Scottish Government Equality Outcomes: Pregnancy and Maternity Evidence Review

6 Poverty

6.1 Pregnancy is one of the key triggers that increase the risk of women living in poverty, particularly where they are lone parents⁴⁸. Research indicates that poverty or deprivation amongst pregnant women is linked with poorer outcomes. For example, one study found that deprivation in pregnancy is associated with diets poor in specific nutrients, and poor diet contributes to inequalities in pregnancy outcomes including pre-term births and lower birth weights. Improving the nutrient intake of disadvantaged women of childbearing age may potentially improve pregnancy outcomes⁴⁹.

6.2 Child poverty affects the life chances of children and is a key concern of the Scottish Government. The pregnancy and maternity periods are key transition times for women to access advice to ensure that they are getting the pay and welfare benefits to which they are entitled. There are services that aim to support women at such transition times, including, for example, the call-back service developed by One Parent Families Scotland⁵⁰. Such support can reduce the risk of family poverty, and mitigate the effects of poverty.

6.3 A project in NHS Greater Glasgow and Clyde aimed to tackle poverty amongst pregnant women and families with children at risk of, or experiencing, child poverty. The "Healthier, Wealthier Children" Project aimed to develop new approaches to providing money/welfare advice and, over a period of 15 months, achieved financial gains in excess of £2.25 million for pregnant women and families accessing advice services through the project. Using innovative approaches, including referrals to money advice services through midwives and health visitors, the project provided a new pathway for improving access to support that could mitigate the impact of poverty. It has been evaluated as having raised awareness of child poverty among the early years health workforce, and offers lessons for the wider early years' workforce across Scotland⁵¹.

Welfare reform

6.4 Projects such as those described above are likely to become more important with the coming reform of social security, tax and benefits. Maternity Action estimates that women stand to lose £911.87 from a "cumulative loss of benefits and reductions in maternity payments during pregnancy and maternity leave"⁵². Cuts already implemented that affect women during pregnancy and maternity include:

• The Health in Pregnancy Grant ceased in 2011. This was a £190 payment to all mothers which was paid in the later stages of pregnancy.
• The Sure Start Maternity Grant was restricted from 2011 to first babies or multiple births. This is a one-off payment of £500 to parents on lower incomes, to assist with the costs of having a new baby.
• Child Benefit (£20.30/week for the first child and £14.30/week for subsequent children) was frozen from 2011. It will be reduced through a new income tax charge on higher earners from April 2013⁵³.

6.5 Analysis by the UK Women's Budget Group also demonstrates that women's incomes are being affected by reductions in pregnancy and maternity related benefits⁵⁴. In addition to the cuts already implemented, payments for maternity, paternity and adoption leave will be subject to the 1% cap on benefits increases to for three years from April 2013, against an expected inflation level of 2.7 - 3.1%. The UK Women's Budget Group estimates that every new mother will lose £180 in statutory payments over the duration of the payments.

Refugees and asylum seekers

6.6 Pregnant women and new mothers in the asylum system are particularly vulnerable to poverty⁵⁵, but their situation can be hidden from official records. Asylum seekers have access to financial support only in restricted circumstances, and pregnant women and new mothers have very limited support, including a smaller maternity grant than is provided through the mainstream welfare benefits system⁵⁶.

6.7 Some women rely on charitable payments from organisations such as the Refugee Survival Trust for grants to buy essential items for a new baby. Those who rely on Section 4 Asylum support do not get cash, but a voucher that they can only use in specified supermarkets. Such cashless support is particularly problematic for new mothers because it restricts access to and the affordability of the items they may need⁵⁷. Research evidence for the EHRC identified that these women do not get the 'milk tokens' payment for pregnant and nursing mothers, which is provided for those receiving Section 95 support (p. 69)⁵⁸.

Teenage pregnancy and poverty

6.8 According to a recent area based research project, My Fair London,

The UK has the second highest rate of teenage pregnancies out of the 21 most developed countries for which comparable figures are available. The proportion of teenage girls becoming pregnant is higher in more unequal societies and increases as inequality increases (p.17)⁵⁹.

6.9 Whilst pregnancy and maternity can increase the risk of poverty for women at any age, teenage pregnancy is often a cause and a consequence of increased social exclusion, of living in poverty with reduced access to social provision such as education, training and benefits. Teenage parents tend to remain poor and are more likely to suffer relationship breakdown, to have no qualifications by the age of 33, and to be on substantially lower incomes in their thirties, than any other group⁶⁰.

6.10 Teenage pregnancy is linked to deprivation, with the rates of teenage pregnancy in deprived areas of Scotland more than treble those of the least deprived areas⁶¹. For women under 20, the most deprived areas have approximately ten times the rate of delivery as the least deprived (64.7 per 1,000 and 6.2 per 1,000 in 2010) and nearly twice the rate of abortion (p.4). In 2010, in the most deprived areas, the rate of teenage pregnancies in the under-16 age group was approximately five times the rate in the least deprived areas (13.7 per 1,000 and 2.7 per 1,000 respectively). NHS Board areas show substantial variations in rates - the rate of pregnancies under 16s was highest in Fife in 2010 (9.2 per 1,000) and lowest in Highland (5.4 per 1,000), while pregnancy rates amongst under 20s was highest in Ayrshire and Arran⁶².

6.11 A large scale study of 'early parenthood' reveals that women were more likely to become teenage parents if they have (or had) negative experiences of schooling, poor material circumstances and low future aspirations in terms of the labour market (Harden et al 2009). The literature reviewed indicated that early childhood and youth interventions that provided social support, increasing aspirations for the future, were effective⁶³. One qualitative study suggests that more work is needed to understand the influence of place for young people's sexual and reproductive health⁶⁴.

6.12 The Health and Sport Committee of the Scottish Parliament is conducting an inquiry into teenage pregnancy rates in Scotland⁶⁵, including seeking views on the relationship between high levels of teenage pregnancy and socio-economic inequality. One Parent Families Scotland has an award-winning project, "Transforming Lives", which aims to provide an integrated pathway of support for young pregnant teenagers and young parents aged between 13 - 21 years, to develop their capacity to become more confident capable parents⁶⁶.