A brand new chapter to this Edition of the Course Manual. Ethnicity and social background adversely affect maternal and perinatal outcomes. This chapter focuses primarily on the inequalities experienced by those of black, Asian and mixed ethnicity as well as those experiencing social deprivation. We explore the impacts of inequity and inequality, as well as strategic action and central support for local improvement. Key learning points: There is an immediate need to act and address inequalities and inequity within maternity services. Non-white ethnicity and social deprivation adversely affect maternal and perinatal outcomes. It is important for individuals and wider society, that women are healthy, educated, and feel safe in their environment. Equality and equity are not the same, both need to be provided for fair and inclusive maternity care. Unacceptable differences in perinatal mortality related to levels of deprivation and ethnicity have increased. Microaggressions and stereotypical assumptions are examples of inequalities that have been reported to contribute to substandard care for women. Research inequalities, and staff representation associated with non-white ethnicity and deprivation, impact clinical care. There are national recommendations to increase research in this area, provide education for staff and women, as well as a call for action to ensure that the quality of maternity care is improved for all.