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INDEPENDENT STUDY CLAIMS
SCOTLAND’S MATERNITY SERVICES NEGLECTS VULNERABLE WOMEN
A new independent report criticises maternity services in Scotland, claiming they are failing to meet the needs of some of the country’s most vulnerable women.

The year-long study, undertaken by the Scottish Women’s Convention (SWC) which was set up with funding from the Scottish Executive to help advise policy makers, examined the provision of antenatal and maternity care in Scotland. It focused on women living in poverty, women with social problems such as drink and drug addiction and women living in rural areas.

The aim of the report is to draw together the findings and knowledge of disparate studies, groups and organisations throughout Scotland to present a comprehensive package of recommendations to be channelled into the government consultation process.

SWC’s Women and Health – Maternity Service Provision Policy Group key findings concerning social or economic deprivation include:

• Poverty and social problems have a huge impact on how and whether women access maternity services. Often contact with such women is provided when there is an emergency, rather than through planned antenatal and postnatal care.

• There is considerable inequality in the provision of care, particularly between the most and least affluent and the gap is widening.

• Babies born in the most deprived areas have lower birth-weights than those born in less deprived areas and rates of premature or maternal deaths are significantly higher.

• There is a lack of understanding about the barriers that prevent women from accessing maternity services. Traditional maternity services, such as those with ‘booking in’ appointments are too inflexible to cater for women with drug or drink addictions. They are less likely to keep such appointments, putting their babies’ lives and their own lives at risk. Maternal deaths are twenty times more likely for such women. Ethnic minority women are twice as likely to die during pregnancy or immediately after the birth of their child as white women.

It was also found that increasing centralisation of services and the consequent downgrading of consultant-led units to midwife-led units means that more women are travelling significant distances to have their baby, particularly first-time mothers and those expecting high-risk births. The policy group claims that this leads to greater risk of maternal and foetal health, the likelihood of increasing numbers of elective caesareans and knock-on effects both socially and economically on communities. There is also increased risk as a result of bad weather, poor roads and heavy traffic and longer term consequences in the form of a higher risk of postnatal depression in women whose family members are unable or cannot afford to travel long distances to be with the woman and baby.

It is the first time government has been offered a multi-agency picture of maternity services in Scotland and the barriers faced by many women. The SWC consulted extensively with other organisations such as the Women’s Reproductive Health Service, Greater Easterhouse Women’s Aid, the North Action Group (which campaigns for the provision of a comprehensive maternity unit in Caithness and Sutherland), hospitals and patients’ representative groups.

It is now pushing for a joined up approach to ensure policies take into full account the complexities of women disadvantaged through poverty or geography. They state that the current lack of joined up services increases costs to the NHS and other agencies with women requiring long-term support from health, child protection and other social services.

The group is also recommending:

• Social and economic disadvantage should be an underpinning feature in the design and delivery of maternity services. Services should recognise the impact of substance abuse and their associated problems on the health and social outcomes of pregnancy. Likewise, they should recognise barriers faced by women from some minority ethnic groups, homeless or travelling women, women with psychiatric problems and refugees and asylum seekers;

•  Training for midwives, maternity consultants and other relevant healthcare staff should place more emphasis on issues relating to socio-economic deprivation;

•  Models of care in rural areas should take full account of the social, economic, transport and community infrastructure;

• Outreach clinics should have continued, mainstreamed funding at an appropriate level;

• Women should have an informed choice about where and how and in what circumstances they have their babies. A ‘one size fits all’ approach should not be applied;

• There should be adequate transport, e.g. air and road to ensure that women receive services promptly and accommodation of a reasonable standard should be provided for partners and close family for women who have to travel to hospital away from their home area. Travel costs should be quickly reimbursed;

• Women are represented on decision-making boards to ensure women’s voices are heard and their concerns taken into account as new services are developed;

• Successful models of joined-up approaches of working with the country’s most vulnerable women, such as the Women’s Reproductive Health Service which provides healthcare for women with social problems, should be replicated across Scotland.

Consultant obstetrician Dr Mary Hepburn, who sits on the Policy Group, said: “For women living in poverty or with disadvantage, there are huge issues. Far more of them die and far more of their babies die. There is a much higher risk of babies being born prematurely and with low birth weight. These babies grow into sick adults with less good reproductive health. So the knock on effects are felt through the generations and are a huge drain on health services, never mind the human cost to women and their families.

“At present, services are more designed for middle class women. We instead need to provide the services flexibly in ways that take account of what is going on in the lives of all women in different situations and in all parts of Scotland.”

The SWC plans to use the findings of the report to highlight key issues, to generate further debate and to raise the key themes which have emerged with the Scottish Executive and Scottish Parliament.

The SWC, established at the end of 2003, is an independent body funded by the Scottish Executive until 2006 to work across organisations focusing on women’s interests. The SWC aims to systematically take the views of women on issues to policy makers. It has formed policy groups on women and health, women and poverty, women and the criminal justice system and violence against women.

The SWC’s Women and Health Maternity Service Provision Policy Group was motivated to report on rural maternity services following concern over the increasing centralisation of maternity services, such as the threat to consultant-led maternity services in Caithness and Sutherland and the proposal to close the Queen Mother’s Maternity Hospital in Glasgow. The resulting Maternity Service Provision Policy Group agreed to extend its focus to include socio-economic maternity issues in light of recent reports which highlight inequalities in the provision of services.

In addition to consulting with agencies representing women’s interests throughout Scotland, the Women and Health Policy Group also held a workshop on International Women’s Day to ensure they were reflecting relevant issues of concern facing women in Scotland.

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