1. Introduction
1. 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 childhood, and on the woman's health and
experience of motherhood. Yet some of the most disadvantaged and
vulnerable women, who have the greatest need of care and support
throughout pregnancy and the early stages of motherhood, are less
likely to receive the same quality of care as other women. In
some cases, they do not gain access to services at all. We are
concerned that inequalities in access to appropriate services
may contribute to the maternal death rate amongst unemployed families,
which was found to be 20 times higher than that for women in the
highest two social classes.[1]
2. On 12 December 2002 we appointed a Maternity Services
Sub-committee to undertake a series of short inquiries. In our
first inquiry we set out to establish a picture of maternity services
as they are provided across the country. In this inquiry we focus
on the inequities and inequalities which might prevent access
to appropriate services. Our third and final inquiry will examine
the role of choice in a woman's experience of maternity services.
3. We were assisted by the four specialist advisers
who helped us during our inquiry into provision of maternity services:
Dr Susan Bewley from Guy's and St Thomas' Hospital, Professor
Lesley Page from the Royal Free Hospital, Professor Alison Macfarlane
from City University and Professor Martin Whittle from the University
of Birmingham. Once again we wish to express our gratitude to
them for their assistance.
4. In formulating our terms of reference we were
all too aware that there were many more groups of disadvantaged
women than we would be able to list, and that some women experienced
multiple disadvantages which affected their access to care. We
chose a range of disadvantaged groups in order to explore a number
of access problems and solutions, and if possible, to draw together
common factors which might contribute to full access to appropriate
care and advocacy services. We recognise that there are also specific
issues to be addressed in the provision of appropriate services
for other groups, such as very young mothers, women with HIV/AIDS
and women with drug addictions.
5. On 28 March 2003 we announced the following terms
of reference:
6. In addition to the memoranda submitted for our
first inquiry, we received 13 which focused exclusively on inequalities
in access to maternity services and contributors included individual
maternity care teams as well as professional bodies and charitable
organisations.
7. We set out to explore a range of perspectives
in our programme of oral evidence and we sought views from researchers
in the field, organisations campaigning to improve access and
services, national organisations for specific groups, community
organisations serving a local population, and maternity care staff
working to develop and provide specialised services. We heard
from nine witnesses over two evidence sessions, held on 13 and
20 May 2003. We took evidence from witnesses representing the
Maternity Alliance, the National Perinatal Epidemiology Unit (NPEU),
the Disabled Parents Network (DPN), Women's Health and Family
Services (a community health advocacy organisation based in Tower
Hamlets, London), Queen Charlotte's and Chelsea Hospital, London,
and Newham Healthcare NHS Trust. We are extremely grateful to
all those who submitted written and oral evidence.
1 Why Mothers Die 1997-1999:
The Confidential Enquiries into Maternal Deaths in the United
Kingdom, RCOG Press, 2001 Back
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