Neighboring Health and Childbearing Women

Public Health is the combined societal effort in averting disease, promoting health and extending life (Department of Health, 2009). Public health has been high on the health agenda for many years, starting very early with drivers such as, the black report (1980) and more recently, the Marmot Review (2008). Both these reports highlighted the importance of health inequalities and the need for change.

The neighbourhoods within society hold vast ranges of disproportionate health outcomes. These health inconsistencies have a bearing on outcomes for childbearing women and families.

Midwives play an important role in promoting public health and making an impact on the health and wellbeing of society. In particular, engaging with vulnerable communities and encouraging healthy behaviours can have a positive effect on mortality and morbidity rates.

In this assignment I aim to analyse the impact of neighbouring health on childbearing women and their families. I will do this by examining the health aspects of an anonymous local area of which I will refer to as *Summer Fields.

I will also compare Summer Fields to national statistics and place emphasis on its implications for midwifery practice.

The research I have conducted on the area of Summer Fields paints quite a bleak picture. GCSE results and breastfeeding rates are down, whilst infant mortality and teenage pregnancy are high.

The vicinity of Summer Fields is an economically deprived multi-cultural area, highly populated by Asian families. According to Joint Strategic needs assessment for Kirklees (2013), of the 1028 births in Kirklees, 54% of these were born to Asian women. Many of these Asian women speak little or no English, which can elevate a barrier to optimal health outcomes. Cresswell etal (2013) claim that women from ethnic minorities and refer to themselves as Asian, tend to book later in pregnancy than women from a white background.

They also claim that this may be due to language barriers or unfamiliarity with uk maternity care systems. Reports such as CMACE (2011) also highlight that language barriers have a major impact on mortality and morbidity rates. Early Antenatal care is important to enable women and their midwife to monitor the health and well being throughout pregnancy.

It also enables health professionals to identify any concerns early and recognise any high risk factors. For example, routine, early care allows the midwife to commence and monitor the measuring of symphasis – fundal height. This enables the detection of small or large for gestational age foetuses and sanctions the schedule of care. Therefore without regular antenatal care, early risk factor signs could missed.

Often Asian women are unaware of the services available to them and how to manage their personal health. Therefore in an attempt to try and combat these issues, the Chandni Clinic was developed. The NHS trust website (2014) says “the Chandni Clinic enables women from sometimes hard to reach communities to talk confidently about sexual health with a female doctor in their own language”. It is described as a place where women feel confident to discuss their health with a familiar face in the community.

This encourages women to become more engaged in their health by providing information in their own language and acting as a sign post to other services such as a midwife. Furthermore, it can have a big impact on maternity provision as it enables women to gain a wider understanding of health services and the choices that are available.

In contrast, whilst this clinic has won national awards for its achievements, I feel that it may not reach the entire intended target of women because some women may feel unable to share their health issues with a female doctor that is ‘known in the community”. This could therefore alienate some local women and would maybe benefit from a doctor who is from outside the area.

In a more affluent area, there is a service called the Claire Hill Muslim Women’s Society which is held in a community centre. It caters for Muslim women’s health, education and Social needs through group interaction. This service may be of benefit in an area such as Summer Fields as it allows women to come together without the fear of isolation.

In addition, The department for Education (2014) reports that GCSE results for Summer Fields are lower than the national average (60%), with only 23% achieving 5 or more A-C grades at one school (see appendix 1). The World Health Organisation (n.d) states that low education levels are linked to poor health and lower self-confidence. The department for education (2014), reports that children from lower economic backgrounds tend to have lower educational attainment. Appendix 2 also corresponds with this by illustrating that children from poorer households that also claim free school meals, achieve fewer academic goals.

Higher educational achievements bring children additional lifetime prospects. It is also the biggest opportunity for children of low incomes to become more financially stable, break the poverty cycle and remove economic inequality. A Joseph Rowntree Foundation’s paper (2010) emphasizes that educational accomplishment is a “strong determinant of later- life”.

Leading on from the importance of education, Summer Fields has a high rate of teenage pregnancy in the area with the Department for Education (2010) saying that teenage mothers are 20% more likely to have no qualifications.

The Department of Health (2012) Health Profile states that the area surrounding and including Summer Fields has a significantly high teenage pregnancy rate of 46.6% compared to the national average of 38.1% (see appendix 3). Teenage pregnancy is associated with fewer optimal health outcomes such as low birth weight newborns, greater infant mortality and reduced antenatal health (Department of Health, 2013). This also includes wider health inequalities such as inadequate school attainment, poverty and social isolation (Marshall & Raynor 2014).

Teenage mothers may require more tailored care from midwives. This includes more intensive antenatal and postnatal care such as, promoting a healthy lifestyle, detection of postnatal depression and parenting skills. Also Lee & MaKay-Moffat (2010) state that teenage pregnancies can result in later booking which can be due to many reasons including, concealed pregnancy, lack of knowledge and lack of support. Late booking can also mean that these young mothers can miss out on early antenatal screening such as Nuchal Translucency.

Schemes such as the family nurse partnership (FNP) have been put in place to cater for teenage pregnancy and women that require more one-to-one intensive support. The FNP service is a voluntary service that aims to “improve the chances of the most disadvantaged children and reduce intergenerational inequality” (Family nurse partnership, 2014).

The FNP programme has had many successes such as, reduced the amount of subsequent pregnancies, improved parenting practices and increased father involvement (Department of Health 2012). However, there has been criticisms of FNP due to it only offering the service to first time mothers. Its successes of reducing subsequent pregnancies could be of benefit to young mothers that are already on their second or third pregnancy with the view of reducing more in the future.

Summer Fields also has a significantly higher rate of infant mortality (appendix 4). According to the Kirklees strategic joint needs assessment (2013), Summer Fields 2009-11 rate per 1000 births was 6.7% compared to a rate of 4.2 %nationally. UNICEF (n.d) defines infant mortality as “the probability of dying between birth and exactly one year of age expressed per 1,000 live births”.

Maternal and fetal health are influenced by their surroundings. This includes their social, economic and environmental status. Many of these contribute to the high rates of infant mortality such as, deprivation, smoking, alcohol & substance misuse, low birth weight, maternal morbidity, age, congenital abnormalities and prematurity. Whilst this list is not include all the causes, it highlights the need for increased awareness for areas such as Summer Fields.

As midwives we have a responsibility to inform and educate the public about the causes and preventative measures of infant mortality. This is achieved by promoting healthy behaviours in pregnancy such as stopping smoking. Smoking in pregnancy has been found to significantly increase the risk of infant mortality by around 40% (Department of Health 2007). The NICE guidance (2010) on smoking in pregnancy recommends that women should be offered a test for carbon monoxide levels at booking and subsequent appointments. It then goes on to say that we should also recommend referring to NHS stop smoking services.

We can also achieve this by continued promotion of the Healthy Start programme which provides women and families on low incomes with vouchers which can be exchanged for fruit, vegetables and milk. This programme seeks to ensure that a nutritional, balanced diet is accessible to all childbearing women. This service also provides women with free vitamins that can be obtained from midwives and Sure Start Childens centres. Healthy start vitamins contain the daily recommended intake of vitamins and minerals for pregnant and breastfeeding women. The NHS Healthy Start (n.d) website reports that these vitamins are especially important for younger women and women from ethnic minorities as they are at greater risk of having a vitamin D deficiency.

Key information giving from midwives is also an essential part of the maternity care package that women and families need to reduce their risk. Information such as safer sleeping and sudden infant death syndrome (SIDS) can be quite morbid subjects to discuss with new mothers but none the less highly important. The NICE (2014) postnatal guidelines encourage midwives to discuss safer sleeping and discourage co-sleeping due to the risk of SIDS.

The wider health proffesionals such as health visitors can also assist in ensuring lower rates of infant death by highlighting home safety and child health during home visits. Moreover, breastfeeding rates in Summer Fields are lower than the national statistics. Unicef (2012) report that in 2010, 81% of mothers in the UK initiated breastfeeding compared to only 64% initiation in Summer Fields. Breastfeeding has many health benefits that are now widely promoted and advertised. It also has an impact on a child’s future health and wellbeing and therefore reduces health inequalities. NHS Choices (2014) reports that breastfeeding reduces the rates of childhood obesity and obesity-related illnesses such as, type 2 diabetes later in life.

A number of services are available in the locality of Summer Fields to help promote initiation and continued breastfeeding. Services such as Auntie Pam’s aid the community by providing support on a wide range of family issues from housing and money to babies and breastfeeding. The NICE (2014) Maternal and Child Health guidelines recommends that all health professionals should take an active role in promoting and raising awareness of breastfeeding and its benefits.

A Sure start centre is also accessible in the immediate area that also supports families with breastfeeding. These services also have a regular attending midwife and health visitor are there to promote these issues and interact with harder to reach families.

There has been nationwide enthusiasm in support of Sure Start children’s centres. They are there to “improve outcomes for young children and their families, with a particular focus on those with the greatest need” (Department of Education, 2014). They aim to ensure children are ‘school ready’ and support for parents. However the National Evaluation of Sure Start (2010) reports that mothers who have accessed Sure Start local Programmes are more likely to suffer from depression. This also continued to be the case during the NESS (2012) report.

Health proffesionals that have an input into women and childrens lives are encouraged to ‘make every contact count’. This means taking the opportunity to utilise every encounter to its fullest. This enables and promote women to make informed choices and decisions about both theirs and their families health. Making every contact count also plays a big role in safeguarding women and children and building professional relationships with them.

Often women choose not to disclose potential harmful lifestyles or behaivours on the first encounter. Women often like to get to know their midwife better before they feel they can confide in them. Therefore, taking the time to talk things through and discuss with women can enable them to make positive, healthy and informed decisions.

From an outside view, Summer Fields has in place a variety of services that are aiming to reduce health inequalities. However due to more than half the children born in 2013 were to Asian women, I feel more services are needed to primarily focus on this group. In addition to the information I presented earlier around booking later and language difficulties, for women from ethnic minorities the gap in infant mortality is far greater (Department of Health, 2007).

Many of the bigger cities in the UK have more provision aimed as this group (see appendix 5 and 6). The provisions referred to in appendix 5 and 6, are ethnicity and culture related services that are in place to tailor health care to meet the needs of their population. I feel these specialist services would greatly benefit Summer Fields as many of the health inequalities in the area are directly associated with the ethnic backgrounds.

In conclusion, it is clear that the impact of the neighbourhood can have drastic consequences on the health and wellbeing of childbearing women and families. My assignment has shown that health is influenced by many factors. The area in which we work, develop and are born into, has the potential to shape our future outcomes. Summer Fields is an area that continues to have negative outcomes of the lives of the people that live there and without the continued input from midwives and other health professionals; it may continue to stay that way.