Maternal health and the poverty trap
In June of this year Frank Field MP was appointed ‘Poverty Czar’ to the coalition government describing his role as an opportunity to forge a programme of action which particularly emphasises extending the life chances of poorer children. In the same month Chancellor George Osborne’s Emergency Budget saw the announcement of the cancellation of the health-in-pregnancy grant; a one-off payment of £190 for expectant mothers granted on or after the 25th week of pregnancy and the Sure Start Maternity Grant to all but the first child. These cuts were set against the back drop of an already concerning level of unemployment benefit at £51.85 a week and £65.45 a week for under and over 25s respectively; with JRF minimum income food standards for a single adult at £44.34 a self evident shortfall is identified.
When the Zacchaeus 2000 Trust, headed by Chairman Revd Paul Nicolson, made its submission to Field’s review, therefore, it was in the context of assessing the effect of poverty, and specifically poverty induced by low levels of unemployment benefit, on the health and well being of both mother and child before and during pregnancy.
It is a fact now widely accepted by nutritional scientists, including Prof. M. A Crawford, Dr W. Doyle and Dr G. A Rees to name but a few of the most prominent researchers in the field, that the poor nutrition of the mother before and during pregnancy, especially during the first trimester, can promote a range of health deficiencies in the infant including, and most notably, increased risk of Low Birth Weight.
The effects of Low Birth Weight range from increased risks of infant mortality and morbidity to neurological abnormalities and preterm births. This relationship is most striking between poverty, poor nutrition and Low Birth Weight with Prof. Jonathan Bradshaw, writing for the CPAG, suggesting that living in poverty increases the risk of LBW by 61% (Poverty 121, Summer 2005, p.16).
The effects of poverty on limiting levels of nutritious food available have been identified by the National Institute for Clinical Excellence. In the NICE public health guidance report of March 2008 36% of people in the ‘low-income group’ reported that they could not afford to eat balanced meals, one fifth of those questioned stated that they reduced or entirely skipped meals due to financial difficulty and 5% reported that, on occasion, they had not eaten for a whole day as they did not have the money to purchase enough food (NICE Public Health Guidance,11, 2008 p.19).
The North West Public Health Observatory has additionally released statistical evidence this month indicating that mothers from the most deprived areas of the North West are 1.7 times more likely to have an LBW baby than babies born to mothers in the least deprived areas (NWPHO from ONS births dataset, 2004-08). As we enter this time of government austerity it could therefore be considered unwise to sacrifice long term preventative measures for the sake of a potential short term financial gain which, as an alternative, is in itself questionable as depicted in some foreign models of intervention.
During the United States Women, Infant and Children (WIC) nutrient supplementation programme the US General Accounting Office reported that “savings made from reductions in estimated Medicare expenditure in the first year post-partum more than offset the cost of the Federal prenatal WIC programme” (Journal of Human Nutrition and Dietetics, 12, 1999, p.518). So preventative measures acting to secure the health of babies born into poverty not only saw an effective reduction in LBW births but also enabled long term financial savings by reducing demand on health care services in later life.
From the research conducted to date there has been significant indications that poor nutrition dramatically affects the health of both mother and child. When a parent, through adverse circumstances, is required to live on an income of £65.45 a week (or less in many cases) the ability to procure sufficient amounts of nutritious food is significantly reduced and conclusively the risk of LBW birth and the myriad health concerns associated with it are enhanced.
It would appear that the poverty trap to which David Cameron referred when appointing Frank Field to lead this review is one which must, fundamentally, concern both wealth and health.