Health care disparities persist as an important public health problem in the United States, and clear inequities exist between racial/ethnic, socioeconomic and geographic groups. There is a disproportionate rate of maternal mortality for Black, Indigenous and other people of color, and for children living in low income and rural communities, there is an increased likelihood that they will suffer from preventable illness and have limited access to essential preventive healthcare services. The disparities are not caused by biology, but are directly associated with larger structural challenges faced by the health care system, including lack of health care providers, broken systems of health care delivery, and systemic racism and poverty. This narrative review highlights evidence from peer-reviewed studies and applied research in five areas: socioeconomic and structural determinants of health inequities, insurance coverage and Medicaid policy interventions, community-based care approaches including doula programs and community health worker initiatives, telehealth and workforce development strategies, and behavioral and psychosocial factors that influence health outcomes. In each of these themes, the evidence suggests a similar conclusion: none of the interventions will be enough to completely close these entrenched inequities. A coordinated, multi-level approach that enhances access to health care, and tackles the social and structural factors that drive inequalities, is required for meaningful progress. The results provide an impetus to create a more comprehensive approach to maternal and child health policy that integrates clinical service provision, community support and structural reform. Creating a more equitable state of maternal and child health will take a long time, continued investments, long-term political will and health care systems that are purposefully designed to meet the needs and experiences of historically marginalized communities.