Maternity and neonatal care - Best Start implementation: equality impact assessment

Stage 2: Data and evidence gathering, involvement and consultation

Include here the results of your evidence gathering (including framing exercise), including qualitative and quantitative data and the source of that information, whether national statistics, surveys, or consultations with relevant equality groups.

Characteristic^[1]: Age

Evidence gathered and Strength/quality of evidence

In relation to age, we know from Information Services Division (ISD) statistics that women are now giving birth later in life. Often this can bring an additional element of complexity to a pregnancy therefore care needs to be based around each woman and her individual needs.

Source

Maternity and Births Publications

Data gaps identified and action taken

• Choice of place of birth location currently contains guidelines on age. A literature review has been undertaken to establish if these restrictions are the most up to date evidence.
• Research into the rising Caesarean section rate will consider if age is a factor.

Characteristic: Disability

Evidence gathered and Strength/quality of evidence

In 2012, 28 per cent of men and 35 per cent of women in Scotland reported a limiting long-term condition or disability.

In 2011, the proportion of people in Scotland with a long- term activity-limiting health problem or disability was 20 per cent (1,040,000 people), the same proportion as reported in 2001 (1,027,872 people).

Sources

Scottish Health Survey 2012

2011 Census

Data gaps identified and action taken

• The ethos of Best Start is that care is individualised around each woman and any clinical, social, physical, and psychological needs.
• Care should be delivered closer to home wherever possible, including the use of technology where appropriate.

Characteristic: Sex

Evidence gathered and Strength/quality of evidence

The large majority of lone parent households are headed by women and these households tend to experience high poverty rates: 34% were in poverty in 2014/15, compared with 26% of single working age women without children. For comparison, 16% of couples with dependent children were in poverty in 2014/15. These statistics have implications for child poverty, as women tend to be the main carers of children.

Source

Sourced from the Equality Impact Assessment for the Child Poverty (Scotland) Bill.

Data gaps identified and action taken

• Redesigning neonatal care may have an impact on the ability of women and their partners to be able to visit and bond with their baby. Creation of the Neonatal Expenses Fund should mitigate this by reimbursing travel costs. However, this would affect a very small number of families whose baby would require highly specialised care.
• This is also balanced with the overall redesign of neonatal care which will see an increased role for families in caring for their baby in neonatal care and an increase in facilities for families to stay, for example in Neonatal Transitional Care.
• An increase in partners to stay in maternity units should be consistent across Scotland to ensure equity of access and improve support for mothers and increased bonding.

Characteristic: Pregnancy and Maternity

N/A

Characteristic: Gender Reassignment

N/A

Characteristic: Sexual Orientation

N/A

Characteristic: Race

Black women still have more than five times the risk of dying in pregnancy or up to six weeks postpartum compared with white women, women of mixed ethnicity three times the risk and Asian women almost twice the risk.

Source

Oxford Population Health - Research

Data gaps identified and action taken

• Outcomes for Black, Asian, and minority ethnic (BAME) women and their babies are poorer. Introducing continuity of carer should help mitigate this.
• Individualised care planning should identify clinical, social, physical, and psychological needs including risks associated with women from BAME background. Best Start recommendation 29: Women who present out with a maternity setting or have a pre-existing condition should receive timely medical advice in relation to their pregnancy.

Characteristic: Religion or Belief

N/A

Characteristic: Marriage and Civil Partnership

N/A

(the Scottish Government does not require assessment against this protected characteristic unless the policy or practice relates to work, for example HR policies and practices - refer to Definitions of Protected Characteristics document for details)