Table 4 Main quotes from the individual interviews– Categories 1 to 3

Category 1

Impact of equity and anti-racist training

“It made us have a better understanding of our processes. Through the cases presented, we learn and can look at the process concerning how we interact with women assisted…We also adapted to improve this system”

Interview 3

Understanding racism helped leaders to prioritize the creation of spaces to confront racism.

“It is not seen as something real and visible, but it is present in interpersonal relationships, whether between physician and patient, nurse and technician, or technician and patient… Racism is here, so we must make people see it to fight it. This is our goal: through conversation, to fight structural racism.”

Interview 13

Internal analysis of the cultural transformation process as well as the discussion for prioritizing and translating knowledge into action

“It really made us change ourselves and each person we talk to. It was also shown the importance of passing this to someone, talking to people, and exposing all of this. So, I believe it has completely transformed us; it is a seed that was planted.”

Interview 4

Tensions arise when leaders act and prioritize anti-racism in their care settings.

“I have been prioritizing this long since I joined, but the physicians do not pay attention [to women at socioeconomic risk]. People do not pay much attention to these mothers… Sometimes they ignore them. There is a problem of not wanting to deal with the patient, which is a problem for everyone in the hospital team.”

Interview 17

Leaders and hesitation about racism being real

“We have a lot of mixed and black people here. We do not see much [Racism] here and do not witness it, at least in our environment. We have no reports of racism.”

Interview 16

Category 2

Use of data stratified by race and ethnicity for analysis

“We now stratify all indicators based on race. The team received training to approach the patient about the colour with which he/she identifies.”

Interview 11

Institutions analyzed their indicators and stratified data to understand and act on inequities in the system.

“Right now, we have tools to do that. We have tools to access data by race: anaesthesia by race, complications by race…Today we also implemented a hospital information system. We filled out a form for near-miss events. This way, we also have a tool to evaluate near-miss events according to race… We created a small space here to create several indicators and work on this issue.”

Interview 6

Dissemination of awareness and socialization of anti-racist education and socioeconomic risks within teams

“We start with monthly or weekly meetings to discuss this issue. And then, we started to address the issue in triage, at the nursing station, with the doctors.”

Interview 14

Transformation in a team that considers socioeconomic risk as part of women’s quality care at the intersection of poverty, racism, and other social health determinants

“Understanding the vulnerability of these mothers was not seen before as important. So we started to collect and look for vulnerability —the ability to begin to understand our service— and have the patience to observe how we care for patients. This way, you start to present actions and reduce this vulnerability in the service. So I think that is what has been changing.”

Interview 4

Identifying and prioritizing women at socioeconomic risk is a way to adapt the service to those needing attention.

“We identify the socioeconomic risk as soon as they arrive at the unit. In the pre-delivery period, all employees can identify whether they need more attention, as they may not have access to health services. So, they should be screened, as they may have yet to have full access to prenatal care. Internally, the team can see this as a priority, which would already be the nurse’s job.”

Interview 11

Cultural adaptations according to communities that present socioeconomic risks or risks of facing racism

“We reach many indigenous women and focus on respecting their culture. Therefore, doing our job and respecting the culture is essential to provide the best service.”

Interview 7

Category 3

Understand the importance of the process and use the data to develop a more solid analysis of what equity actions are

“In terms of the data, we were able to ask about race and ethnicity and have this indicator of maternal mortality stratified. What is missing from our action plan is what to do with this data.

Interview 16

Tension and resistance to anti-racism by leaders, specific physicians, and other frontline professionals

“When we bring the data, we feel much resistance from the medical team. When we say that mortality is higher in black women and that they die more from preventable causes, it is like they do not pay attention.”

Interview 5

Challenges including staff time and COVID-19 pandemic restrictions

“There are many comments about the lack of staff and the mental exhaustion experienced when people feel overwhelmed because when we arrive with a new proposal, even when it is important, care comes first. Whoever brings new projects or ideas for improvements is not well seen, but rather seen as the person who brought more work and problems.”

Interview 19

Emotional resources and how the equity program affected listening

“I think that showed me that listening to what people say is important. Even when you speak, everything becomes evident, and you begin to understand that person’s perspective and when he understood. So, I think feedback is essential.”

Interview 4

Challenges when providing feedback to teams who engage in racist actions towards patients or other healthcare professionals

“We did not think about that [incorporating feedback into these actions] because it is a very delicate approach. I do not even know how to do it during care… Sometimes you hear reports of racism, but there is little intervention in communicating with others about your racist action.”

Interview 13