The Health Protection (Coronavirus) (Requirements) (Scotland) Amendment Regulations 2022 and The Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No. 2) Regulations 2022: equality impact assessment

Pregnancy and Maternity

Background

Current evidence, focusing on the delta variant, suggests that pregnant women are no more likely to get Covid-19 than adults without health conditions, but that they may be at increased risk of becoming severely unwell compared to women who are not pregnant, particularly in the third trimester.^{[143] [144] [145] [146]}

Though evidence surrounding whether COVID during pregnancy increases the risk of still birth is conflicting, recent evidence suggests an increased risk.^{[147] [148]} A study from the American Journal of Obstetrics and Gynaecology that studied more than 340,000 births in England up to January 2021 found that women who tested positive for Covid-19 around the time of birth were twice as likely to have a stillbirth, and were more likely to have an emergency caesarean birth compared with those who didn't have Covid-19 when giving birth. Another global study of 2,100 pregnant women across 18 countries found that women who contracted Covid-19 during pregnancy were over 50% more likely to experience pregnancy complications, and that their risk of dying during pregnancy and in the postnatal period was 22 times higher than in the non-infected pregnant women.^[149] Babies born to mothers who have Covid are also more likely to be born pre term.^{[150] [151]} Although there was less evidence earlier in the pandemic, pregnant women had been included in the list of people at moderate risk if they contracted the virus as a precaution, and a small number were asked to shield during the pandemic if they had congenital or acquired heart disease.^[152]

The Royal College of Obstetricians and Gynaecologist have said that vaccination in pregnancy against COVID-19 is strongly recommended and should be offered at the same time as the rest of the population based on age and clinical risk.^[153] JCVI and the NHS also recommend pregnant women are offered the vaccine as well as encouraging them to get the second dose while pregnant, if not pregnant at the time of their first dose.^{[154] [155]}

The virus has also impacted pregnant women's wellbeing and economic prospects. A survey of almost 20,000 mothers and pregnant women, conducted after the first wave by Pregnant Then Screwed, showed that 15% of mothers surveyed were either made redundant or expected to be made redundant. 72% of mothers reported needing to work fewer hours because of childcare issues, and 65% of mothers who were furloughed said a lack of childcare was the reason.^[156]

Differential impacts

Positive impacts

Public insights polling has found that 53% of those surveyed agreed that the high level of people with two doses of the vaccine in Scotland gives them more confidence to go out and about^[157] and 62% of respondents agreed that, it they wanted to go to premises or an event, having Covid Status Certification in place would make them feel more comfortable doing this.^[158] This was particularly true of women, who were 7 percentage points more likely to agree that it would make them feel more comfortable (women 65% vs men 58%).

Therefore Covid Status Certification could add a layer of reassurance to pregnant women and support them to feel safer and more confident participating in society. More recent polling of 9,000 pregnant women by Pregnant Then Screwed showed that three quarters of respondents said they feel anxious about the easing of Covid-19 restrictions.^[159]

If the policy objectives to reduce the risk of transmission is achieved, Covid Status Certification could benefit pregnant women as they are at a higher risk of poorer health outcomes if they contract the virus.

Stakeholders highlighted that, if the policy objective to allow higher risk settings continue to operate as an alternative to closure or more restrictive measures is achieved, Covid Status Certification would be welcomed by many pregnant women as they have been negatively and sharply impacted by the economic burden of restrictions and lockdowns.

Negative impacts

We know that vaccine hesitancy is higher in women, particularly younger women, in part due to fears related to fertility.^[160] Stakeholders have highlighted anecdotal evidence that women who conceived through IVF are particularly vaccine hesitant. Whilst direct comparisons are not currently available, the data on Covid-19 vaccination in pregnancy shows that, to date, vaccination rates have been lower in pregnant women compared to non-pregnant women in the same age groups. Public Health Scotland data shows that 30% of women aged 35-39 who delivered their baby in July 2021 had received a Covid-19 vaccination by the time of delivery. By contrast, data available for the general population shows that by the end of July 2021, 81% of adults aged 30-39 years in the general population had received at least one dose vaccine.^[161] Data from NHS England also found that 98% of pregnant women admitted to hospital in England with Covid-19 had not been vaccinated.^[162]

Pregnant women could then be impacted by Covid Status Certification if they are not vaccinated and are denied access to the settings in scope. However, adding testing to Covid Status Certification would mitigate against this as pregnant women or those breastfeeding who choose not to be vaccinated can provide a record of a negative test in order to access a regulated setting.

There are very few circumstances where pregnant women are advised against vaccination due to pregnancy related complications. In these circumstances record of a negative test can be provided as an alternative to proof of vaccination.

Data from the Office for National Statistics from February to March 2021 shows that not being able to find childcare was a key reason why some people were unable to attend their vaccination appointments.^[163] This is a particular issue for women, who are more likely to have caring responsibilities, and also more likely to be reliant on public transport.^[164] If people with childcare responsibilities are then unable to access vaccination, this could impact their ability to access venues in scope. While testing is available as an alternative, this may be less convenient than being vaccinated, especially for those who may not have much free time to self-test.

If Covid Status Certification exceeds the policy intention and is used by private businesses or third parties as a condition or employment, then this could negatively impact on pregnant women if they have not been vaccinated. A negative test could be used as an alternative to proof of vaccination, however as a LFD test result is only valid for 24 hours, testing every day could be burdensome. Businesses which are not covered by the Government's scheme are required to meet their obligations under all relevant law including data protection, the Equality Act and Human rights. For more information see the Equality and Human Rights Commission Guidance for Employers..