Personal female autonomy is a hard fought for feminist right but autonomy operates at its' best when a person is given adequate information and support in making an informed choice that is fully reflective of their ability to understand what it is they are signing up to. Autonomy operates within a framework of informed facts and a resulting choice of options offered. The maternity review which published its' findings today, quite frankly, would have scared the life out of me if were contemplating having a baby in the near future.
I haven't seen a government response to this review so there is a chance that it will not be implemented but, for now, let's examine the first recommendation made to provide pregnant women with a £3,000 'personal budget' which is packaged up as a personalised care system.
Women will decide for themselves how to spend this money: they will chose the provider of their antenatal, intrapartum, and postnatal care; they will choose the support they need during birth and whether they would prefer to give birth in a midwifery unit, an obstretic unit or at home. The only mandatory requirement is for every pregnant women to have a midwife. Everything else, as far as I can make out, will be a personal choice.
I cannot help but think that the element of 'choice', which is a strong thread running through the entire review, is more like an 'illusion of choice'. Through my work with a charity (Powerhouse for women) I know that personal budgets can be a burden sometimes and does not always produce results in the best interests of the beneficiary. Pregnancy requires medical intervention and advice. Is the current health system operating at a optimum to be able to accommodate these sort of changes? My worry is that a struggling NHS will further struggle to accommodate a multitude of demands. No two pregnancies are the same. Magnify this figure and imagine a local community midwifery group coping with extra workloads.
Every pregnant woman will be allocated a 'digital maternity tool' which'enables them to access their own health records and information that is appropriate to them, including the latest evidence and what services are available locally'. This presupposes that every pregnant woman in the land will have a smart phone or a desktop/laptop PC to access this digital service. I know of people who are on low levels of income who don't have laptops/desktops PC and run their phones on a pay as you go basis, frequently running out of credit. What if someone is living in a part of the country with no broadband access? There are so many variables that I wonder how a uniform service could be provided with a duty of care.
There are a number of ways to dissect this review and the following are links worth looking at: