By Rosalind Bragg, Director
So often, health policy focuses exclusively on health services, ignoring the many factors which impact on women’s mental and physical health. It was a refreshing change to see the Government’s women’s health strategy consultation throwing the net more widely. As our advice services support women to resolve problems at work and benefits entitlements, it is very clear to us at Maternity Action that employment, housing and income have a direct and immediate impact on the health and wellbeing of pregnant women and new mothers. In our response to the consultation, we argued that action to address these problems should form an integral part of the new strategy.
A succession of Confidential Inquiries into Maternal Deaths has shown that socio-economic status and ethnicity are key factors associated with maternal health inequalities. Women living in deprived locations are three times more likely to die than those in the least deprived locations. Black women are more than four times more likely to die than White women. One in five of the women who died are known to social services.
In Maternity Action’s Mothers Voices research, based on interviews with 81 women from diverse ethnic background, mothers spoke about struggling on very low incomes, difficulties in obtaining benefits and the impact of poverty on health and wellbeing.
“You might want to live a healthy lifestyle, but if you don’t have the money to buy, for example, a good salad or fish or, I don’t know, salmon – it’s expensive – then you’d rather go and… I like chicken and chips because it’s like £1.99 or something, so it kind of helps if you have resources around you.”
(Focus group participant, Hackney Playbus, London)
Migrant and asylum seeking mothers, and the community workers who supported them, spoke about extreme poverty and destitution.
“…the asylum system, even if you are actually in it and receiving support, it’s a really tough system to be in, if you’re a family. It’s very difficult for women to make ends meet, to look after themselves properly, keep their mental health relatively in good shape and their physical health in good shape when they’re facing these incredible anxieties and pressures. Just the basics of having a roof over your head and being able to feed your children.”
(VCSE community worker, ASAP, London)
For women in the workplace, widespread discrimination and poor treatment is impacting on women’s health. Research by the Equality and Human Rights Commission in 2016 found disturbingly high levels of pregnancy and maternity discrimination, with one in nine women losing their jobs as a result. This research found that 41% of mothers reported a negative impact on their health as a result of their treatment at work. A worrying 10% of women reported that their employer discouraged them from attending their antenatal appointments.
The rise in insecure contracts is exacerbating the risks to pregnant workers. In our Insecure Labour research, we found that the legal protections in place for pregnant women and new mothers were often unavailable to women on zero hours, short term and other casual contracts.
Georgia requested flexible working to care for her new baby, however this was refused, forcing her to resign from her job in the advertising industry. A few weeks after she left, her employer contacted her offering her the same work on a self-employed basis. She took the contract as she had few options. She is now reluctant to take time off work when she is ill or for a holiday, as she is unsure if she will have work when she returns. Georgia has considered having another child but does not want to do that while freelancing knowing that she will not be entitled to statutory maternity pay.
A recent Kings Fund report, commissioned by NHS England and NHS Improvement, recommended that the NHS actively support the formation of health justice partnerships as part of a programme of work to tackle poverty. This report used the Maternity Action advice services as a case study. By integrating free legal advice into maternity services, women get swifter access to legal help, improving health outcomes and freeing up midwives’ time to focus on delivering healthcare.
The operation of Hostile Environment policies creates additional barriers to health for migrant and asylum seeking women. In our submission, we also flagged the harsh impact of charging destitute migrant women for their NHS maternity care. Maternity Action’s What Price Safe Motherhood? research documented the deterrent effect of imposing charges of £7,000 or more on women who are in no position to pay for their care. Our research with midwives, confirmed these findings, emphasising the vulnerability of the women affected.
“They haven’t got a lot of money for food, they’re having to resort to food banks. They can’t afford the vitamins. There’s domestic abuse sometimes and they’re dependent on this spouse for money, when they haven’t got any access to anything themselves. So they’re vulnerable women. These are the issues, really.” (Community midwife)
Read our full submission to the Women’s Health Strategy consultation.
We’re grateful for all donations to support our ongoing work. If you would like to donate, please click here.