Labour's most recent election manifesto promised that by 2009 all women would have choice on where and how they have their baby.

Labour's most recent election manifesto promised that by 2009 all women would have choice on where and how they have their baby.

Choice in community services has been repeatedly emphasised by ministers. But this week's news analysis suggests that the current financial pressures could be having a disproportionate effect on maternity provision.

The loss of much-loved local services - in particular midwife-led and birthing units - has also reopened an old debate about the 'best' and safest model. And although the government has expressed a commitment to home births, in some parts of the country trusts say they are now unable to support them. The trend towards centralisation of maternity units continues apace.

The National Childbirth Trust says as many as 19 midwife-led and birthing units have recently closed or are at risk. It suggests that the government's policy, which endorses the importance of choice, is well ahead of the current reality.

While maternity is in many ways unique, the way in which its services - particularly those representing the preferences of a minority - cope with the pressures of the market offers wider lessons. The debate is not for local decision-makers alone, but one in which the government may need to re-engage.