Maternal and reproductive healthcare services cut to the bone

Protest against the closure of Bridgenorth Maternity Unit

Longer waits, reduced access and a lack of staff have become the norm in women’s health care as services have been eroded. There is only so long apologies and sticking plasters can cover such wounds. Each cut, closure – and occasional victory – must be used to expose and oppose the depth of the care crisis.

Maternity services in crisis

Maternity services are stretched to breaking point. Last year, NHS England gained just 67 midwives, despite a known shortage of 3,500 full-time midwives. For every 30 midwives trained, 29 leave the NHS – mostly due to retirement but increasingly due to the toxic mix of being unable to provide safe and good care, understaffing and stress. Midwives are also leaving due to worry over Brexit. Between January and March this year 33 midwives from the EU registered to work in the NHS – the same period two years ago saw 272 register. The number of midwives from the EU leaving the NHS rose from 160 to 234 in the same period this year.

The government has made much of its additional 3,000 training places as a promise to solve this problem. The latest figures show it is not enough to even maintain provision. In addition, the numbers applying to train have plummeted since the introduction of £9,000 a year tuition fees in 2017 – applications to nursing and midwifery courses dropped by 23% that year and in 2018 applications fell by a further 13%.

Increasingly complex care is needed for women, for example rising rates of diabetes and blood pressure problems, as seen across wider society. Midwives are spending more time trying to support women with problems made worse by other funding cuts – poor housing, for example, and domestic violence. Shortages become more unsafe and impossible. Deep existing inequalities will be exacerbated. Black women already face a 121% increased risk of stillbirth compared to white women and a 50% increased risk of neonatal death.* Whilst a radical wider change is needed to respond to such devastating figures, the crisis in maternity care can only make things worse.

Unsurprisingly, given that the services and staff are stretched to their limits, complaints against midwives by women and their families have risen faster than against any other health care professional in 2017-2018 – a rise of 11% from the previous year. The number of both medical and nursing care complaints fell from the previous year. Maternity is at the sharp end of Britain’s social crisis.

Sexual health clinic council cuts

Sexual health clinics have faced continuous funding cuts over the past five years resulting in a steady reduction in services and staff, and creeping privatisation. Last year however saw a record number of visits as well as increasingly complex issues and staff are warning of a system unable to cope. The 3,323,275 attendances in 2017 were subject to significant waiting times and rushed appointments. Clinics turned people away due to a lack of capacity. As Dr Olwen Williams, president of the British Association for Sexual Health and HIV (BASHH), explained: ‘record demand for services, dramatic increases in syphilis and gonorrhoea diagnoses, and the spread of treatment-resistant infection in recent years mean that many services are struggling to cope, despite valiant efforts from staff’. Things are set to get worse. As well as reducing this year’s public health grant to £3.21bn, down from the £3.3bn allocated last year, the government is set to remove the funding ringfence from next year, giving local authorities the power to reallocate this money. This gradual attack has seen little resistance – the care’s sensitive nature and relatively low-risk procedures make it prime for wearing down and then privatising.

Wider public health cuts exacerbate the problem, with 90% of councils cutting spending on alcohol misuse support, smoking cessation and weight management. This short-term approach will simply cost other services more, further down the line – and cost people’s health overall.

Despite education and prevention being essential to good sexual health, some of the first jobs to go were sexual health advisors. Specialist services, for example supporting sex workers and men who have sex with men, have faced a similar fate. Meanwhile, a growing interest in new technological solutions, for example online infection screening and apps designed to monitor women’s hormonal cycles, make accompanying education about complex and variable situations more necessary, not less so.

Abortion – another victory

There has been a small but important victory – in August the Minister for Health and Social Care announced that women in England will be permitted to take abortion pills at home. Abortion is still defined by criminal law and therefore permission is needed from two doctors – but rather than women being forced to take the pills in hospital and risk pain, bleeding and the possibility of the abortion happening whilst travelling, women can now manage this at home. Whilst this was rightly raised as a success by campaigners, there were many missed chances to raise the often abysmal lack of support surrounding this care because of the overstretched and underfunded services. For many women, barriers to accessing abortion, such as problems at home, a lack of childcare or support, or a difficult employer will remain barriers and received scant attention. However, with ongoing discussions about abortion access in the north of Ireland and women discussing the importance of accessing safe, legal reproductive care, it is vital services and cuts are not viewed in isolation but instead as part of a wider, deeper and more urgent crisis of care that demands a response.

Rachel Francis

Fight Racism! Fight Imperialism! 266 October/November 2018

* Perinatal Mortality Surveillance Report, Draper et al 2018.


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