Moving beyond good intentions: a qualitative study exploring healthcare professionals’ perspectives on delivering equitable prenatal testing in the English NHS

BACKGROUND: Prenatal testing (prenatal screening and diagnostic testing) is a central component of prenatal care in the UK. Healthcare professionals (HCPs) play a key role in guiding parents through the testing pathway. Against a backdrop where Black and racially minoritised parents are disproportionately impacted by maternal health inequalities, little is known about how HCPs working in prenatal testing services navigate the delivery of equitable care in everyday practice. Understanding HCP perspectives is essential, especially as prenatal testing technology advances. METHODS: We conducted semi-structured interviews with 30 HCPs who deliver prenatal testing across England. Interviews explored experiences of discussing prenatal testing with parents from Black and racially minoritised backgrounds, influences on delivering equitable care, and views on service improvement. Data were analysed using codebook thematic analysis informed by Critical Race Theory to examine how structural factors shaped practice. RESULTS: HCPs valued equitable care, making deliberate efforts to support parents' varying needs. However, four interrelated themes highlighted constraints on equitable delivery: unequal starting points for parents entering testing discussions; uneven clinical confidence and knowledge of genetics across the workforce; variability in support for culturally sensitive care; and reliance on informal, individual labour to address gaps in service design. These dynamics meant that equitable care was often pursued through personal adaptation rather than consistently supported systems. CONCLUSIONS: Providing equitable care cannot rely on individual effort. System-level investment in clinical education, service design, and organisational cultures that support culturally sensitive care is needed. With the expansion of prenatal genomics, addressing these structural conditions will be essential for ensuring the benefits of prenatal testing are realised equitably.