Under extrusion

I have tried bed levelling, adding a skirt, ensuring flow rate on cura slicer is 100%, e-step calibration, tightened any loose screws

and my print still comes out like this, what could I do to try and fix it?

I have tried bed levelling, adding a skirt, ensuring flow rate on cura slicer is 100%, e-step calibration, tightened any loose screws

and my print still comes out like this, what could I do to try and fix it?