Talking about human rights in maternity care helps the wider human rights debate

“What have human rights got to do with pregnancy?”

“I wouldn’t have thought you have any rights – isn’t it about what’s best for the baby?”

“That’s not an issue in this country, surely?”

Before embarking on a project for Birthrights earlier this year, i decided to conduct my own straw poll of women – of mothers – I knew. I explained what Birthrights did and asked them what they thought. I was expecting questions, positive interest and challenges but it was these three responses that really got me thinking. Why is it so hard to connect human rights with something as ordinary and commonplace as pregnancy and childbirth?

I’ve been working for human rights and equality organisations for almost 15 years, including directing campaigns at the leading UK pressure group, Liberty, so I’ve seen and heard first-hand some of the biggest myths and misconceptions that exist around these issues. Part of the problem is that there isn’t – there has never been – enough public education from the Government about what human rights are and how they protect us. Human and rights might sound pretty self explanatory but once you get into the dry, legalistic territory of the European Convention and the Human Rights Act 1998 and you definitely don’t “have me at hello.”

When translated into straightforward language, the Human Rights Act is difficult not to love. Why wouldn’t you want a right to life, to speak freely, to practise your religion, to personal privacy and family life? What’s so bad about treating every human being equally, with fairness, dignity and respect? Why wouldn’t you want protection against discrimination, torture and inhumane treatment and arbitrary detention? But when you start to talk about ‘articles’, qualified and limited rights and about lawyers and courts you lose people’s interest. Most people are lucky enough to go through life without ever having to defend their rights in court and without having to hold the state to account, so why would they relate? And even when a hugely important human rights case, like that of the Hillsborough families, becomes front page news, it can be difficult for campaigners to communicate the link between justice and human rights. Add to this the regular attacks on human rights lawyers by some politicians and sections of the press and you have a toxic mix.

One of the biggest misconceptions is that human rights are only about lawyers and courts – that human rights make ‘fat cat’ lawyers richer and society poorer. But nothing could be further from the truth. The Human Rights Act means that you can defend your rights in UK courts and has brought justice and answers for many but it also means that public organisations, including the Government, the police and local councils, must treat everyone equally, with fairness, dignity and respect.  The Human Rights Act has helped thousands of people protect their rights without going to court.  It means that local authorities have had to review policies to make sure they treat the vulnerable respect and users of a wide range of public services have used the Act as a tool to argue for better and fairer services.

This is why what Birthrights does is such an important part of the puzzle. Their work is about defending the human rights of all childbearing women, with a particular focus on vulnerable groups such as asylum seeking and refugee women, disabled women, women in prison and women with other, complex, social needs, who are most in need. Their work raises the importance of providing respectful, personalised care for all women and the benefits of this for safer and better births. And their work highlights that respect for human rights is fundamental to all healthcare and the legal imperative to respect the autonomy and dignity of women, whether in relation to maternity care or to abortion rights.

Human rights protect us all but it is people who are most vulnerable who are in most need of protection against abuse. This inevitably leads to negative and misleading narratives about human rights and the way that the law is applied and this can be difficult to challenge in a way that is meaningful and persuasive for people who are otherwise, unconvinced. Campaigners must engage people in thinking about and looking at rights in a different way, through the lens of situations which are relatable. If this helps begin a conversation, we have more hope of increasing understanding and respect. If safety, equality, autonomy and dignity matters to one woman during pregnancy and birth, then why wouldn’t it matter to all women? If we can’t start life with these principles in mind, then where do we go from here?

Sabina Frediani is a campaigner and freelance writer. She spent over a decade working for the human rights and civil liberties pressure group, Liberty, where she directed award winning public and political campaigns, and has recently been helping Birthrights with our organisational strategy.

Birthrights intervenes in Supreme Court case

On the 2nd November, Helen Mountfield QC will be intervening, on behalf of Birthrights and a coalition of charities, in an important appeal, R (A and B) v Secretary of State for Health to be heard at the Supreme Court challenging the Secretary of State’s decision to bar women who travel from Northern Ireland to England from NHS-funded abortion care.

The case, was originally brought in 2014 by a young woman, A, and her mother, B. At the time of her abortion, A was a 15 year old girl resident in Northern Ireland, who travelled to Manchester in 2012 with her mother to end her pregnancy, at a cost of £900. While their case was originally unsuccessful at the High Court and the Court of Appeal, A and B have been granted permission to appeal to the Supreme Court.

Birthrights is part of a coalition which also comprises Alliance for Choice, the British Pregnancy Advisory Service (bpas), FPA, and the Abortion Support Network. They are represented at the Supreme Court by two barristers; Helen Mountfield QC, from Matrix chambers, and Jude Bunting, at Doughty Street Chambers; and the leading firm of solicitors, Leigh Day & Co.

Speaking in advance of the appeal, Rebecca Schiller, CEO of Birthrights, said:

“It is shocking that the human rights rights of Northern Irish women are still being contravened to such a degree in 2016. It is unacceptable that women must choose between keeping an unwanted pregnancy, risk prosecution by purchasing illegal abortion pills or spend significant sums to travel to England. We hope that the outcome of this appeal will be the beginning of Northern Irish women’s human rights being upheld; both at home and in England.”

You can read our written intervention here.

Birthrights can provide press spokespeople – please see our Press page for more details.

 

Birthrights training eligible for Maternity Safety Training Funding

Last August, Birthrights, the President of the RCM, and others wrote to the National Maternity Review team stating our belief that “safe maternity care is contingent on respectful care” and asking Baroness Cumberlege to put human rights at the centre of the Review process.

On the 17th October, the Department of Health launched a Maternity Safety Action Plan. We believe as strongly as ever, that the roll out of a human rights framework in maternity care needs to be the touchstone of that Plan. The good news is that Birthrights training is eligible for funding from the £8m Maternity Safety Training Fund that will make £40-£80k available to each Trust to enable them to implement the Maternity Safety Action Plan. So if you are interested in Birthrights training, this is a great opportunity. You can find full details of our one-day “Creating a Safe Maternity Culture” course here. Do get in touch with us as soon as possible at info@birthrights.org.uk to check availability.

More information on the Fund itself can be found here. The deadline for applications is the 18th November.

Starting a #newchapter

It’s a busy week for human rights in childbirth activists….

Firstly, its #newchapter book club week when nearly 80 book clubs will be meeting to discuss Why Human Rights in Childbirth Matter! We are absolutely delighted that so many people are showing their support for Birthrights in this way. #Newchapter book clubs are not only raising the profile of human rights in childbirth they are also raising funds to help us continue our work. So we want to say a big thank you to all our book clubbers, both here in the UK and across the globe!

Don’t forget to share your photos and posts using the hashtag #newchapter!

At the same time, our Chair, Elizabeth Prochaska, and our CEO Rebecca Schiller, are on their way to Strasbourg for the Human Rights in Childbirth Summit.  The chosen topics for the summit are informed consent and midwifery/out of hospital birth. Elizabeth and Rebecca will be reporting on the situation in the UK and hearing about the experience of other countries. More on the Summit to follow…

To coincide with our #newchapter campaign, the Human Rights in Childbirth Summit, and a generally busy autumn for human rights in childbirth, look out for our new series of guest blogs, starting with a look at childbirth in India…

birthrights-ukThanks to James Crawford for supplying our #newchapter book club graphics.

“Safety” must include a maternity system that supports respectful care

In a statement responding to the Health Secretary’s announcement today of a package of measures aimed at improving safety in maternity care, Birthrights CEO Rebecca Schiller said:

Birthrights welcomes innovation and investment in maternity care. We are particularly pleased to see the Health Secretary’s commitment to the Better Birth report’s recommendation that a ‘rapid redress and resolution’ compensation system is introduced. We frequently see the negative impact of a culture of fear on healthcare practitioners, and the women they care for, and believe that this new model has the potential to improve transparency and practice in maternity care as well as the lives of people whose babies are damaged during birth.
 
Investment in maternity care is desperately needed but we are concerned that a narrow focus on ‘safety’, at the expense of a maternity system that enables midwives and doctors to provide respectful, personalised care, will not deliver the high-quality, safe service we need for all women in England. We urge those taking this initiative forwards to ensure that the vision of the National Maternity Review, which recognises that safe care is only possible in a system that wraps around the individual women, remains a key driver for positive change.

Maternity Care Failing Some Disabled Women

Research published today (15/09/16) by Bournemouth University and commissioned by Birthrights highlights how maternity care may not be meeting the needs of some pregnant disabled women.

A survey of women with physical or sensory impairment or long term health conditions highlighted how  – despite most women rating the support they received from maternity health carers positively – only 19% of women thought that reasonable adjustments or accommodations had been made for them. Some found birth rooms, postnatal wards and their maternity notes and scans “completely inaccessible”,  while a quarter of women reported that they felt they were treated less favourably because of their disability. Most strikingly, more than half (56%) felt that health care providers did not have appropriate attitudes to disability.

Just over half of the participants expressed dissatisfaction with one or more care providers, particularly their awareness of the impact of disability and their perception that their choices in pregnancy and birth were being reduced or overruled. One participant with a physical impairment and a long-term health condition stated, “No one understood my disability. No one knew how to help or who to send me to for support.” Another added, “I didn’t have any control or any choice. Everything was decided for me.” And one woman said, “They did not listen to me. I advised them on the unique way my body works. They did not listen to my advocates.”

Speaking in advance of the publication of her book Why Human Rights in Childbirth Matter and the Birthrights #newchapter campaign linked to the launch, Rebecca Schiller, chief executive of Birthrights said, “this interim report suggests that there are significant human rights issues at stake for disabled pregnant women in the UK and Ireland. More than a quarter of women we surveyed felt that their rights were either poorly or very poorly respected. This is unacceptable and we will be working hard to address this over the coming years.

After Birthrights’ dignity in childbirth survey (2013) we became concerned that the needs of disabled women in the system were not being met. Though it’s heartening to see how overall most women were satisfied with their care and hear some positive stories of excellent practice there is clearly progress to be made. The women surveyed asked overwhelmingly to be listened to. It is crucial to listen to and trust women to ensure the system is genuinely meeting their requirements and that they are at the heart of decisions about their maternity care. The Equality Act 2010 places a duty on the public sector to provide services that meet the diverse needs of those who use them yet participants indicated worrying lack of attention to accessibility of maternity services and facilities for women with a range of disabilities.

The survey is indicative of a wider problem around women’s rights in childbirth that can impact on all women and often most forcefully on the most vulnerable . This month Birthrights is launching a campaign for a #newchapter in pregnancy and childbirth to ensure safe, quality, respectful care is available to all women. Pregnancy and childbirth are a vulnerable time and the physical and emotional impact on women and their babies of a negative journey through pregnancy and childbirth can be severe.”

Professor Vanora Hundley of Bournemouth University added, “while this is a small survey the findings echo the recommendations of the National Maternity Review published earlier this year, which highlighted the importance of personalised, woman-centred care with continuity of carer. It is clear that these are important considerations for all women, but particularly for those women who have a disability.”

Read the full interim report here. We expected the full report to be released in January 2017 when the qualitative research is completed. With thanks to the Matrix Causes Fund for supporting this work.

Help Us Start A New Chapter for Childbirth

RS Book cover

On 15th September Rebecca Schiller’s book Why Human Rights in Childbirth Matter will be published by Pinter and Martin. The book advocates for the human rights of all childbearing women here in the UK and around the globe, telling their stories and exploring the cultural and political forces surrounding birth in 2016. Insisting that women matter in the birth room, Rebecca shows how neglecting birth rights can have serious implications for women’s broader freedoms at home and abroad.

We need your help to seize this chance to start a new chapter for human rights in childbirth. Help Birthrights protect childbearing women by hosting a fundraising book club to put these issues firmly in the spotlight. We’re asking you to invite your friends and colleagues round to discuss Rebecca’s book and to make a small donation to support our work. We are suggesting you do this in the week commencing the 17th October and to join in the conversation using the #newchapter hashtag on social media.You can help us spread the word about what Birthrights does and why it matters.

As Birthrights starts a new chapter in its growth, we need to grow our income too. The funds you raise will help us continue to provide expert legal advice, give midwives and doctors the tools they need to provide respectful care, influence maternity policy and campaign for change for all women.

Register your interest in being a #newchapter book club host here.

You can find some information about hosting a #newchapter book club here, and also some questions to get discussion started.

Human dignity after the EU referendum

In the volatile political, economic and social climate of post-referendum UK many of us are anxious and uncertain about the future. As a charity Birthrights did not take a position on the referendum and it would be wrong for us to do so now.

What is clear to me today is that we are presented with a range of opportunities at a challenging time. For some these are opportunities for division, discrimination, violence, extremism and hate. As an organisation founded on respect for basic human dignity, we deplore those who have exploited these opportunities and the acts of xenophobia, racism and violence we have seen over recent days. The murder of women’s rights champion Jo Cox MP is a tragic testament to the consequences of allowing these divisions to widen.

But this isn’t all that lies within reach. Whatever our beliefs (and however the consequences of last week’s vote unfold) there is now a chance to reinforce and promote another set of values: respect, dignity, equality, justice and fairness. The values of the human rights movement.

The need for an understanding of our human rights framework has never been greater. As we cast about for an anchor in this storm we can hold on to the legal protection of our rights as individuals and the specific provisions for vulnerable groups. These protections exists in UK law (particularly in the Human Rights Act 1998) at a European level (through the European Convention on Human Rights which is not directly threatened by our leaving the EU, contingent as it is on our membership of the Council of Europe) and at an international level.

The values that underpin the human rights movement and the legal scaffolding that gives them teeth are vital now more than ever. Yesterday the United Nations expressed “serious concern” about the impact of UK’s pre-existing austerity policies on the most marginalised and disadvantaged. As we face the prospect of further economic disruption and begin to imagine how this could affect vulnerable groups, it is important to know we are not in a vacuum. Our government has key human rights obligations and it must fulfil them.

With this in mind Birthrights will continue to defend the human rights of all childbearing women, with a particular focus on those vulnerable groups who need us most. Whatever the impact of the referendum on the NHS, on midwives, doctors or on the vulnerable migrant women whose risk of maternal death or stillbirth is so high, we will continue to advise women and families, champion their rights, inspire and train their caregivers and use the power of the law to protect them.

Pregnancy and childbirth are an intensely vulnerable time for an individual. The way they are treated during birth affects them at a time in their lives when their identities as mothers are being forged and when they are developing their relationship with the next generation. The long-term physical health of women and babies is at stake in the care they are given and women’s fundamental rights to human dignity and autonomy can be profoundly affected by their experience of maternity care.

Human dignity matters in the post-referendum UK. It should be the principle we live by and the basis of the world we aspire to live in. The safety, equality, respect and dignity of each woman during pregnancy and birth will always be a strong foundation for that aspiration.

Rebecca Schiller, CEO, Birthrights

Birthrights needs your support today.

Birthrights Submission to Health Committee’s Maternity Inquiry

Yesterday the parliamentary Health Committee met as part of a short inquiry into maternity services following the publication of the National Maternity Review report ‘Better Births’. Birthrights submitted written evidence to the Committee, which is now publicly available on the Health Committee’s website.

In summary, Birthrights agrees with the National Maternity Review report’s vision that safe maternity care is personalised care and welcomes its recommendations. In our August 2015 letter to the Review team we set out that safe maternity care is contingent on respectful care and that a rights-based approach offers the best means of improving maternity services in the UK. We echo the insistence throughout the report that healthcare professionals should offer genuine choice and unbiased information and that service infrastructure should be wrapped around women and their needs.

We believe that the human rights legal framework and the values it promotes are vital tools in seeing this vision come to life. Many of the report’s recommendations are supported by rights women should already enjoy. These rights arise from human rights law and existing policy and could provide a strong platform from which to drive implementation forwards.

Respect for human rights is fundamental to all healthcare. It is particularly critical in maternity care, given the transformative nature of childbirth and the moral and legal imperative to respect theautonomy and dignity of women. Moreover, quality maternity care improves experiences for the woman and her family, and affects a baby’s start in life and subsequent life chances. Every mother and baby should have equal access to quality care.

Birthrights believes that the Better Births recommendations could enable professional carers to provide respectful, woman-centred, personalised care which, we argue, will contribute towards optimal physical and psychological outcomes and secure family relationships. We urge the Health Select Committee to draw on the positive power of the human rights principles and framework in making these recommendations a reality.

Read our submission in full here.

Last chance to stand up for Supervisors of Midwives

SoM image

Tomorrow (17th June) this unassuming consultation on amendments to modernise midwifery regulation comes to an end:

Remarkably the key role that Supervisors of Midwives play in advocating for women doesn’t even get a mention in the consultation document. As an organisation we refer women to SoMs on a daily basis – they are crucial defenders of women’s human rights. Today we need to defend these defenders. That is why we have today submitted the response below to 3 key questions in the consultation. If you haven’t already – please join us in submitting a response…

Q1. Do you agree that this additional tier of regulation for midwives should be removed? 

No. At Birthrights, we believe that safe maternity care is contingent on respectful care and that a human rights-based approach offers the best means of improving maternity services in the UK.

In the current regulatory system in the UK, Supervisors of Midwives (known as SoMs) play a dual role: they are responsible for making sure that midwives under their charge abide by professional standards and they are responsible for supporting and facilitating women’s decisions about their pregnancy and birth. SoMs provide a critical protection for women’s rights in maternity care. They enable women who may have been refused access to specific services to obtain the care they want and need; they negotiate with obstetricians and other members of the maternity team to support women’s choices; they are at the heart of planning safe and respectful care for more complex births. Birthrights calls on the help of SoMs for the women we advise on a daily basis. Remarkably, this aspect of SoM’s role does not appear in the consultation document. Birthrights is deeply concerned about the consequences of removing the role of SoMs without giving any proper thought to how to maintain this critical function.

We recognise that improvements must be made to the current regulatory system. Morecambe Bay showed what can happen if the statutory supervision system is not well understood, supported and implemented. A weak supervisory system can be subverted to protect midwives rather than to advocate for women. However, we believe that the response to the tragic failures at Morecambe Bay and elsewhere must put respect for women at its heart. Safety can only be achieved by full recognition of women’s right to dignity and respect in maternity care. This entails much more than compliance with protocols or improved documentation; it means genuinely personalised care given by staff who listen to women and respect their individual needs. This requires ongoing access for women to an “expert” who understands the care setting and can help women to navigate it. The role of SoM, protected by statute, provides a healthy level of challenge to Trusts to ensure they remain focused on women’s needs, and fulfil their obligations under the NMC Code and human rights law.

With the RCM, and others, we are concerned that putting supervision on a non-statutory basis will leave supervision at the mercy of employers to fund and implement. These changes move supervision from a must have to a nice to have. In the current financial climate of the NHS, that does not bode well. Indeed it could create many of the problems with supervision that were reported in Morecambe Bay where supervision was not prioritised, and where SoMs put their loyalty to their employer, and colleagues, above their loyalty to the Local Supervising Authority. Supervisors may be forced to tow the line of their employer or leave themselves exposed for standing up for women. Regulatory systems that fail to protect women also fail to protect midwives: Birthrights is aware of cases in other countries where midwives have faced criminal prosecution because they have supported women’s decisions to give birth in ways that are not supported by mainstream health providers. There is a real risk that eroding the distinctive system of regulation for midwives will leave women and midwives in a highly vulnerable position.

The proposal in the consultation document that supervision continues merely “as a vehicle for professional support and development” entirely fails to appreciate the distinctive role of SoMs in the provision of safe and respectful care for women. In their focus on the regulatory intricacies of supervision, the Department of Health and the NMC have overlooked this crucial aspect of safe care. They do so at the risk of endangering women and babies and degrading the quality of maternity services.

Birthrights calls for guaranteed access for women to SoMs who are explicitly charged with promoting respectful care and upholding the NMC Code.

Q2.Do you agree that the current requirement in the NMC’s legislation for a statutory Midwifery Committee should be removed? 

Birthrights does not agree that the statutory Midwifery Committee should be removed.

Midwifery is a distinct profession from nursing. It is not based on a curative model of care, but on a social model, which has significant implications for the way it is both practised and regulated. Midwifery puts the needs of women and their families at its heart; its does not treat a specific complaint but supports a woman in her transition to motherhood. The NMC must ensure that the unique characteristics of midwifery are respected and protected and maintaining the Midwifery Committee is the means of achieving this.

Furthermore, modern regulation should understand and meet the needs of the community that it regulates. It is contrary to best regulatory practice to create super-regulators that are distant from the professionals they serve. The abolition of the midwifery committee will lead to the loss of midwifery standards and ethics in regulation; and the assumption of nursing standards will be detrimental to the distinctive practice of midwifery.

Q13:Do you think that any of the proposals would help achieve any of the following aims: 

  • eliminating discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010? 
  • advancing equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it? 
  • fostering good relations between persons who share a relevant protected characteristic and persons who do not share it?

No. Birthrights is concerned that the elimination of statutory protection for the role of Supervisor of Midwives will have a detrimental impact on pregnant women. Currently, pregnant women have access to a SoM who supports and facilitates their healthcare decisions. This role reflects the unique position of pregnant women in healthcare services; for the majority, they are not receiving treatment for a condition, but seeking support for a normal life process which requires support and respect for their decisions. If pregnant women are no longer able to access SoMs, they will undoubtedly receive less support, the quality of their care will diminish and their safety will be compromised.

These proposals should be changed so that the role SoMs play in supporting women is given proper recognition. This may be by maintaining statutory supervision or by placing an enforceable obligation on Trusts to ensure that women are given guaranteed access for women to SoMs who are explicitly charged with promoting respectful care and upholding the NMC Code.