More low-weight babies are born in Britain than anywhere else in Europe. This should be at the front of the next prime minister’s mind as he strives to give every child an equal chance, says Louise Bamfield
As the day of Tony Blair’s departure from Number 10 draws closer, speculation in Westminster is not about the name of the next prime minister, but what a change of leader will mean for government policy.
It is well known that chancellor Gordon Brown’s priorities are not the same as Mr Blair’s. One of the nagging questions facing Mr Brown will be: ‘Is this as good as it gets for Labour on health and social justice?’
One concern for the chancellor is the government’s struggle to make progress in the battle against poverty and inequality, causes he has personally championed. In the new Fabian report Born Unequal, we consider why Britain has the worst record for low birth weight babies in Europe - and establish that the record is getting worse.
Over the past 20 years, the proportion of low birth weight babies in the UK has risen from 6.7 per cent of births in 1989 to 7.6 per cent in 1999 and 7.8 per cent in 2006. Research also shows a clear social class divide. Poorer parents are 1.5 times more likely to have a low birth weight baby than parents in professional or managerial jobs.
These figures highlight the day-to-day inequalities that individuals struggle with inside the world’s fourth-biggest economy, and which Mr Brown must attempt to tackle during his term in office.
The challenge for Mr Brown is to prove the Labour government has not reached the limits of the social progress it is capable of. While its quiet but persistent efforts to chip away at poverty and inequality have brought significant, and underrated, progress, in other areas its ground-breaking commitments - for instance the pledge, backed by public service agreement targets, to reduce inequalities in infant mortality and life expectancy - are proving tough to fulfil.
Mr Brown can continue to advance the social justice agenda in health and social policy by doing two things. First, Labour needs to go public about its values. The government’s attack on child poverty, the creation of Sure Start and child trust funds, are animated by a concern about unequal life chances, which sees an equal start and fair chance in life as a defining mission for progressive politics.
A question of confidence
Often accused of operating quietly, even stealthily, Gordon Brown will need to find the right language, and the confidence, to communicate the vision which lies at the heart of the poverty and inequality agenda.
Second, he needs to challenge David Cameron and the right - who, while forced to pay lip service to the language of social justice and relative poverty and the virtues of a national health service, would prefer to move back to a position of lower overall spending with which they are naturally more comfortable.
What Mr Brown must do, therefore, is challenge the right with new popular causes that can mobilise public support by telling a story about the vision of a fairer society which lies behind them.
One policy area which passes both these tests is interventions to promote life chances before birth - what we have called a new ‘pre-birth’ agenda, an emerging priority for the government in recent months.
Mr Brown’s decision to start paying child benefit before birth - from 2009 it will be paid from the 29th week of pregnancy - responded to evidence put by the Fabian life chances commission and other campaigners showing that low income was a significant factor in whether some pregnant women could afford the diet they needed.
Being born at a low birth weight casts a long shadow over children’s prospects for the rest of their lives. It is an obvious cause for concern, therefore, that the UK has the worst record on low birth weight of any European country, and that babies born to poorer families are significantly more likely to be born underweight.
Aiming to give every child the best start, and breaking through cycles of deprivation which begin before a baby is born, should be a key priority for any social justice agenda. This agenda also chimes with what women voters want.
As well as providing adequate support for parents in the stressful and demanding time after the birth of a child and the first years of life, we need to relieve pressures on parents-to-be by introducing greater flexibility in patterns of study, training and employment.
Body of evidence
Fabian research on inequality and poverty has shown that producing evidence of the effectiveness of policy can influence opinion. You are no longer simply tugging at people’s heart strings, but putting the economic case - that investing in children and their future is money well spent and avoids the bills of social failure later on.
Usefully for Mr Brown, focusing on the pre-birth agenda will open up a new argument between left and right, about the causes and consequences of poverty and inequality and how to narrow them.
Hard questions remain for the right over its commitment to social justice. It needs to answer the charge that its renewed focus on ‘social responsibility’, rather than the state, will not in practice equate to an abdication of governmental responsibility for outcomes.
The opposition has yet to offer much acknowledgement - still less a convincing analysis - of why inequality grew so sharply in the 1980s, but the central lesson is surely that the policies of governments do matter a lot.
So how should the government take forward the pre-birth agenda? First, in the vulnerable period during labour and immediately after birth, the priority is to ensure that every sick, premature or underweight baby has access to the appropriate level of care for his or her needs.
According to recent research only a tiny minority of units (three out of 143 surveyed) achieved the recommended nursing level in 2006, while almost 90 per cent of intensive care units reported having to close their doors to new admissions in the previous six months.
Importantly, analysis by the premature baby charity BLISS shows that what is needed is not so much an increase in the number of staffed cots in intensive care, but better clinical management to prevent ‘bed blocking’ by infants needing lower (high dependency or special) levels of care.
Although the need for one-to-one nursing for babies in intensive care was acknowledged by the government in 2003, the Department of Health has yet to make it mandatory. It must do so urgently, while also incentivising neonatal units to adopt more flexible ways of working to promote staff recruitment and retention.
Prior to birth, more needs to be done, especially through investing in specially trained nursing staff and outreach workers to help meet the needs of pregnant women most at risk of having a low birth weight baby. Given the tight fiscal climate, it may be more realistic to envisage this extra investment coming from a redistribution of expenditure rather than an increase in overall funding for maternity care (although the latter would certainly help).
As the UK currently aims for a relatively high number of antenatal appointments for pregnant women - 13 compared to nine in many EU countries - it should be possible to ‘rebalance’ antenatal services, by reducing the standard number of antenatal visits, which would then release resources to focus support on the most disadvantaged pregnant women.
Clearly, such redistribution of resources would not be universally popular. Recent local campaigns against reconfiguring maternity services are a reminder of how contentious this kind of ‘rebalancing’ can be - especially when the motivation for change is perceived as being financial or political, rather than best clinical practice.
So it is important to be clear about the rationale behind any such proposal, reassure women that changes to the pattern of care are consistent with best practice and convince mothers that it will not compromise care.
Above all, the government must signal its determination to improve birth outcomes by making a reduction in low birth weight babies a national health and social priority. It also needs to address the lack of knowledge about what policies are most effective in promoting maternal and infant health.
To build up the evidence on effective policy interventions, the government must increase investment in rigorous research studies (for example, encouraging larger sample sizes and funding randomised control trials).
Adequate financial support is also needed before and during pregnancy to promote the health of pregnant women and prospective parents, particularly young pregnant women and parents-to-be, who currently receive less income support than those aged 25 and above.
Given that risk behaviours by mothers, such as smoking, are key factors affecting the health of babies, the discussion of life chances before birth inevitably raises sensitive debates about how much mothers are responsible for foetal well-being. Sections of the liberal left have, perhaps understandably, traditionally avoided such debates, for fear of undermining their own political position: that women should have the right to govern their own pregnancies.
This silence has been unfortunate, as it has left the debate monopolised by commentators who make moral judgements about mothers. In the UK this has been evident in the harsh stories about teenage, working and single mothers in the right wing press.
The ambition to reduce inequalities at birth will not be easily achieved. A generational political shift is needed on the scale achieved by Attlee in welfare or by Thatcher in the role of the market. But it offers the new Labour prime minister a chance to throw down the gauntlet to all who lay claim to the mantle of social justice, across the political spectrum. -
Louise Bamfield is a senior research fellow at the Fabian Society. The new Fabian Society report, Born Unequal: why we need a progressive pre-birth agenda, was published yesterday, www.fabian-society.org.uk