Convention on the elimination of all forms of discrimination against women: position statement

Article 12: Women's health

1. States Parties shall take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care services, including those related to family planning.

2. Notwithstanding the provisions of paragraph I of this article, States Parties shall ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation.

The Scottish Government acknowledged that reducing health inequalities is a significant challenge; they are a symptom of wider social inequalities. The Scottish Government is working to address the underlying causes: ending poverty, fair wages, supporting families, and improving our physical and social environments. Measures to tackle these inequalities are driving investment; affordable housing, free school meals, free prescriptions, concessionary travel and free personal care. The Scottish Government is also taking decisive action to address alcohol consumption, smoking rates, active living, healthy eating, and investment to improve mental health services.

12.1 Tackling Health Inequalities in Scotland

The Community Links Worker (CLW) programme, funded by the Scottish Government, involves a dedicated individual working in GP surgeries, helping patients on a one-to-one basis with non-medical problems that are making them feel unwell. The programme is being delivered in areas of socio- economic deprivation (including widespread and pocket deprivation, in both urban and rural/remote areas). It is focused on mitigating health inequalities and alleviating pressures in GP practice teams. Forty CLWs were in place by September 2017 and the Scottish Government will increase the number in disadvantaged areas to 250 over the next five years.

The Scottish Government is expanding access to Family Nurse Partnership(FNP), an intensive, preventive, one-to-one home visiting programme for young, first time mothers and their children from early pregnancy until the child reaches the age of two. FNP aims to break the cycle of disadvantage by working directly with young mothers and their children to improve their health and wellbeing. It is currently available to first time mothers aged up to 19 in ten NHS health board areas and supports almost two-thirds of the first time, young mother population at any one time. There are high levels of engagement and retention. The expansion will widen the programme offered to eligible first time mothers up to age 24.

Since 2014-15, NHS Health Scotland has used an internal prioritisation tool that includes consideration of human rights when planning work to help it focus resources on the things that will make the biggest difference in reducing health inequalities. This is being refined through an internal improvement project to align with a rights based approach.

In June 2017, NHS Health Scotland produced a new recourse to support NHS Boards in reducing health inequalities. ' Maximising the Role of NHSScotland in Reducing Health Inequalities', aims to provide senior NHS staff with advice on how they can contribute to reducing health inequalities. It describes practical actions they can put in place to reduce health inequalities to ensure the best attainable health outcomes for both the people and communities they serve and the staff they employ. The resource has been shared with all Scottish NHS Health Boards.

12.2 Maternity

The report of the Scottish Government commissioned review of maternity and neonatal services – The Best Start: A Five Year Forward Plan for Maternity and Neonatal Care in Scotland was published in January 2017. The report contained 76 recommendations that will fundamentally reshape services to truly put the mother, baby and family at the centre of service planning and care delivery, and to keep mother and baby together as much as possible. Implementation of the recommendations is underway and early changes will include a move to a continuity of carer model of care.

12.3 Baby Box

The Scottish Government is determined that every child, regardless of their circumstances, should get the best start in life, and Scotland's Baby Box ensures that families have access to essential items in the first few months of a child's life. It has been awarded British Safety Standard accreditation as a crib for domestic use and, as well as health care items for babies, contains breast pads and maternity towels. The registration process for Scotland's Baby Box offers health professionals the opportunity to engage with parents at timely intervals throughout pregnancy. This is an important step in encouraging the small number of expectant mothers who do not currently register for ante- natal services to do so, and to receive appropriate support and health care for themselves and their baby. The Baby Box also provides health professionals with a timely opportunity to introduce expectant parents to a wide range of health promotion information, such as adopting healthy eating and lifestyle habits, smoking cessation and carbon monoxide monitoring, as well as 'no alcohol' messaging. Registration for Scotland Baby Box opened on 15 June 2017, with over 10,000 registrations. Delivery began on 15 August 2017 and over 3,000 boxes have already been despatched. From 1 November 2017, Baby Boxes will be delivered at least four weeks before the baby's due date.

12.4 Sexual Health and Wellbeing

The first Sexual Health and Blood Borne Virus Framework was published by the Scottish Government in 2011 and was refreshed in 2015. The Framework brought together policy on sexual health and wellbeing, HIV and viral hepatitis for the first time. It sets out five high-level outcomes, and sought to strengthen and improve the way in which the NHS, the third sector and Local Authorities supported and worked with individuals at risk of poor sexual health or blood borne viruses.

In Scotland the Pregnancy and Parenthood in Young People Strategy ( PPYP Strategy), published in 2016, specifically mentions the importance of supporting positive relationships, high quality sexual health education, as well as the need for comprehensive sexual and reproductive health services in relation to young people. The Strategy was developed with the input of young people from across Scotland.

12.5 Abortion Services in Scotland

In Scotland, abortion is carried out under the terms of the Abortion Act 1967. This means an abortion must be certified by two registered medical practitioners and justified under one or more of the seven statutory grounds set out in the Act. Most commonly this will mean that the doctors agree an abortion would cause less risk to a woman's physical or mental health (or that of her existing children) than continuing with the pregnancy. Abortion is available up to 24 weeks into pregnancy, however in rare circumstances, where it is necessary to save the woman's life, prevent severe permanent injury to the physical or mental health of the pregnant woman or if there is a substantial risk the child would be born with physical or mental abnormalities and be seriously handicapped, it can be provided after 24 weeks.

12.6 Supporting access to abortion services for women in Northern Ireland

The Scottish Government believes that a woman from Northern Ireland, in Scotland, should be able to access an abortion for free on the same basis as women in Scotland. A statutory instrument came in to force on 6 November 2017 which provides a legal basis for NHS Boards to provide free abortion care, in Scotland, to women from Northern Ireland.

12.7 Mental Health

The Scottish Government's vision for mental health is of a Scotland where people can get the right help at the right time, expect recovery, and fully enjoy their rights, free from discrimination and stigma. The Scottish Government was the first part of the UK to have a Ministerial post dedicated to mental health, and the Mental Health Strategy 2017-2027 was published in March 2017. The Strategy contains a vision of a Scotland where people can get the right help at the right time, expect recovery, and fully enjoy their rights, free from discrimination and stigma. It sets out how, over the 10 year lifespan of the Strategy, the Government will work on achieving parity between mental and physical health.

The strategy contains an initial 40 actions, and progress will be reported on through a bi-annual stakeholder forum and through the annual report that the Minister for Mental Health will present to Parliament, starting in Summer 2018.