Pregnancy, births and maternity: policy context
Maternity care and birth outcomes
A Refreshed Framework for Maternity Care in Scotland developed by the Maternity Services Action Group (Scottish Government 2011) provides the current framework and principles which inform the delivery of maternity services in Scotland. In February 2015, the Minister for Public Health announced that this framework would be reviewed, using the latest evidence and best practice to inform service delivery. The review is being informed by the results of Scotland’s 2013 and 2015 Maternity Care Surveys which give an overview of women’s experience of maternity care. Overall the findings show that the majority of women have a positive experience of maternity services; both reports do however identify some areas for improvement. The review is expected to report in late 2016.
Inequalities can impact on the outcome of pregnancy just as they can on other health outcomes. Whilst in general, rates of maternal and perinatal death in Scotland are low, ethnicity and deprivation remain associated with increased rates of stillbirth and neonatal death; reducing stillbirths and neonatal deaths in these groups remains a difficult but important public health challenge.
Reducing Antenatal Health Inequalities (2011) gives specific actions for Health Boards based on a review of what the evidence says needs to happen. The actions are:
- Carry out rapid health needs profile of women of reproductive age for benchmarking and service planning purposes
- Work towards all women accessing antenatal care services by 12 weeks of pregnancy
- Ensure the Getting It Right For Every Child (GIRFEC) national practice model and inequalities sensitive practice is integral to assessment of need and care responses within antenatal services
- Carry out a risk assessment of communication, liaison and referral processes between maternity services, primary care and other key NHS services including mental health and substance misuse services and Local Authority services.
- Routinely measure short term (conception - postnatal phase) health outcomes of antenatal care for women and their babies in high risk groups
- Ensure that women's pre-conceptual general health is cared for, particularly those women in high risk groups
- Promote long lasting reversible contraceptives particularly to teenagers, women with addiction problems and sex workers prior to discharge from postnatal care
These actions aim to:
- Improve access to antenatal healthcare services
- Improve the assessment of health and social need
- Ensure equity in the quality of care
Maternal and infant nutrition
The Breastfeeding etc. (Scotland) Act 2005 made provision in relation to the promotion and support of breastfeeding, and made it an offence to prevent or stop a person in charge of a child under two years of age, who is otherwise permitted to be in a public place or licensed premises, from feeding milk to him/her there.
The national framework on Improving Maternal and Infant Nutrition (2011) recognises that diet and nutrition of the mother both before and during pregnancy, during breastfeeding, and the diet and nutrition of the child during infancy all contribute significantly to the long term health of the population. This framework is also currently being reviewed and the new version is expected to be published in late 2016. The 2011 report makes recommendations aimed at achieving the following outcomes:
- Women entering pregnancy are a healthy weight, in good nutritional health and that this continues throughout their pregnancy and beyond.
- All parents receive full information they can understand on infant feeding to enable them to make an informed choice on how they will feed their infant.
- All women receive the support they need to initiate and continue breastfeeding for as long as they wish.
- Infants are given appropriate and timely complementary foods and continue to have a wide and varied healthy diet throughout early childhood.
The UNICEF Baby Friendly Initiative (BFI) supports and accredits maternity and community healthcare facilities, neonatal units, Children's Centres and higher education institutions that have met best practice standards for breastfeeding. The standards were revised and updated in 2012. All maternity units and community NHS services in Scotland have either received or are working towards BFI accreditation. There is a commitment within the Improving Maternal and Infant Nutrition framework for all Maternity Units and Community Health Partnerships to achieve and maintain Baby Friendly accreditation.
In June 2016, the Scottish Government announced that all pregnant women will be entitled to free vitamins from spring 2017 (this extends the provision currently made to some pregnant women via the NHS Healthy Start scheme). The Scottish Government's 2016-17 programme for government includes plans to provide all newborn babies in Scotland with a box of essential items (the box can be used as a cot for the first few months of life).
A wealth of information for professionals on pregnancy and the early years can be found on the Early Years section of the NHS Health Scotland website.