Health: Women and Low-income Groups

Baroness Hayman Excerpts

Thursday 20th March 2014 Grand Committee

[Baroness Hayman (CB)]

My Lords, the noble Baroness, Lady Manzoor, has given us the opportunity to cover a very wide canvas this afternoon on an issue that is so deeply rooted in deprivation and its results that it is difficult to do it justice in the course of an hour. I fear that I shall make the problem even greater by dealing predominantly not with inequalities in the UK but with those across the world, because some of the most stark and striking inequalities in health, particularly women’s health, occur globally. I should perhaps reassure the Minister that I will not expect a fully fledged, all-singing, all-dancing DfID response from her today. However, I would be grateful if she could pass on these comments to colleagues.

Whichever society one is dealing with and wherever in the world, ill health is both the outcome of deprivation—social, economic and educational—and itself a cause of deprivation. At its most stark, it is illustrated in life expectancy: there are those figures that the noble Baroness gave us of a healthy life expectancy for a woman in the UK varying from 54.1 years in Tower Hamlets to 72.1 years in Richmond-upon-Thames. There is a great deal to discuss but I shall concentrate on women’s health and those areas specific to women, pregnancy and childbirth, where men do not risk morbidity and mortality at all. We should remember that gender-specific risk starts early. For some, it starts with selective infanticide, while there is female genital mutilation and child marriage, which is not just a social ill but a health threat as well. A girl who gives birth while aged under 15 is five times more likely to die than one who is over 15, and so are her babies.

I should declare some interests. My international development interests are as in the register but, particularly, I am chair of the external advisory group at the Centre for Maternal and Newborn Health at Liverpool School of Tropical Medicine and, in the UK, a member of the General Medical Council. I am also grateful to Professor Gwyneth Lewis of the UCL Institute for Women’s Health, who has done so much work on maternal mortality in this country and abroad.

Maternal death rates illustrate the inequalities that exist in world health and between women all over the world today. In 2010—I think all my figures are from that year—287,000 women died in childbirth. One woman dies in childbirth every two minutes across the world. In the UK, where the maternal mortality rate of deaths per 100,000 is 11, every one of those deaths would be subject to a confidential maternal death inquiry. In sub-Saharan Africa, where the MMR is 500 deaths in every 100,000, that inquiry would be considered completely inappropriate and impossible to carry out. Many of those deaths may not even be officially recorded. The lifetime risk of dying in pregnancy is one in 20,000 in the United Kingdom; in Sierra Leone, it is one in seven.

Of course, these deaths are not the only consequence. For every woman who dies, perhaps 15 suffer morbidity. Neonatal rates are absolutely related to maternal deaths and yet perhaps 80% of maternal and perinatal deaths are preventable. It was said by Mahmoud Fathalla in 1988:

“Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving”.

We can see in our international development programme that there are programmes that work, that are sustainable and that bring skilled birth attendance—perhaps the single thing that makes the difference to maternal mortality. Across countries in Africa, the Making It Happen programme, led by Nynke Van den Broek of Liverpool, is providing sustainable training and support for the maternity services so that they can improve their death rates. I very much hope that in the response to come from DfID we will get continuing commitment to such programmes.

Returning to this country, where we have one of the lowest death rates in the world, considering how good our recording is, poverty and deprivation still make it more dangerous to give birth in this country if you are from a lower social class or have less education. The statistic that stands out to me is that women, single or in partnership, in a family with no wage income are 10 times more likely to die or suffer complications in childbirth—10 times. The link between poverty and health continues in this country, as it does between countries.