Women’s health: rising inequality and resistance

2012 was a year of swingeing cuts to women’s reproductive, sexual and maternal health services in Britain. As the capitalist crisis deepens and inequality rises, the gap widens between those who can afford to make choices about health and reproduction and those who cannot. RACHEL FRANCIS and CAT ALLISON report.

Contraception and sexual health

Contraception and sexual health (CaSH) clinics around the country have been closed over the last two years by health authorities desperate to make cuts. The greatest users of CaSH clinics are young people, ethnic minorities and women from deprived areas. A recent audit by the All-Parliamentary Group on Sexual Health (April 2012) found that up to a third of all women in the UK did not have access to a full range of contraceptive services; clinic opening times have been reduced and posts for trained clinical staff cut. Derbyshire Community Health Service is cutting 20% of its sexual health budget over the next four years, resulting in ‘cuts to contraceptive, STI and menopause services … and cuts to doctors and nurses’. Southampton has lost nine of its 17 sexual health clinics in the recent period.

In 2012, major sexual health organisations like the Family Planning Association (FPA) and Brook lost their core funding from the Department of Health. Brook in particular offers services and advice to young people aged under 25. The FPA, for example, has had to close a project it was running with Centrepoint for young homeless people who were sexually vulnerable. Brook has had to end much of its education work, including a project with boys and young men.

These cuts come at the same time as sex education in schools is under attack. The government has refused to make sex and relationships education part of the new school curriculum, and the FPA’s Speakeasy programme, which for over ten years trained more than 10,000 parents and carers to talk to children about sex and relationships is no longer getting funding from the Department for Education in England, while in Scotland its Big Lottery funding has ended (Rachel Williams, The Guardian, 23 April 2012).

Meanwhile, Britain has the highest rate of teenage pregnancy in Europe (second only to the US in the developed world), with 50% of teenagers who become pregnant coming from the poorest areas of the country.

Abortion rights under attack – again

The insidious ideological attack on women’s right to abortion continues. In November 2012, Maria Miller, the Minister for Women and Equalities, became the latest politician to enter the fray, announcing her preference for lowering the limit for abortion from 24 to 20 weeks and citing not medical fact but her view that ‘I want to make sure that the law keeps pace with people’s views on this issue’! Her words came only a few weeks after Jeremy Hunt, newly appointed as health minister, said he would like to see the limit set at 12 weeks. Prime Minister David Cameron has also indicated he would like to see a ‘modest reduction’ in the time limit for abortions. This at a time when working class women are increasingly deprived of the affordable childcare, suitable housing, adequate jobs or benefits that would make having an unplanned child a ‘choice’. Defend the right to abortion!

Defend maternity services

Inequality in maternal health is already high and rising rapidly. Rates of stillbirth are twice as high in the poorest areas of England compared with the most affluent. In 2011, a woman from a couple where both were unemployed was 20 times more at risk than a woman from a more affluent background. Problems are particularly acute in London, where the maternal death rate has doubled since 2005. The figure of 19.3 per 100,000 births is low on an international scale but the problem remains: as services are reduced and living standards cut, more women are dying, and these are overwhelmingly working class women. Black women, asylum seekers, refugees and newly-arrived migrants make up the highest figures; despite comprising less than 0.5% of the population, asylum-seeking women account for 12% of all maternal deaths.

The closure and reduction of services will make access to essential care even harder for working class women. Since 2011, nine maternity units have temporarily or permanently closed. Women in labour are having to travel further to receive care. In Lewisham, south London, which contains some of the poorest areas in London, there are plans to close the hospital’s maternity services as well as its Accident & Emergency department. Any reduction in services would have an impact on mothers in Lewisham, and a significant one for women who cannot afford travel or pay for extra support. Significantly, the most deprived parts of Lewisham have the highest projected number of births. Women with immediate needs will be hit hard, and nearby hospitals are already overstretched. A mother whose ill baby was born at Lewisham questioned the implications of forcing women to travel to more distant hospitals: how could they afford to visit a sick child? The proposed closure would also leave one A&E for the boroughs of Lewisham, Greenwich and Bexley, which have a combined population of 750,000. No wonder 15,000 marched in defence of Lewisham hospital in November, and 25,000 in January.

The shortage of midwives is another significant problem for maternal health. Women who can pay are able to choose their care and place of birth; those who cannot are not only denied their choice of birth, but in many cases denied safe, quality care. Midwives report having to close their doors to women and every region is failing to meet the recommended ratio of midwives to number of births. 5,000 more midwives are desperately needed in Britain, yet a third of those newly qualified are struggling to find work. Only half of those in work are able to get full-time hours. David Cameron has reneged on his pre-election promise of 3,000 more midwives, claiming the birth rate had tailed off, whilst in fact it has risen to its highest in 40 years. Maternal health is increasingly a two-tier system, with wealthier women enjoying one-to-one care, while the reality for working class women is increasing risk and maternal and infant deaths.

The fight to defend women’s health is a class struggle. The fightback against the closure, downgrading and restriction of essential sexual health and reproductive services is part of the wider struggle against the sell-off of the NHS, unprecedented cuts in public services, and rising poverty and inequality. 2013 will bring further attacks, but it must also bring resistance which relates women’s oppression to the cuts and the attack on the working class as a whole.

Fight Racism! Fight Imperialism! 231 February-March 2013