Baby Loss (Public Health Guidelines)

Gavin Robinson Excerpts

Tuesday 21st March 2017 Commons Chamber

[Tim Loughton (East Worthing and Shoreham) (Con)]

I had not intended to speak in this debate—I just wanted to be part of it and perhaps to question the Minister—but you have tempted me, Mr Deputy Speaker, to add my three penn’orth. I, too, will not take up the remainder of the three hours and 50 minutes in making a few comments. I again congratulate my hon. Friend the Member for Colchester (Will Quince) on securing the debate.

The Government have made good progress on the smoking front, and that needs to be recognised, but 10.6% of people still smoke through pregnancy. That figure needs to be brought well down into single figures. My hon. Friend made a good point about the use of advertising messages with regard to alcohol. Of course, unlike alcohol, this issue affects only half the population. The graphic images on cigarette packets of diseased lungs, and those grisly television adverts with pus coming out of lungs and so on, really send home the message about the harm that any smoking can do. Making that clear to women who still take the risk of smoking during pregnancy would help to get the figure down further.

We still have a major problem in this country with high levels of baby loss through stillbirth as well as through the rather less quantifiable form of miscarriage, the true extent of which we do not really know. As I said earlier, it must be a priority for Government to work out why we have regional and cultural differences, and to extend and learn from best practice rather better than we do at the moment. Some of the pilots and experiments that have happened in Scotland are something for the rest of the country to look at and learn from.

Given the title of this debate, we could, strictly speaking, extend it well beyond just smoking, and I am going to take advantage of that. On drinking, there has been a very confused message for some time. I am an officer of the all-party foetal alcohol syndrome group. We produced a report that urged complete abstinence as the only safe way, and that must be the default position. For women who do choose to continue to drink in some form during pregnancy, there need to be very clear health messages, and perhaps lower-alcohol alternatives. If someone has to drink, there are ways of potentially doing less damage to their baby. The Government can be part of that through the differential pricing tax mechanism. We are rather bad at that in this area.

I remember going to Denmark some years ago and visiting a children’s home just outside Copenhagen that specialised in treating children who were the victims of foetal alcohol syndrome—particularly children of mothers from Greenland, where there is a particular problem with heavy drinking. Those children were born with all sorts of disabilities, some of which manifested themselves as the symptoms that we know of in ongoing conditions such as autism.

There may be an understating of the effects of foetal alcohol syndrome because it can appear somewhere on the autistic spectrum as well. We need to do more research into that. There is no more stark example than we see in Denmark of a direct correlation between excessive drinking and giving birth to a child who will bear the effects of that for his or her whole life, with the learning disabilities and other things that go with it. We have lessons to learn from that. We still need stronger messages to go out to women during pregnancy about the potential, and potentially lifelong, harm that can be done by inappropriate drinking.

[Gavin Robinson (Belfast East) (DUP)]

Although a strong message is important, the delivery of that message is crucial. There is a good argument for saying that the shock-and-awe messaging used in advertisements about driver safety or alcohol, and on cigarette packets, does not have the impact that we believe it should. Many mothers might take cavalier decisions about themselves, as many of us do. I certainly do when it comes to food and its health benefits; I do not follow the guidance. Does the hon. Gentleman agree, however, that a mother would never want to damage the future prospects of her child? The sensitivity of the message, however strong it is, is the most important element.

[Tim Loughton]

The hon. Gentleman makes a fair point. We, as grown-ups, can make a conscious decision to be gluttonous or to over-imbibe. That does damage to our bodies and our bodies alone, although there may be a cost to the taxpayer through the national health service. If anyone should be more sensitive and sensible about the damage that could be done to another individual, it is a pregnant woman. A pregnant woman, or a woman considering pregnancy, should be more amenable to good health messages.

It is a question of horses for courses, and I take the point that the hon. Gentleman makes about shock-and-awe tactics. The AIDS adverts in the ’80s could be described as shock and awe, and they were exceedingly effective at the time. We still remember those tombstones. One can go too far, however; members of the public are smart, and they recognise over-emphasis for effect. It hits them in the face, and they say, “I do not need to take any notice of that.” We need smart messaging, which is credible and honed appropriately for its target audience.

That is why when we in the all-party group on foetal alcohol syndrome produced our report, we had a big debate about whether we should recommend complete abstinence or whether that was just not realistic for some people, who were still going to drink. I take the view that the default position must be that drinking harms a woman’s baby, but if someone absolutely has to drink, for whatever reason, there are less harmful—but always harmful—ways of doing so. We need to nuance that message appropriately for different audiences. Of course, different cultures have different attitudes to drinking, foods and so on.

I move on to a subject that is completely different, but still within the scope of this Adjournment debate: perinatal mental health. I declare an interest as the chair of the all-party group for the 1,001 critical days, and as the chairman of Parent Infant Partnership UK, a charity that is all about promoting good attachment among parents and their children in the period between conception and age two. One of the biggest, most powerful and most effective public health messages that we can give is that effecting a strong attachment with one’s child, right from the earliest days, will have lifelong benefits for that child. That includes the time that the child is in the womb. A mother who is happy, settled and in a good place is much more likely to pass on those positive messages to a child than a mother who is stressed and suffering from perinatal mental illness or various other pressures.

At least one in six women in this country will suffer some form of perinatal illness. We know from the science, which is producing considerable data, that a child who is not securely attached—preferably to both parents but certainly to the mother, to start with—is much less likely to thrive at school and to be settled and sociable, and more likely to fall into drink and drug problems and to have difficulties with housing and employment. The first 1,001 days are absolutely critical, and we should be doing more. It is a false economy not to do so, and not to invest money early on.

The Government have quite rightly flagged up the importance of mental health. The Prime Minister absolutely gets the importance of mental health, and particularly of perinatal mental health. The additional money allocated is good, but it is still not enough. The problem, as we all know, is that that money is not making it through to the sharp end, so opportunities are still being missed to identify women who have some form of mental health problem—typically depression around the time of pregnancy—signpost them to the appropriate services and deliver quality and appropriate services in a timely fashion. That is why the charity I chair, PIP UK, has seven PIPs around the country, operating out of children’s centres, to which women can be referred, often with their partners, to get the support and confidence they need to effect the strong bond and attachment with their child.

The Maternal Mental Health Alliance has costed the problem of not forming such bonds at £8.1 billion each and every year. I repeat that, each year, the cost of getting it wrong is over £8 billion. The cost of getting it right is substantially less, yet too many clinical commissioning groups around the country still do not even have a plan for delivering perinatal mental health for women where and when they actually need it. On top of that, in our report “Building Great Britons”, the all-party group calculated that the cost of child neglect is over £15 billion a year in this country. By not getting it right for really young children and for babies, we are therefore wasting £23 billion financially, but far more importantly we are not giving those children the very best start in life socially, which we could do with a bit more, smarter and better targeted up-front investment.

I reiterate to the Minister and his colleague, the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood)—she very kindly saw a delegation from the all-party group on the 1,001 critical days recently, and I know she takes this subject very seriously and has convened a roundtable—that we absolutely must come up with such public health messages and talk in this place about the importance of getting it right early on, but what matters at the end of the day is actually delivering the service to those women where it is needed, at the appropriate time and place.

Finally, may I take the liberty of mentioning to the Minister, as I think I did in a previous Adjournment debate, the question of the registration of stillbirths? It is a subject on which I have campaigned for some years in this place, and on which I have had a private Member’s Bill. This falls within the remit of baby loss, which is in the title of this Adjournment debate; I know you are scrupulous, Mr Speaker, about our not straying beyond the remit of a debate.

Following some very helpful responses from predecessor Ministers and officials at the Department of Health and having convened various roundtables—with the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists and other key players, as well as various stillborn charities—I thought we had got to a place where the law could be changed to emulate what has been done in New South Wales in Australia. However, we still have a iniquitous and highly distressing situation: somebody who has gone through the trauma of carrying a child as far as 23 weeks and six days will find, if the child is, tragically, born prematurely and stillborn, that the child is not recognised in the eyes of the state, although a child born just after the 24-week threshold will be recognised as a stillborn child. I have previously raised the example of a woman who had twins either side of that threshold: sadly, they both died, but one was never recognised, while the other was recognised as a stillborn child, with a certificate being issued by the hospital.

For a woman who has given birth to a stillborn child, such a situation is one of the most sensitive and vulnerable of times. My hon. Friend the Member for Colchester knows this so well, and other hon. Members have given their own very emotional accounts of going through such traumas. The fact is that the state has still, so far, failed to take the straightforward and fairly cost-free step of coming up with a simple registration scheme for those for whom such a scheme would help to provide some form of closure.

For a stillborn child born at under 24 weeks—what I am talking about is different from miscarriage, although I am in no way trying to underplay the trauma caused by having a miscarriage—to be recognised as a human being, rather than as a child who, sadly, was born before an artificial threshold, seems to me to be a sensible but humane thing to do to help the too many women who still give birth to stillborn babies. We need to bring that figure down, and we are doing so. In the meantime, we can at least give some succour and comfort to parents who have to go through this situation by saying that we appreciate and recognise what has happened, and sympathise and empathise with what they have gone through.

May I ask the Minister again whether there is any way that we can get this campaign going again? The issue has featured in one of our national soaps: an actress who went through it in real life re-enacted it in “Coronation Street”. There has also been a lot about it in the press. I ask the Minister to ask his Department to look at this issue again to see whether something can be done, because I think there could be a solution.

Mr Speaker, I have more than abused my privilege in this three hour and 50 minute debate, but these are issues on which there is a good deal of sympathy and empathy in the House. Yet again, we are greatly indebted to my hon. Friend the Member for Colchester for bringing them back to the House, where we have the power to make a difference to our future constituents’ lives.