Juliet Rayment1, Christine McCourt2, Miranda Scanlon3, Lorraine Culley4, Helen Spiby5, Simon Bishop6, Layara Avila de Lima7. 1. City, University of London, 1 Myddelton Street, London, EC1R 1UB, UK. Electronic address: juliet.rayment.1@city.ac.uk. 2. City, University of London, 1 Myddelton Street, London, EC1R 1UB, UK. Electronic address: christine.mccourt.1@city.ac.uk. 3. City, University of London, 1 Myddelton Street, London, EC1R 1UB, UK. Electronic address: miranda.scanlon@btinternet.com. 4. De Montfort University, The Gateway, Leicester, LE1 9BH, UK. Electronic address: lac@dmu.ac.uk. 5. University of Nottingham, University Park, Nottingham, NG7 2RD, UK. Electronic address: helen.spiby@nottingham.ac.uk. 6. University of Nottingham, University Park, Nottingham, NG7 2RD, UK. Electronic address: simon.bishop@nottingham.ac.uk. 7. Universidade federal do Rio de Janeiro, 275 - Cidade Nova, Rio de Janeiro, RJ, 20071-003, Brazil.
Abstract
PROBLEM: Despite clinical guidelines and policy promoting choice of place of birth, 14 Freestanding Midwifery Units were closed between 2008 and 2015, closures reported in the media as justified by low use and financial constraints. BACKGROUND: The Birthplace in England Programme found that freestanding midwifery units provided the most cost-effective birthplace for women at low risk of complications. Women planning birth in a freestanding unit were less likely to experience interventions and serious morbidity than those planning obstetric unit birth, with no difference in outcomes for babies. METHODS: This paper uses an interpretative technique developed for policy analysis to explore the representation of these closures in 191 news articles, to explore the public climate in which they occurred. FINDINGS AND DISCUSSION: The articles focussed on underuse by women and financial constraints on services. Despite the inclusion of service user voices, the power of framing was held by service managers and commissioners. The analysis exposed how neoliberalist and austerity policies have privileged representation of individual consumer choice and market-driven provision as drivers of changes in health services. This normative framing presents the reasons given for closure as hard to refute and cultural norms persist that birth is safest in an obstetric setting, despite evidence to the contrary. CONCLUSION: The rise of neoliberalism and austerity in contemporary Britain has influenced the reform of maternity services, in particular the closure of midwifery units. Justifications given for closure silence other narratives, predominantly from service users, that attempt to present women's choice in terms of rights and a social model of care.
PROBLEM: Despite clinical guidelines and policy promoting choice of place of birth, 14 Freestanding Midwifery Units were closed between 2008 and 2015, closures reported in the media as justified by low use and financial constraints. BACKGROUND: The Birthplace in England Programme found that freestanding midwifery units provided the most cost-effective birthplace for women at low risk of complications. Women planning birth in a freestanding unit were less likely to experience interventions and serious morbidity than those planning obstetric unit birth, with no difference in outcomes for babies. METHODS: This paper uses an interpretative technique developed for policy analysis to explore the representation of these closures in 191 news articles, to explore the public climate in which they occurred. FINDINGS AND DISCUSSION: The articles focussed on underuse by women and financial constraints on services. Despite the inclusion of service user voices, the power of framing was held by service managers and commissioners. The analysis exposed how neoliberalist and austerity policies have privileged representation of individual consumer choice and market-driven provision as drivers of changes in health services. This normative framing presents the reasons given for closure as hard to refute and cultural norms persist that birth is safest in an obstetric setting, despite evidence to the contrary. CONCLUSION: The rise of neoliberalism and austerity in contemporary Britain has influenced the reform of maternity services, in particular the closure of midwifery units. Justifications given for closure silence other narratives, predominantly from service users, that attempt to present women's choice in terms of rights and a social model of care.
Authors: Christopher Grollman; Marina A S Daniele; Lia Brigante; Gwenan M Knight; Laura Latina; Andrei S Morgan; Soo Downe Journal: BMJ Open Date: 2022-09-21 Impact factor: 3.006