201 babies and nine women could have survived if the Shrewsbury and Telford hospital NHS trust had provided better maternity care. This is the heart-breaking conclusion of the independent report by Donna Ockenden, which exposes failures of leadership and a refusal to taken women’s experiences seriously. Ockenden describes how “for more than two decades they have tried to raise concerns, but they were brushed aside, ignored and not listened to”.
This has an ominously familiar ring to it. In his 2015 report into unnecessary deaths and harm to mothers and babies at Morecambe Bay NHS Trust, Bill Kirkup commented “These events have finally been brought to light thanks to the efforts of some diligent and courageous families, who persistently refused to accept what they were being told. Those families deserve great credit. That it needed their efforts over such a prolonged period reflects little credit on any of the NHS organisations concerned.”
Four years later Cath Broderick investigated maternity care at Cwn Taf in Wales and found: “Women did not feel that they had been treated with respect, provided with information they needed and given the care and support they required. The consequence of this had both physical and psychological impacts on them and their families”.
A chilling pattern emerges with the 2020 Julia Cumberledge, ‘First Do No Harm’ report findings that thousands of women and babies were harmed by Primodos, Sodium Valrpoate and pelvic mesh use.
In Morecambe Bay a culture of bullying and a failure by the board to face up to problems was revealed. One staff member who tried to raise concerns “was referred straight to occupational health. It seemed that as I dared to raise a concern I must obviously be mentally unwell… This whole conversation was held in public.”
These repeated failures to provide safe or even adequate healthcare for women underline the gender health gap that exists. In fact, the UK has the largest female health gap in the G20 and the 12th largest in the world. Countless studies show women experience poorer outcomes in healthcare. Women with dementia are shown to see their GP less often, are monitored less and are more likely to be given potentially harmful medication than men. In acute pain women are less likely to receive strong pain killers or this is delayed compared to men.
When it comes to maternity care, mothers from ethnic minority backgrounds, those with underlying health conditions, and those who are socially deprived and facing other forms of disadvantage are even more at risk of harm. Black women are four times as likely and Asian women are twice as likely to die in childbirth as white women in the UK, and stillbirth rates are higher in ethnic minority groups than white groups. The covid-19 pandemic has further widened these disparities, with evidence suggesting women of colour may be at greater risk of complications from covid-19.
Systemic change needed
These reports underline that these health inequalities are not about a few uncaring individual health workers (though some of those may exist). Fundamentally, they represent systemic failures, responsibility for which is concentrated at the top. Decades of underfunding across the NHS, combined with the sexism and racism which are endemic to capitalist society, have combined to create a health service that regularly fails women – especially women of colour. This crisis can only be solved by a transformation of the basis on which our health service is run. As a starting point, that means fully funding the NHS, reversing privatisation, paying NHS workers properly and training more staff to help them deliver the personalised care needed. It also requires a special focus on increasing the resources available to areas of the NHS that have been particularly badly overlooked and underfunded, such as maternity, gynaecology and women’s health. Real democratic control and management of the health service by staff and patients is also crucial to ensuring the lessons of these reports, as well as of the wider experiences of women in the health service, are fully absorbed and the necessary changes implemented.
Poverty, sexism and racism are woven into the fabric of capitalist society. So genuine dignity for all women and birthing people will never be fully possible while the system that generates these inequalities continues to exist. That’s why the fight for decent healthcare, particularly women’s, BAME, LGBT+ and disabled people’s healthcare, is intrinsically linked with the fight for a socialist society – one based on solidarity and human need, as opposed to capitalist greed. On the basis of public ownership of the major monopolies and democratic control by working-class people over the economy, it would not only be possible to massively increase the resources available of healthcare of all kinds, but to invest in challenging the backwards ideology which denies women bodily autonomy and discriminates against BAME people. This is the society which Socialist Alternative fights for – one which offers real liberation for all.