The inclusion of maternity services in the national service framework on child health is a vital step in tackling health inequalities.

The framework - and maternity services in particular - is potentially more important than any other so far: not only because maternity services have a unique role that benefits the whole population, but also because the evidence base supporting socio-economic action and service intervention is one of the strongest.

1Former chief medical officer Sir Donald Acheson made clear in his report on health inequalities that improving women's health was key to improving the health of children and the whole population.

Despite a growing number of competing frameworks and NHS plan objectives, the framework on children could deliver the greatest overall health benefit, provided that key crossgovernment connections are made. It should become the implementation plan for achieving the national target on reducing inequalities in infant mortality.

Anyone familiar with evidence on maternal and child health will know there is more to effective maternity care than continuity of midwifery during labour. In fact, themost important determinants of a healthy outcome are set well before labour.

We should take every chance to develop this framework as a public health programme, not simply as a hospital midwifery initiative.

The small amount of extra cash for midwives is welcome, to recoup much of the ground lost after the Cumberlege initiative on 'woman-centred, midwife-led care' over a decade ago.

Here is a golden opportunity to focus this framework on crossagency and cross-government preventive action. This would draw together many of the fragmented but important crossgovernment initiatives Acheson recommended - such as Sure Start, daughters of Sure Start, the teenage pregnancy initiative, family tax credit, New Deal for lone parents, better maternity/ paternity entitlements - into a proper strategic framework .

The focus of the NHS should not be exclusively on labour, but on providing accessible, evidence-based antenatal care.

The key challenge is how primary and secondary care together enable pregnant women to make early, informed choices about what is best for their babies.

In many deprived inner city areas more than one in five women do not benefit from evidence-based early antenatal intervention because they book too late. Primary care trusts, as well as hospitals, need to see this as a priority issue.

The task is relatively easy where general health is good; it is a tall order in deprived, multi-ethnic areas where informed choice means meeting language needs as a prerequisite of accessible care.

Diehard antenatal practices unsupported by evidence are difficult to tackle: unnecessary antenatal visits, unjustified measurements and interventions that, at best, waste women's valuable time and, at worst, cause actual harm.

Women and their GPs often know that only a more distant hospital offers a cost-effective service. The answer is not to shift workload from one unit to the other but to use the framework standard-setting process to ensure equity of access.

The midwife shortage and dependency on agency staff in London and the south east will not be resolved quickly or by royal colleges with competing agendas. Maternity workforce issues relate also to the Royal College of Obstetricians, which has trained too many obstetricians, and to new requirements for labour-ward duty that, if fully implemented, would risk creating obstetrician rather than midwife-led care.

The framework needs to ensure that the service views its multidisciplinary workforce comprehensively. A call to create managed maternity services networks could break down interdisciplinary barriers. Such networks will need creative solutions that use both obstetric and midwifery resources in pregnant women's best interests.

If the current glut of consultant obstetricians could be deployed to support the preventive care provided by midwives rather than high-tech intervention, it might provide a partial solution to the shortage of midwives.

While it would be wrong to advocate that obstetricians become more like midwives, it would break new and justified ground if we were to see one or two chairs in antenatal health open to competition from both midwives and obstetricians.

But, of course, it would take at least two royal colleges to tango.