Health Committee

No 37, Session 2002-03                           23 July 2003

Inequalities in Access to Maternity Services

Report published

Julia Drown MP, Chair of the Maternity Services Sub-committee said:

We undertook this inquiry because we knew that pregnancy outcomes for mothers and babies differed according to people's backgrounds. For example, the maternal death rate amongst unemployed families is 20 times higher than that for women in the highest two social classes and a disproportionate number of women from the travelling community die in childbirth or shortly afterwards. The babies of disadvantaged women are more likely to be born with low birth weights.

We saw some examples of excellent practice in meeting the needs of disadvantaged groups - some of which were directly attributable to Government initiatives such as Sure Start - but 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 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. We identified problems with access to interpreting services, for people who do not speak English as their first language, and for those who are deaf. 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 are subject to domestic violence, relying on partners to interpret can conceal the problem, and may ultimately be extremely dangerous.

Throughout our inquiry we heard that women's experiences of maternity care 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.

Across the NHS, maternity services for different groups can only be described as patchy. We urge the Government in our report to address the inequalities in services so that every woman, whatever her background, can be assured of high quality services.

Notes to Editors

The Health Committee will publish its Eighth and Ninth Reports of Session 2002-03 on Inequalities in Access to Maternity Services (HC 696) and Choice in Maternity Services (HC 796) on Wednesday 23 July.


Although childbirth is now safer than ever before, some women still go without the kind of advice and support that they need, throughout and after their pregnancies, to secure the best possible health outcomes for themselves and for their babies. In December 2002 the Health Committee appointed a Sub-committee to undertake a series of short inquiries in this area. In its first inquiry the Sub-committee set out to look at the services available to women in England today and at the variation in these services across the country. In conducting its second inquiry, into Inequalities in Access to Maternity Services, the Sub-committee chose a range of disadvantaged groups of women in order to explore a number of access problems and solutions, and to attempt to draw together some common factors which might contribute to full access to appropriate care and advocacy services. In its third and final inquiry, into Choice in Maternity Services, the Sub-committee examined the degree of choice and control a woman has over her maternity care.

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