The morning after: the beginnings of an assessment of the FP Summit

16/07/2012 Comments Off on The morning after: the beginnings of an assessment of the FP Summit

Marge Berer
Editor, Reproductive Health Matters

13 July 2012

From a communications point of view, the FP Summit was a raving success. Newspapers, TV and radio all over the world covered it. Around the globe everyone reached by the media heard how wonderful family planning is and how neglected it has been, the Lancet launched a special edition , Guttmacher and others released facts and figures showing the extent of unmet need. Across the women’s health movement the listserves, Facebook and Twitter were full of it. All in all, the day – and many of the messages it gave birth to – had enthusiastic, even missionary, overtones.

On the absolutely fabulous side, Melinda Gates’ challenge to the Pope to acknowledge that contraception is ‘not controversial’ even amongst Catholic women, is likely to rock the foundations of the Vatican’s whole policy on abstinence, condoms and contraception from the grassroots of the Catholic church up. It was God’s gift to Catholics for Choice, who will be promoting Condoms-for-Life and safer sex at the upcoming AIDS conference later this month.

Also on the plus side, there were representatives of governments and many, many others who are making progressive change happen in their countries, and who spoke out about it. These are people who can make a big difference when they get home who did support comprehensive sexual and reproductive health and rights from the podium and the floor of the meeting, and who insisted that family planning services can only be provided within that wider remit. There were people who needed to learn what it was all about, some of whom were too young to have lived the history, but who came with strong pro-choice views.

The media exposure of the value of family planning has a huge potential for good, because it will have reached people who didn’t know family planning existed or whether it’s good for them and safe, and others who have never had a chance to talk about these matters with others. It will also have put fertility control as a public good on the map around the world. And hopefully it will spur those with expertise in sexuality and reproduction to start talking about what they know, and what is and is not true amongst all the hoopla – and to assert that the power of money must not be allowed to take precedence over public health values and human rights principles, or the values of knowledge and truth.

On the oh-God-help-us-no-no-no side, though, Melinda Gates anointed herself as the new saviour of women’s and children’s health, and the press ate it up in both pictures and words. Some of the best people in the field of sexual and reproductive health, were unexpectedly uncritical, singing the praises of this wonderful opportunity. Perhaps not surprising given the historical shortfall in funding for family planning.

A golden moment, the kind that big money and a Tory government are at home in, stage-managed by a slick public relations company called McKinsey (who describe themselves as “the trusted advisor and counsellor to many of the world’s most influential businesses and institutions”). With big pharma, having abandoned contraceptives for many years, talking about the opportunity (“70% of this market is under-served”) to make a profit from family planning needs and then give some of it back to women – as a charitable gift. Patting each other on the back for being so wonderful as to finally have recognised that women have health needs they can exploit. A truly Hollywood event, except this is not entertainment. This is women’s lives.

This golden moment, which had to happen mainly because so many governments have failed to take responsibility for the public health needs of their citizens, for maternal health, family planning, abortion, sexual health, in the only equitable manner that works – by providing publicly funded, well-resourced services.

It was a day that showed the world it was possible for one very well-meaning woman, backed by the power and money of her husband, to direct global policy and claim ownership of the provision of family planning to 120 million women and at the same time, to disparage and stigmatise women’s need for abortion to the entire world – and get away with it without being challenged. She had the courage to challenge the Pope. It is a shame that a summit attended by many of the world’s experts on these subjects could not emulate her bravery and challenge her in return.

She was not the only one who got away with it. The Summit also gave the podium to and applauded politicians from countries where millions of women have the very unmet need for contraception in whose name this Summit was called: women who are still dying from unsafe abortions because their governments are too cowardly to make abortion legal and safe; and women who are dying from complications of pregnancies because they have no access to life-saving maternity care. Countries that since the 1960s have received hundreds of millions if not billions of US dollars for family planning, which have as good as disappeared, or been squandered and misspent.

It included representatives of the very same private sectors whose services and prices for contraceptive methods and safe abortions remain inaccessible to and unaffordable for many in the world’s population who need them, especially young women and men. And not only in low- and middle-income countries, but also in the United States, a country whose health industry has made life hell for Barack Obama for trying to make health care even a little bit more affordable, excluding abortion of course, for millions of disenfranchised people. The United States – a country that has the biggest and most violent and aggressive anti-abortion movement on earth, second only to the Vatican, and some of the highest unintended pregnancy rates in the developed world, especially among poor women.

It was addressed by the Prime Minister of the UK, the Right Honourable David Cameron, who got a standing ovation for a speech about the importance of empowering women, a speech that stank of hypocrisy. A Prime Minister who is responsible for indefensible, swingeing spending cuts that are adversely affecting women, young people and children above all, including cuts in family planning, sexual health services and welfare, at a time when it has never before cost so much to raise a family. Whose Secretary of State for Health is selling off our National Health Service piece by piece, who has wasted public time and at least £1 million in public money harassing some of the real heroes of women’s rights, that is, abortion service providers, for no credible reason. Whose Minister for Public Health put an anti-abortion group on the government’s sexual health advisory group “for the sake of balance” and to propitiate anti-abortion fanatics in Parliament – a Minister who described abortion as a “sensitive” issue, after 45 years of safe, legal abortions (except for women in Northern Ireland, of course).

And now it’s the morning after. How to go on from here and engage in what will happen? It’s a pity about Melinda Gates’ prejudices against abortion. I hope she will reconsider them because it would make her a far more credible ambassador for this cause which, after all, does not belong to her.

Does midwifery have to be privatised to provide continuity of care for women?

30/03/2012 Comments Off on Does midwifery have to be privatised to provide continuity of care for women?

Published on the British Medical Journal Guest Blog, 29 March 2012

Earlier this year we received news of a social enterprise, Neighbourhood Midwives, providing midwifery services in the community in London, and a private company providing midwifery services for NHS Wirral Primary Care Trust. One to One, in the Wirral, promotes itself as offering the kind of continuity of care in pregnancy and maternity that midwives have wanted to provide but have often been unable to, for decades. It heralds its high rates of home births—part of which it, bizarrely, appears to attribute to the launch of the BBC drama Call the Midwife set in the East End of London in the 1950s. Of course women would prefer a single familiar and friendly midwife to see them through pregnancy and labour, instead of a roll call of harassed and overworked ones who they may only meet once, or one who barks commands as she flits between different women on the labour ward (a la real life in One Born Every Minute, Channel Four). Of course what women most want is a safe delivery and a healthy baby.

It is hardly necessary to revisit all the ways in which midwifery is failing women and midwives are being failed in turn by the health system. The Royal College of Midwives has long been calling for the urgent recruitment of 5,000 more midwives to deal with a spiralling birth rate amid great uncertainty about future resourcing in the wake of cuts and NHS reforms. In this context it is certainly worth considering the opportunities and pitfalls presented by independent organisations of midwives providing services to exploit the new liberalised health commissioning environment.

Different questions arise:

Will midwives be attracted to leave the NHS and join groups of independent providers? Which ones? Will they be those who are highly motivated to provide a good quality of service for women, continuity of care, and women-centred midwifery; or those who are unhappy or ill equipped for providing the spectrum of care women need including support through complex or high risk pregnancies and obstetric emergencies (which happen in some 15% of all pregnancies); or those who seek better or easier working conditions. This is strongly related to the question about why there is such a shortfall of midwives in the NHS, where independent organisations will find the midwives to staff their services, and—if they can find them—why the NHS can’t recruit and retain them instead?

How will these services be linked in, and relate to, services in NHS settings? It is clear that such services will be set up to support women only through low-risk pregnancies, but inevitably a proportion of those women will end up in NHS maternity units through choice or necessity. What will the impact be on NHS service planning for emergency and unplanned admissions from independent providers?

How will the comparative effectiveness and efficiency of these services be assessed when they, by their nature, will cream off the low-risk cases and have greater capacity to provide home-births which are less costly? It is not hard to see how attractive this kind of low-risk provision might be to the private sector and how essential it would be for them to return women back to the NHS as soon as it might cost them a penny more than expected.

Will the NHS—as in so many areas of care—be expected to treat only the complex and expensive cases, or handle the mistakes of the private sector? If so, what are the implications for NHS midwives who also need to look after low risk cases as part of the spectrum of care they offer, and enjoy doing so? If private provision leads to even more medicalisation of NHS services could it result in a further haemorrhaging of good midwives from the NHS?

If NHS maternity services are at risk of becoming a dumping ground for complex cases and obstetric emergency, how will this impact on options for those women who may want a more low-intervention approach, but with the safety net of doing so in a hospital setting?

Will the independent, community-based service be open to and promoted to all women, or will we end up with two tiers of provision? Will women who are well-versed in what they want get shiny new community services, while everyone else—including teenagers, those with language or learning difficulties, the poor, and those simply lacking in knowledge and confidence—is expected to “like it or lump it” in the local hospital?

How have these new groups managed to organise NHS support to arrange professional insurance when this is something independent midwives have often struggled or failed to do?

Finally, the question we are asking about all NHS services: is it just a matter of time before we are expected to pay fees for some services, and could privately provided midwifery be one of these?

We would all like to see services providing continuity of care for pregnant women in the community. If this is to be provided by independent organisations it must be freely available, and must not be provided at the expense of good quality, comprehensive NHS maternity provision by midwife-led units, whether within or attached to NHS hospitals.

A guest blog by Lisa Hallgarten: social media manager at Reproductive Health Matters; sexual health trainer, educator, and blogger at Education For Choice; and advocate for better sex education for all young people.

An open letter to Shirley Williams

17/02/2012 Comments Off on An open letter to Shirley Williams

Dear Baroness Williams,

I have greatly appreciated your continuing efforts during the debate on the NHS Bill in the House of Lords until recently and that you took the time to send out the group emails that have kept those of us on the outside informed.

I am writing now, however, to say how disheartened I was to learn earlier this week that you have called for the Bill to be amended and passed, as if the entire Bill were not about competition, intended to open the door wide to privatisation and atomisation of the NHS, which is the Government’s strategy not only with the Health Service but with home and social care, with education and indeed almost everything else.

Your Party, as part of the Coalition, is certainly in an untenable position, as you are the ones who will make the passage of the Bill possible. I would not want to be in your shoes with the public when the true nature of the betrayal of the Health Service emerges if the Bill goes forward. Simon Hughes misguidedly believes that removing Andrew Lansley after you pass the Bill will save the situation, but it will not, though indeed Andrew Lansley should go precisely because he tried to sign away responsibility for his own position. But he must go along with the Bill, not after it or instead of it.

No one, from David Cameron on down, can ignore the increasingly articulated views of most health professionals as well as the public, which have grown in strength over the past few months as more and more people come to understand what is at stake. If democracy still means anything, then both Houses of Parliament must bow to the strength of public opinion and withdraw this Bill before it can do any further damage.

If all the Conservatives could find to say in defence of the Bill, e.g. on Question Time, is that the BMA didn’t support the NHS in 1948 either (a misreading of history), and that because it is already being implemented it is too late to turn back, then they (and you) have well and truly lost the argument.

Indeed, I would ask you whether the extent of implementation of the Bill – even before it has been debated fully, let alone voted upon – is unconstitutional. If it isn’t, then it should be.

I urge you from your position of leadership to convince both parties in the Coalition that this Bill is unsalvageable and should be withdrawn – as the only honourable thing left to do.

 

With kind regards,

Marge Berer

Editor, Reproductive Health Matters

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