• By Dartington SRU
  • Posted on Tuesday 23rd February, 2010

Midwives – it's time to sweat that early intervention asset

The vital importance of the midwife as a "channel" of insight connecting universal and targeted family services was highlighted at a UK conference to launch publication of the UK Strategic Review of Health Inequalities.Naomi Eisenstadt, the retiring director of the UK Social Exclusion Task Force and a former chief adviser on children's services, was making the case for a "second wave" of activity to consolidate Labour's Healthy Child program.She stressed the value of the earliest of all possible early intervention strategies – with the minus-nine months to two age group. "When I went to the Department for Children Schools and Families in 1999 they thought that children were born at five," she said. "When I left in 2006 they thought that they were born at two. There's something about the way we work with young children that's tied in with institutional frameworks, not to children. In fact, it was a major effort to get them to stop calling infants 'pupils'."Midwives represented a more versatile, free-ranging approach to assessment and to meeting community need."I think we have to sweat the asset. We have fabulous universal services. We don't use them flexibly enough in the way that people live their lives. So for example:– the midwife is checking over the pregnant woman. The woman has brought her six-year-old son. It turns out during the check that the son has a different father from the new baby. I want the midwife to ask 'and how's he getting on with his new Dad?' "I want her job to be not just about the bump. I want the job to about an initial family assessment. It's a universal service; it's not stigmatized. "We have opportunities here to use our public services in a much more creative way. It requires more investment, but just think about language development between zero and two. Before kids ever get near a nursery a lot has already happened, and a lot has happened that is already very hard to catch up on. I think that early family assessment can happen in pregnancy. In the process of "sweating their assets" policy makers had to resist the impulse to choose between support strategies as if they were mutually opposed.An example of such damaging either–or debates was 'fiscal measures or better service design,' she said. Money alone wouldn't do it, nor would love alone. It took money and love. Relationships and income mattered most in outcomes.Another such false distinction was drawn between better early education and care services for children and better parent support. "We need both," she said. "We know how to make early education and care better; we are very weak at knowing how to change adult behavior. But we need to do both if we're going to make the change." A third example was universal services or targeting, when both were needed as much. Midwifery was a prime example: "We need the universal services like midwifery as an entry into how to give disadvantaged people the most nuanced and appropriate services".Targeting was nevertheless an important issue in its own right."We know there's a very high risk in families where there's an adult in prison, but do we do an automatic assessment on children's services for the children of prisoners? Sometimes we don't even know if they have children. Even with female prisoners, sometimes we don't know what's happened to their children while they're in prison."Much the same was true for women with mental health problems, Naomi Eisenstadt said. "Again we know what the correlation is between mental health problems in a mother and child outcomes. We have enormous amounts of data on risk and yet we do not do the automatic assessment that would lead to better family support. "And, finally, we need a radical approach to the health of young women between the ages of 15 to 25. What is their health like preconception? How do we really make sure that young women have their health needs answered to produce healthy pregnancies. Almost everything we do in pregnancy on low birth weight is too late, except stopping smoking. But there's a huge amount that we should be doing pre-pregnancy."• The Strategic Review of Health Inequalities in England was commissioned to advise the UK Secretary of State for Health on the future development of a health inequalities strategy, by taking into account the best global evidence from the WHO Commission on the Social Determinants of Health, and the work of the last ten years. Documents and launch conference proceedings are available online.

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