively, health professionals and service users can introduce changes across pregnancy, birth, and the postnatal period that reduce the carbon footprint of having a baby. In doing so, we highlight the vital importance of sustainable maternity care — improving outcomes for families while also protecting the environment.
Please contact Hazel Walsh, CSH’s Clinical Transformation Programme Manager for more information.