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Maternity Action - Prevention Consultation 2019

1. Which health and social care policies should be reviewed to improve the health of

people living in poorer communities or excluded groups?

Maternity Action welcomes the focus on the health of people living in poorer communities

and in excluded groups. As the UK’s leading charity committed to ending inequality and

improving the health and wellbeing of pregnant women, partners and young children, we

believe policies need to address both barriers to accessing health services and the broader

social determinants of health. Of particular interest are policies to address the drivers of

poverty, the impact of temporary and unsuitable housing, and the marginalisation of

migrants and asylum seekers. Our research and advice work indicates that several health and

social care policies should be reviewed to improve the health of vulnerable pregnant women

and new mothers, in particular low income and BAME mothers.

Address barriers to accessing primary care services for pregnant women and new

mothers associated with insecure housing and lack of identity documents

Address barriers to accessing welfare benefits arising from GP charges for letters,

such as letters to support applications for Sure Start Maternity Grant

Reduce poverty and disadvantage for pregnant women, new mothers and their

families by integrating legal advice on maternity rights at work and social security

entitlements into maternity services, building on social prescribing

Reduce barriers to accessing perinatal mental health services by improving the six

week postnatal check for new mothers to better assess women’s mental health as

well as the health of their babies

Improve access to over the counter medicines for women on low incomes,

recognising that even low-cost medications can be unaffordable for those on low

incomes

Suspend NHS charges for maternity care for overseas visitors, which deters women

from accessing care, increasing the risk of poor outcomes for them and their babies

Reduce the health inequalities experienced by asylum seeking women through better

coordination between health services and the Home Office, including in relation to

dispersal (relocation) of asylum-seeking women during pregnancy and new

motherhood

2. Do you have any ideas for how the NHS Health Checks programme could be improved?

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3. What ideas should the government consider to raise funds for helping people stop

smoking?

Smoking is associated with poor outcomes for mothers and babies. Smoking in pregnancy is

also a health inequality with women from the most deprived communities 12 times more

likely to smoke during pregnancy than women from more affluent areas. The NHS Long Term

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Plan commits to both an enhanced midwife model and specialist smoking cessation support

to help these women quit, alongside the introduction of a new “smoke-free pathway.” Given

the critical importance of smoking cessation to improving the health of pregnant women,

new mothers and their babies, the Government should fully fund these services from general

revenue. Increasing taxation of tobacco and related products may contribute to reduction in

smoking.

4. How can we do more to support mothers to breastfeed?

To better support mothers to breastfeed, Maternity Action calls on the Government to

strengthen legal protections for breastfeeding mothers at work, increase partnership working

between health agencies and VCSE organisations providing practical support to breastfeeding

mothers, and better resource local services providing practical support to breastfeeding

mothers.

Strengthen legal protections for breastfeeding mothers at work: At present, legal protections

for breastfeeding at work are relatively weak. Employers are legally required to provide a

space for mothers who are breastfeeding to lie down and rest if they need to (ACAS, 2014;

NHS, 2018). But health and safety law does not require employers to provide breaks to

breastfeed or express or for a private space in which to do so. Women are entitled to

request flexible working arrangements to accommodate breastfeeding, however these can

be refused by the employer. Maternity Action’s Maternity Rights Advice Line regularly hears

from women whose request for flexible arrangements to support breastfeeding have been

refused. To address this, we need a new, statutory right to breaks for breastfeeding or

expressing and for suitable facilities to support this. The Department of Business Energy and

Industrial Strategy is currently consulting on changes to parental leave which are aimed at

promoting greater take-up of leave by fathers. It is disappointing that the consultation does

not include improvements in breastfeeding protections at work, despite the increased leave

for fathers impacting on expected duration of leave taken by mothers.

Increase partnership working between health agencies and VCSE organisations providing

practical support to breastfeeding mothers: Partnership working with infant feeding groups

has the potential to make a significant contribution to improving physical and mental health

outcomes, particularly in promoting equality and reducing health inequalities. There is a need

for greater voice for new parents, both mothers who are breastfeeding and parents who use

other forms of infant feeding, and for the VCSE organisations which support them. There is

potential for co-produced solutions to the many challenges in improving rates of

breastfeeding commencement and duration. Partnership working has the potential to

significantly improve the flow of information from policy leads to VCSE organisations and

communities, and from communities and VCSE organisations back to policy leads. For

example, VCSE organisations can provide case studies of effective integrated breastfeeding

support, involving health professionals, lactation consultants, breastfeeding counsellors and

peer supporters. Investing in a forum for VCSE breastfeeding groups would support item AG4

of the BBFI index.

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Increase investment in local services providing practical support to breastfeeding mothers: In

addition to national telephone advice services, breastfeeding mothers should have access to

peer support services, specialist signposting and equal access to tongue tie services in their

local areas. VCSE organisations provide effective peer support services, however these do

require appropriate resourcing and many have experienced significant cuts in recent years.

5. How can we better support families with children aged 0 to 5 years to eat well?

Maternity Action strongly recommends cross-Government action to reduce poverty, which is

a key driver of poor nutrition for families with young children. These include:

Increasing the number of women who retain their job during pregnancy and new

motherhood by taking action to reduce the incidence of maternity discrimination

(which results in one in nine pregnant women in the workplace losing their jobs),

including better health and safety protections (currently one in 25 mother leave their

jobs because of health and safety concerns), and improving flexible working

entitlements.

Reducing poverty by improving access to social security, addressing inequalities

inherent in Universal Credit such as the two child limit, and addressing inequalities in

access to Maternity Allowance, low rates of Statutory Maternity Pay and Maternity

Allowance.

Reducing poverty amongst asylum-seeking women and destitute women reliant on

local authority support (under Section 17) by increasing rates of asylum support and

Section 17 support.

Maternity Action recommends reforms to the Healthy Start programme. The UK-wide

Healthy Start scheme provides low-income families on certain qualifying benefits with a

‘nutritional safety net’ in the form of vouchers for milk, fruit and vegetables as well as free

vitamins. But this scheme is not available to women who are excluded from the mainstream

benefits system by virtue of their migration status or to low income women in work.

However, pregnant women and mothers of young children who are in receipt of asylum

support can apply for extra payments which mirror the Healthy Start payments, although

these are paid at a slightly lower rate and do not include free vitamins.

The Healthy Start scheme was introduced in 2006. At its inception, it was spending £160

million a year. In 2015/2016, spending had fallen to less than half (£72 million) despite

increasing food poverty and no reduction in the number of births. Decreasing entitlement

due to benefit changes and lower uptake have been given as reasons for this decline.

We recommend universal access to free vitamins to all women planning a pregnancy,

pregnant women, women with a child under 12 months, and children from birth to age 5,

regardless of income or immigration status. We also recommend that the extra payments

available to pregnant women and mothers of young children who are in receipt of asylum

support mirror the Healthy Start payments.

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Maternity Action recommends increasing access to free school meals. For those children

living below the poverty line, and for whom the price of school meals is prohibitively

expensive, free school meals have been shown to improve health and help tackle health

inequalities, as well as removing the poverty trap faced by parents trying to move into

employment. Yet children in nursery are not entitled to free school meals, and nor are slightly

older children in Year 3. Children whose parents have no recourse to public funds, have no

leave to remain, or who are undocumented are not entitled to free school meals, irrespective

of income. This includes families who are in receipt of Section 17 (migrant families) support

from their local authority due to destitution. For example, the Children’s Society has reported

that all the families on Section 17 support and those waiting for a decision from the local

authority in their London Project were recorded as needing food banks in order to feed their

families.1 Furthermore, there is no provision of meals during holiday time to those children

whose families are reliant on the financial relief they bring.

In order to better support families with children aged 0 to 5 years to eat well, Maternity

Action urges the Government to: provide universal free school meals for all nursery-aged

children and extend the free school meal provision for Reception and Key Stage 1 children to

ensure universal access regardless of immigration status, including children whose parents

have no access to public funds, are undocumented and/or are in receipt of Section 17

support.

Maternity Action recommends reintroduction of the ‘Pregnancy and Birth to Five’ books to

improve information for pregnant women and new parents. These books

(https://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/Publicationsandstat

istics/Publications/PublicationsPolicyAndGuidance/DH_107303), which were given to all

pregnant women, provide health, benefits and employment rights advice. This was an

invaluable resource that reached the largest possible number of pregnant women by virtue

of being available in print (therefore posing no barrier to women without internet access or

digital skills) and in translation (overcoming language barriers for women for whom English is

a second language). These resources have recently been reintroduced for all pregnant

women in Scotland.

Maternity Action recommends reinvestment in local Sure Start centres. These centres

provide free and convenient access to dieticians and nutritionists to support mothers to eat

healthily and make healthy choices when weaning their children.

6. How else can we help people reach and stay at a healthier weight?

1 Children’s Society, Children’s Future Food Inquiry Briefing for Westminster Hall Debate Wednesday 8th May, available at: https://www.childrenssociety.org.uk/sites/default/files/childrens-food-inquiry-wh-debate-8th-may.pdf

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Maternity Action is concerned about health inequalities in relation to the weight of pregnant

women, new mothers and their children. Women from low-income backgrounds are more

likely to be obese or experience slower than average weight gain during pregnancy. Risks to

the foetus from poor nutrition include low birth weight. Women from low-income

backgrounds are more likely than men to forego meals to ensure their children can eat.

According to NatCen research for the Food Standards Agency in 2017, one in four low-

income households struggles to eat regularly or healthily because of a lack of money.

Women who took part in Maternity Action’s research with low-income BME mothers

(Mothers Voices 2018) gave practical examples of the impact of poverty on the food which

they and their families ate.

“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.”

As we noted in Question 5 above, we strongly recommends cross-Government action to

reduce poverty, which is a key driver of poor nutrition for families with young children. These

measures include support for women to remain in work during their childbearing years

(reducing maternity discrimination, improved flexible working entitlements); improved access

to social security (low rates of Statutory Maternity Pay and Maternity Allowance, inequitable

treatment of Maternity Allowance in Universal Credit, and the two-child limit); and

addressing low rates of asylum support and local authority support (Section 17).

7. Have you got examples or ideas that would help people to do more strength and

balance exercises?

Maternity Action is concerned about women experiencing debilitating muscular-skeletal

conditions in pregnancy (such as symphysis pubis dysfunction (SPD) and after birth (such as

anal sphincter and pelvic floor injuries sustained in childbirth that cause faecal or urinary

incontinence). These can be life-altering and permanent conditions. We welcome the NHS

Long Term Plan’s commitment to expanding physiotherapy services to increase women’s

pelvic strength during pregnancy and after birth. Maternity Action calls for routine antenatal

and postnatal pelvic health classes, ideally located in Sure Start children’s centres in local

communities, and postnatal referrals to special continence centres, which could further assist

in the treatment of these injuries. Since ‘prevention is better than cure,’ we also ask that

healthcare professionals provide more individually-tailored information about the risks of

different modes of delivery so that women can make informed choices about how they want

to give birth.

8. Can you give any examples of any local schemes that help people to do more strength

and balance exercises?

Low cost or free antenatal and postnatal exercise classes, such as tailored yoga and Pilates, in

Sure Start children’s centres in local communities help pregnant women and new mothers to

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do more strength and balance exercises at a time and in a location that suits them and their

childcare needs.

9. There are many factors affecting people’s mental health. How can we support the

things that are good for mental health and prevent the things that are bad for mental health, in

addition to the mental health actions in the green paper?

Perinatal mental ill-health is linked to a variety of individual, familial and social factors.

Socioeconomic deprivation has been shown to increase the risk of all mental illnesses and

perinatal mental illness (PMI) more broadly.2 Women’s chances of developing a perinatal

mental health (PMH) condition may also be increased by their being part of a socially at-risk

group. At-risk groups include South Asian and Black Caribbean populations, recent migrants,

asylum seekers, refugees and those whose immigration status is uncertain, young mothers,

LGBT mothers and parents, and mothers in Gypsy and Traveller communities.

Maternity Action believes that reducing poverty, and tackling the other causes and

socioeconomic risk factors associated with PMI would help to prevent perinatal mental ill-

health. As noted in Q5 above, we recommend cross-Government action to reduce poverty,

including measures to support women to remain in work during their childbearing years

(reducing maternity discrimination, improved flexible working entitlements); improved access

to social security (low rates of Statutory Maternity Pay and Maternity Allowance, inequitable

treatment of Maternity Allowance in Universal Credit, and the two-child limit); and

addressing low rates of asylum support and local authority support (Section 17).

Further, we believe that eliminating the barriers to accessing timely and effective treatment

affecting mothers and parents in at-risk groups would help those already suffering from PMI

to regain good mental health.

Maternity Action’s recent research into PMI identified a number of ways in which

commissioners and service providers can work with Voluntary, Community and Social

Enterprise (VCSE) organisations to improve the PMH of vulnerable pregnant women and new

mothers:

• Develop an understanding of, seek input from, and explore strategies to support local

VCSE organisations working with women in at-risk, seldom heard groups

• Fund VCSE organisations to deliver peer support, health advocacy, advice, and crèche

and transport services, as well as to co-produce information about PMH conditions

and services

• Work with VCSEs to co-produce PMH training to increase awareness of the symptoms

of PMI, and treatment pathways

2 Ban, L. et al., Impact of socioeconomic deprivation on maternal perinatal mental illnesses presenting to UK general practice, British Journal of General Practice, 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459774/

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• Ensure that place-based approaches accommodate the needs of women who move

between places, including Gypsy and Traveller women, and dispersed asylum seekers

• Improve local commissioning by more actively involving VCSEs at all stages of the Joint

Strategic Needs Assessment (JSNA) process, disaggregating data by ethnic and

equalities groups, recognising the resource implications for VCSEs of collating

information for JSNAs, facilitating assets-based commissioning, and using a variety of

approaches to procurement to include smaller VCSEs

10. Have you got examples or ideas about using technology to prevent mental ill-health,

and promote good mental health and wellbeing?

Maternity Action’s research on perinatal mental health shows that anonymous, moderated

online forums can provide a valued space for women to access information and support.

Maternity apps can raise awareness about the signs and symptoms of perinatal mental illness

and signpost to local services.

However, many vulnerable women struggle to access digital health services, including those

who cannot access physical devices and/or have language, literacy or learning difficulties, or

physical disabilities. Technology is only part of the solution for some people. Technology

cannot, and must not, replace face-to-face, individualised and specialist treatment with

skilled healthcare professionals. Those developing technology in this area need to factor in

the needs of those who cannot access physical devices and/or have language, literacy or

learning difficulties, or physical disabilities, to ensure that digital developments are inclusive.

11. We recognise that sleep deprivation (not getting enough sleep) is bad for your health in

several ways. What would help people get 7 to 9 hours of sleep a night?

Sleep deprivation is common for new mothers, but some socioeconomic factors and policies

can exacerbate some women’s lack of sleep during this critical time. Women on low incomes

may have to return to work owing to financial pressures or because they fear losing their

jobs. This points to the importance of increasing access to social security, including increasing

rates of Statutory Maternity Pay and Maternity Allowance. There is a need for stronger rights

to flexible working to enable mothers to transition back to work rather than return

immediately to full time work. Overcrowding in poor accommodation is a factor which also

mitigates against getting sufficient sleep for mothers. As set out in Question 15 below, the

Government should recognise the detrimental physical and mental impact of temporary,

unsuitable and overcrowded housing on pregnant women and new mothers, and commit to

ensuring that all pregnant women and new mothers are housed in suitable accommodation

that does not leave them geographically or socially isolated. Providing practical, evidence-

based information about infant feeding options and how to manage feeding arrangements to

maximise sleep could also help women to mitigate the effects of sleep deprivation during this

period.

12. Have you got examples or ideas for services or advice that could be delivered by

community pharmacies to promote health?

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13. What should the role of water companies be in water fluoridation schemes?

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14. What would you like to see included in a call for evidence on musculoskeletal (MSK)

health?

Maternity Action is concerned about women experiencing debilitating muscular-skeletal

(MSK) conditions in pregnancy, such as symphysis pubis dysfunction (SPD), and after birth,

such as anal sphincter and pelvic floor injuries sustained in childbirth that can cause faecal

and/or urinary incontinence. These can be life-altering and permanent conditions.

In a call for evidence, we would like to see research on the relative effectiveness of various

treatment options for these conditions. Comparing the effectiveness of physiotherapy and

surgery in repairing pelvic floor and sphincter injuries and in increasing women’s pelvic

strength would be helpful. We would also like to see research on the MSK outcomes of

different modes of delivery to better inform women about the risks of interventions, like

forceps and ventouse/vacuum extraction, during vaginal birth, and to enable them to make

informed choices about how they want to give birth.

15. What could the government do to help people live more healthily: in homes and

neighbourhoods, when going somewhere, in workplaces, in communities?

Improving the health of pregnant women and new mothers at work: Equality and Human

Rights Commission research (2016) found that 54,000 new mothers lose their jobs each year

as a result of pregnancy discrimination, which is one in nine pregnant women and new

mothers in the labour market. The research also highlighted poor health and safety practices,

with one in 25 women leaving their job because of unsafe working conditions. Approximately

half of all women reported problems with health and safety, pointing to the likelihood that

women were working in conditions which posed a risk to health. The research further found

that 40% of women reported that experiences at work had impacted on their health.

The Government could improve pregnant women’s and new mothers’ health by taking robust

action to end pregnancy discrimination and improve enforcement of existing employment

rights and Health and Safety regulations. Maternity Action urges the Government to

introduce new legislation prohibiting employers from making women redundant in

pregnancy or on maternity leave except in exceptional circumstances. There should be

increased funding for enforcement agencies responsible for enforcing the rights of pregnant

workers. In particular, the EHRC and HSE need to be better resourced and better equipped to

enforce the rights of pregnant women in the workplace.

There are particular problems with health and safety guidance affecting pregnant women

and new mothers. HSE guidance currently erroneously states that employers do not need to

carry out individual risk assessments for women once they disclose that they are pregnant. A

2018 Court of Justice of the European Union ruling (Ramos v Servicio Galego de Saude) ruled

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that a general risk assessment of a worker’s role (which is what the HSE advises is required by

employers in the UK) does not meet the requirement to carry out a risk assessment under

the directive to improve the health and safety at work of pregnant and breastfeeding

workers. The Government must ensure that Health and Safety regulations and the advice

given by the HSE is correct and genuinely safeguards pregnant and breastfeeding women.

The Government should also introduce a statutory right to breastfeeding breaks at work to

allow women who wish to breastfeed to continue to do so once they return to work.

Improving the health of pregnant women, new mothers and their families in the home: The

Government should recognise the detrimental physical and mental impact of temporary,

unsuitable and overcrowded housing on pregnant women and new mothers, and commit to

ensuring that all pregnant women and new mothers are housed in suitable accommodation

that does not leave them geographically or socially isolated.

Maternity Action’s research with low income, BME mothers (Mothers Voices 2018) found

widespread problems of overcrowding, poor quality housing and difficulties in finding

accommodation suitable for families. Comments from women included:

“It’s so expensive and for a family with kids, well it’s difficult to rent an apartment for

just your family. We end up having to share a flat and there’s just one room for an

entire family. So that’s not good for your health because you can’t relax, because you

have to keep an eye on your children to make sure that they don’t go in another room

or make too much noise or because there might be people who you don’t know

coming and going. So that’s as bad for the children as it is for the adults…”

“There are lots of mice in London. There’s always some, in every house. And it’s really

hard to get them to sort those problems out for you. My husband puts out traps… but

we can’t use any poison with the kids around. And it’s pretty disgusting because they

run over everything.”

“I am downstairs, underground. My room is really damp. Rubbish always on top of the

window, which makes it dark. I can’t open it, because there’s something on top. There

is a smell too. Under my wardrobe there are snails coming. The day before yesterday

my baby was not breathing very well, I just called the ambulance and the lady who

saw my baby said there is nothing at the moment for treatment but if you still stay in

this place it will be bad for the baby. The air is not good for him.”

As noted in Question 5 above, we recommend cross-Government action to reduce poverty,

including measures to support women to remain in work during their childbearing years

(reducing maternity discrimination, improved flexible working entitlements); improved access

to social security (low rates of Statutory Maternity Pay and Maternity Allowance, inequitable

treatment of Maternity Allowance in Universal Credit, and the two-child limit); and

addressing low rates of asylum support and local authority support (Section 17).

Improving the health of pregnant women and new mothers in the neighbourhood: Sure Start

Centres provide a community hub for pregnant women and new parents, offering services

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including childcare, nutrition advice, breastfeeding support, advice services, counselling,

employment advice and VAWG services. Research by Action for Children found that usage of

Sure Start Centres by children had dropped by 20% between 2014 and 2018. Worryingly, the

greatest drop in usage was in deprived areas. At least 500 centres have closed since 2010,

with research by The Sutton Trust suggesting that the figure could be as high as 1,000

centres. There is an urgent need for reinvestment in Sure Start Centres to improve early

years provision.

The Government should do more to tackle air pollution. The documented harms from air

pollution (which includes vehicle exhaust and industrial emissions) include smaller head size

and lower birth weight in full-term babies, as well as causing developmental problems in

children, including wheezing and coughing in childhood. It is evident that the deprived lower

half of the population has twice the health risk than less deprived groups in relation to harms

from air pollution, so this is a clear health inequality. Public Health England has been

conducting a review of the effectiveness of interventions designed to improve outdoor air

quality as part of their work to support the Clean Air Strategy. We ask the Government to

swiftly implement and scale-up the interventions which are found to be effective.

16. What is your priority for making England the best country in the world to grow old in,

alongside the work of PHE and national partner organisations?

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17. What government policies (outside of health and social care) do you think have the

biggest impact on people’s mental and physical health? Please describe a top 3.

As the UK’s leading charity committed to ending inequality and improving the health and

wellbeing of pregnant women, partners and young children, Maternity Action believes

policies that drive poverty, deter women from accessing maternity care, and cut pregnant

women off from their care and communities have the biggest impact on their physical and

mental health. These include the following three policies:

1) Reinvest in social security and public services: Cuts in public spending and welfare

reform have exacerbated inequality and have pushed many families into poverty.

Welfare reforms have led to longer waits for social security payments, caps on

payments for women with more than two children, and women who are on Maternity

Allowance being entitled to less Universal Credit than women on Statutory Maternity

Pay and missing out on Sure Start Maternity Grants. Some 500 Sure Start services

which provide vital services to pregnant women and new mothers, including exercise

classes, counselling, baby weighing services, and nutrition advice, have closed in the

past decade due to local authority funding cuts. Cuts to the public sector have had a

negative impact on women’s access to secure and flexible employment. Maternity

Action believes that increased spending on social security, public services, and social

infrastructure (such as supply side childcare investment) would have a positive impact

on the physical and mental health of pregnant women and new mothers.

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2) Suspend NHS charges for maternity care for overseas visitors who are living in the UK:

Some types of migration status in the UK are also associated with NHS maternity care

charges, which research has shown to be a barrier to accessing maternity care in a

population which has disproportionately high levels of poor mental and physical

health. Maternity Action’s research (What Price Safe Motherhood? 2018) has shown

that women who are chargeable and women who fear that they may be chargeable

are deterred from attending maternity care. The research also found high levels of

anxiety and stress amongst women affected by charging, impacting on women’s

mental health. Maternity Action research with NHS midwives (Duty of Care, 2019)

found concerns among midwives about vulnerable women commencing antenatal

care late as a result of fears about charging. It also found midwives were concerned

about the impact of charging on the relationship of trust which midwives seek to

establish with women, and which is of particular importance for vulnerable women at

risk of poor health outcomes. Maternity Action is calling for maternity charging to be

suspended pending a thorough investigation into the impacts of charging.

3) End dispersal (relocation) of pregnant women and new mothers in the asylum system:

The Home Office practice of dispersing (relocating) asylum-seeking women during

pregnancy and new motherhood poses risks to the health of women at high risk of

poor health outcomes. Maternity Action research (When Maternity Doesn’t Matter,

2016) found that women were often relocated multiple times during their pregnancy

or in early motherhood. Dispersal impacts on women’s mental health as it removes

them from existing support networks, including children’s fathers and birth partners.

Dispersal disrupts continuity of care, which is particularly important for this high-risk

group of women. Dispersal severs existing supportive relationships with local VCSEs or

a trusted midwife – factors that can also have wider positive impacts in terms of

emotional wellbeing. One VCSE, Bethel Doula in Birmingham, told us about building

relationships with pregnant women experiencing multiple needs, including poverty

and mental health problems, only for the support to suddenly stop when women are

dispersed. The Home Office policy on dispersal during pregnancy has not been

incorporated into the asylum support contracts, so implementation is extremely poor.

We call on the Government to end the policy of dispersing pregnant women and new

mothers who are asylum seekers.

18. How can we make better use of existing assets – across both the public and private

sectors – to promote the prevention agenda?

There is scope for improved partnership working by statutory agencies and the Voluntary,

Community and Social Enterprise, or VCSE, sector. Maternity Action’s research into effective

VCSE-led strategies overcoming barriers to accessing perinatal mental health services

confronting seldom heard groups (forthcoming) has identified a number of ways in which

commissioners and service providers can work with VCSE organisations to improve the health

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of vulnerable pregnant women and new mothers. VCSEs are in a unique position to support

pregnant women and new mothers due to their extensive networks within communities and

first-hand knowledge of local needs. VCSEs also have the freedom to innovate. They can

provide support that is complimentary to that in more specialised services, and in some cases

may feel more approachable or accessible for many women in at-risk groups, providing an

opportunity for them to access the full range of help on offer.

With this in mind, we believe the Government would make better use of existing assets

across the public and private sector by doing the following:

• Develop an understanding of, seek input from, and explore strategies to support local

VCSE organisations working with women in at-risk, seldom heard groups

• Fund VCSE organisations to deliver peer support, health advocacy, advice, and crèche

and transport services, as well as to co-produce information about PMH conditions

and services

• Work with VCSEs to co-produce PMH training to increase awareness of the symptoms

of PMI and treatment pathways

• Ensure that place-based approaches accommodate the needs of women who move

between places, including Gypsy and Traveller women, and dispersed asylum seekers

• Improve local commissioning by more actively involving VCSEs at all stages of the Joint

Strategic Needs Assessment (JSNA) process, disaggregating data by ethnic and

equalities groups, recognising the resource implications for VCSEs of collating

information for JSNAs, facilitating assets-based commissioning, and using a variety of

approaches to procurement to include smaller VCSEs

19. What more can we do to help local authorities and NHS bodies work well together?

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20. What are the top 3 things you’d like to see covered in a future strategy on sexual and

reproductive health?

Maternity Action would like to see the following three things covered in a future strategy on

sexual and reproductive health:

1. A commitment to countering inequalities in access to sexual and reproductive health

services. All women should have equal access to high quality maternity care,

regardless of geographical location, socioeconomic status, immigration status,

housing situation, or protected characteristics.

2. A commitment to reducing the disparity in maternal health outcomes between black

and white women in the UK. Further work is needed to fully research the causes of

this disparity and develop a strategy to address these.

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3. A commitment to integrating social welfare legal advice services into healthcare

services to ensure that women have access to essential advice at the time they need

it.

21. What other areas (in addition to those set out in this green paper) would you like

future government policy on prevention to cover?

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