| Care for mother and baby throughout pregnancy and the early postnatal period can have a marked effect on the child's healthy development, on resilience to health problems encountered later in life, and on the woman's health and experience of motherhood. Disadvantaged women are more likely to die in childbirth, or shortly afterwards, and their babies are more likely to be born with low birth weights. Disadvantaged women are also less likely to initiate and sustain breast feeding, which helps to perpetuate health inequalities.
Addressing these inequalities involves the development of appropriate services for different groups of people. We learned about some examples of excellent practice in meeting the needs of minority ethnic groups, asylum seekers, homeless people, those who live in poverty, those from the travelling community and those who are affected by domestic violence—some of which were directly attributable to Government initiatives such as Sure Start.
Across all of these areas it was clear to us that the development and implementation of good practice was generally achieved by particular individuals or teams who acted on their own initiative in response to need in their local areas. It was also clear to us that this good practice was rarely taken up in other areas, or indeed shared across the health service. This is deeply disappointing because it means that families across the country are not getting access to the services that they need, and that instigating good practice in different areas involves wasteful duplication of effort by the NHS.
In particular, we were shocked to hear that in many parts of the country there were insufficient numbers of specialist Mother and Baby Units for women suffering from severe mental health problems after the birth of their babies. We were also frustrated that after the recommendations of our predecessor Committee, and of Changing Childbirth, so little progress had been made towards fulfilling the needs of women and families affected by disabilities.
During our inquiry we identified some basic communication problems which prevented some women from gaining access to appropriate care throughout pregnancy and the postnatal period. We heard that when homeless people were moved from one area to another or when asylum seekers were dispersed, information on maternity care —including test results — was often lost, along with any sense of continuity of care. Our report recommends action by the Government to ensure that there is a proper flow of information between maternity services in different areas. We also recommend that the Government's policy on dispersal of asylum seekers should take into account the needs of pregnant women and new mothers, and that the development of one-to-one or continuity of carer schemes should be a particular priority for maternity services which care for women and families from disadvantaged groups.
We identified problems with access to interpreting services, for people who do not have English as a first language, and for those who are deaf. We recommend that steps should be taken to provide qualified interpreters, including British Sign Language interpreters. We are concerned that too many maternity services depend on relatives to interpret, which may be appropriate in some circumstances but not in others. For women who suffer as a result of domestic violence, relying on partners to interpret can conceal the problem, and may ultimately be extremely dangerous.
Throughout our inquiry we heard that a particular experience of maternity services varied a great deal according to the attitude of individual members of maternity care staff. Prejudice in relation to class, race, or disability profoundly affected a woman's experience of pregnancy, birth and motherhood. Staff who care for families at such an important and sensitive time must have access to specialised training and support in these issues. We also recommend that trusts consider recruiting healthcare assistants from different cultures and communities and training them to provide advocacy support as a further means of addressing the needs of particular communities. We recognise that the voluntary sector has a valuable role to play in tackling inequalities and is often better able than the health service to represent the needs and interests of particular groups. We recommend that the health service should ensure that this sector is properly supported.
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