Antenatal care

All NHS boards have adopted maternity policy principles which advocate women and family centred services, with care tailored to individual need and provided by the most appropriately skilled professional. In adopting these principles, services have been developed to take account of the evidence for improving public health and ensure that maternity care provision reflects wider policy.

Public health and early years policies, including Better Health, Better Care, Equally Well and Getting It Right For Every Child (GIRFEC), outline a commitment to reduce health inequalities.

In relation to maternity care, they highlight the importance of seamless and early access to services, alongside early tailored intervention for women and families with additional social or medical need.

Information must be tailored and sensitive to the communication and language needs of the woman which may include learning difficulties, sensory impairment, literacy levels including health literacy, and English as a second language.

Inequalities in antenatal care

Disadvantage starts before birth and increases throughout life and so efforts to reduce health inequalities must begin before birth. Reducing inequalities in pregnancy requires the attention of everyone who works with pregnant women and their partners, across the spectrum of settings and disciplines.

Quick links:

What are health inequalities?

Health inequalities are avoidable differences in health status or determinants between population groups. They are usually the result of a complex matrix of lifestyle choices, personal history and circumstances, and access to services.

The Marmot Review (external link) suggests that these inequalities are reflected best as a gradient across society rather than as a gap between two population groups. The review calls for a universal service, tailored to provide a gradient of support for populations with differing needs.

How can health inequalities be addressed during pregnancy?

It is essential that those providing antenatal care address social and health inequalities. Professionals should aim to provide universal services that are available and accessible to all pregnant women and their partners, identifying individual needs to tailor responses.

This approach is not stigmatising, and allows for early intervention before any issues reach critical levels:

'Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism,' Marmot review.

An example of this need is in provisions for parents with low health literacy levels. Health literacy is the mixture of social skills and understanding that allows people to access and use health information effectively, and to make informed decisions about their health care.

To address low health literacy we need to:

  • break down barriers to health and find ways to help people access the services and support they need
  • help people gain greater control over their health and wellbeing
  • allow them to make informed health choices
  • enable them to advocate for their own health as well as their family and community

Addressing these issues can help to make an impact in pregnancy and support the development of skills that provide protective factors to health.

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Outcomes of health inequalities

Health inequalities in the antenatal phase arise from complex social factors. They have the potential to increase the vulnerability of both the pregnant woman and her child, during and after pregnancy.

The National Institute for health and Clinical Excellence (NICE) guideline, Pregnant women with complex social factors (2010) (external link) highlights complex social factors that are associated with an increased risk of maternal death.

These include:

  • contact with child protection services or social services
  • substance misuse
  • domestic abuse
  • being single
  • being unemployed
  • having a partner who is unemployed or employment unclassifiable
  • being a recent migrant to the UK
  • speaking no English

The guidance recognises the need for multi-agency working and needs assessment. It also states that health professionals should be trained to assess any additional social and psychological needs that women may have.

Infants of women living in complex social circumstances have an increased risk of dying during the perinatal period (NICE Guidance as above). This supports the findings of Confidential Enquiry into Maternal and Child Health - Why Children Die (external link), which says, 'Children born to women from more vulnerable groups also experience a higher risk of death or morbidity and face problems with pre-term labour, intrauterine growth restriction, low birth weight, low levels of breastfeeding and higher levels of neonatal complications'.

Complex social circumstances can constitute a high risk during pregnancy. However, biological, genetic and social factors are often closely linked. Related factors include:

  • the relationships between diabetes, obesity and poor nutrition
  • teenagers, smoking and poverty
  • gender-based violence, substance misuse and poor mental health

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Articles in this topic

Policy

  • External Resource

    Better Health, Better Care: An action plan [2.8MB]

    This Action Plan sets out the Government's programme to deliver a healthier Scotland by helping people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health care.

    • When was this published? 8/17/2010
  • External Resource

    Equally Well [488KB]

    This is the report of the Ministerial Task Force on Health Inequalities.

    • When was this published? 8/18/2010
  • External Resource

    Getting It Right For Every Child

    Getting it right for every child is a programme that aims to improve outcomes for all children and young people.

    • When was this published? 5/22/2013

Evidence

Professional support materials

Information for the public

  • External Resource

    Antenatal Results and Choices (ARC)

    This charity helps parents to make decisions if antenatal tests reveal that their unborn baby may have a serious abnormality. It also helps them to deal with the consequences of their choices.

    • When was this published? 8/17/2010
  • External Resource

    Association for Improvements in the Maternity Service (AIMS)

    AIMS provides independent support and information about maternity choices.

    • When was this published? 8/17/2010
  • External Resource

    BLISS

    This charity provides special care for premature and sick babies.

    • When was this published? 8/17/2010
  • External Resource

    Doula UK

    The association of Doulas (an experienced woman who offers emotional and practical support to a woman (or couple) before, during and after childbirth) in the UK. Member areas for Doula professionals and advice for famlies on how to find a doula can be found here.

    • When was this published? 8/17/2010
  • External Resource

    Family Planning Association Scotland

    This charity offers free help, advice and support about sexual health and relationships. It also provides a range of resources to professionals.

    • When was this published? 8/17/2010
  • External Resource

    From the beginning: leaflet [660KB]

    This leaflet tells the story of pregnancy stage by stage. Using words and illustrations, it gives key messages on how to support speech and language development in pregnancy. Developed by Gretel McEwan, Lynn Jones and Foundry Media

    • When was this published? 5/23/2013
  • External Resource

    Genetic Alliance UK

    Genetic Alliance UK seeks to improve the lives of people affected by genetic conditions by ensuring that high quality services and information are available to all who need them.

    • When was this published? 8/17/2010
  • External Resource

    Miscarriage Association

    This charity offers help and support to women who have suffered a pregnancy loss.

    • When was this published? 8/17/2010
  • External Resource

    My Pregnancy My Choice

    Book for expectant parents with learning disabilities. This book is available free of charge to Early Years professionals in Scotland from NHS Health Scotland as an alternative to Ready Steady Baby! To order contact nhs.HealthScotland-EarlyYears@nhs.net.

    • When was this published? 5/27/2013
  • External Resource

    NCT (formerly The National Childbirth Trust)

    The main website for the National Childbirth Trust provides advice and resources for parents and healthcare professionals.

    • When was this published? 8/17/2010
  • External Resource

    Pregnant pause

    A guide for lesbians on how to get pregnant. This guide has been specifically tailored to the needs of lesbian women. It contains information on conception, looking after yourself during pregnancy, antenatal health care, giving birth, parental rights and responsibilties, looking after a new born

    • When was this published? 2/16/2011
  • External Resource

    Ready Steady Baby!

    A website for the public providing information and advice through pregnancy and the baby's first days.

    • When was this published? 8/18/2010
  • External Resource

    SANDS- Stillbirth and Neonatal death charity

    Sands supports anyone who has been affected by the death of a baby before, during or shortly after birth.

    • When was this published? 10/14/2013
  • External Resource

    Violence reduction posters and leaflets

    The Violence Reduction Unit has a range of posters available which are free to download and can be amended, leaflets targeting parents and children are available which details simple, everyday ways for parents to help to reduce the risk of violence in a child’s life.

    • When was this published? 5/23/2013
  • External Resource

    Whooping cough- information for pregnant women

    NHS Health Scotland has published: Whooping Cough help protect your baby. This leaflet explains how pregnant women can help protect their unborn baby from getting whooping cough by having the whooping cough vaccine while they are pregnant.

    • When was this published? 5/27/2013
  • External Resource

    Young Parents Survival Guide [6.2MB]

    Information and advice for young parents, covering a whole range of topics from when you first suspect you're pregnant to coping with raising your child.

    • When was this published? 8/17/2010
  • External Resource

    Your guide to screening tests during pregnancy [1.4MB]

    A Health Scotland publication for the public which details all the routine screening and diagnostic tests available to pregnant women in Scotland.

    • When was this published? 8/17/2010