I appreciate the remarks that the hon. Member for Torridge and Devon, West (Miss Nicholson) made about the Asian community and voluntary organisations. I share her wish that 'voluntary organisations should be helped and encouraged in their work. In fact, it has been noticeable that during the lifetime of the present Government many voluntary organisations have felt that they are being pushed into being a substitute for the Government rather than playing their proper role as partners and carrying out the kind of work which the hon. Lady correctly outlined, and which cannot be done simply through professional organisations or governmental bodies.
The debate has set the topic of women's health in context, both establishing the importance of good health to women and, as they are the majority of the population, to society in general. We need not justify our anxiety about our own health by reference to our partners or our children. We should defend our right to health in our own terms and for our own benefit.
Nevertheless, as women are the major planners of family diets and have responsibilities—some of them inescapable and some which should be more shared—for child care, they do have a special place in society. I associate myself with my hon. Friends who have set that in the context of poverty and have talked about the impact of bad housing and unemployment on health. It is impossible to consider ill health without considering the ills of society.
I associate myself also with my hon. Friends' remarks about the need for a cross-departmental approach. One of the distressing features of the British style of Government, and perhaps this it true of others—I am not singling out Britain but it is Britain that I observe at close quarters from day to day—is that policy appears to exist in little boxes. Governing in that way simply does not work properly, especially in matters concerning women. I associate myself entirely with the remarks of my hon. Friends on the importance of the Departments of Employment, Transport, and Energy in this context.
References have been made to food, and there has been some give and take about whether it is possible to buy cheap, healthy food as easily in working-class areas as elsewhere. I remind the House that the British Medical Association has established clearly that a healthy diet costs more than an unhealthy one because of the extra cost of supplying enough calories. The individual salad and vegetable items that go to make up a healthy diet may not be excessively priced individually, but it is necessary to provide more food of that sort to obtain enough calories. That should not be ignored. Cost is important, and studies have shown, for example, that it is impossible for expectant mothers on supplementary benefit to provide adequate diets for themselves and their coming babies. Not enough attention is given to these matters by the Government when they reduce the incomes of such mothers.
Even if someone has the money and the wish to eat a healthy diet, it can be well-nigh impossible to achieve it. For example, it is of doubtful benefit to eat lettuces in the winter because of their nitrate levels. A person may want to have good quality food and may have the money to buy it, yet still find it unavailable because of the distortion of agriculture policy. This arises for two main reasons. One is the pursuit of short-term profit and the second is the distortion and wrongful use of public subsidy for purposes that are connected with economic and agriculture objectives that are of less importance than the maintenance of health. The Ministry of Agriculture, Fisheries and Food has a great role to play in enabling the public to have a good diet, assuming that other Departments play their part and we manage to achieve suitable incomes and obtain sufficient knowledge to enable us to want and have a healthy diet.
I associate myself with the remarks that have been made about the desirablility of well woman clinics or centres. In Preston we have a good, popular well woman centre in which women doctors, non-professional helpers and counsellors participate, but it is absolutely tiny so it cannot cope with the demand that exists just underneath the surface. It does great work with ethnic minorities. Its ethnic minority worker, who has splendid contact with the whole of the considerable ethnic minority community, goes out from the clinic and does valuable work in the community.
We do not necessarily need a bigger centre—smallness can be desirable in this sort of context—but we need more of them. This one exists only because Preston borough council helped to find it premises and the district health authority helped it with money, but not enough. That is an area where we can have good partnership between voluntary workers, ancillary health-related people and professionals, such as doctors and nurses. But there needs to be pump priming, and that is not happening, so we have an inadequate network of well woman clinics—enough to show how valuable they are, but not enough to tackle the problems. I recommend the Minister to give that genuine consideration and to take action.
Well women give birth to babies, and maternity is not an illness. I greatly regret that over the years women have been forced into large district general hospitals which are geared to the treatment of illness and have found themselves cared for by people who are accustomed to abnormality rather than normality. The present concept of childbirth is almost one of medical crisis. That is wrong and we need to move in the opposite direction.
I urge the Minister most strongly to look at the need for continuity of care for women who are pregnant, in childbirth and after childbirth. It is monstrous when a woman goes to an antenatal clinic and does everything that the authorities exhort her to do—going monthly, then fortnightly and then weekly—that every time she sees a different midwife or doctor, and sometimes several of them attending to different bits of her. That is dehumanising for the woman and deskilling for the carers. We have gone too far along the wrong road.
I endorse what has been said about the need to pay women, nurses, doctors, health visitors and midwives properly. That is a necessary prerequisite, but job satisfaction, self-respect for clinical judgment are also important. Midwives have an excellent training which equips them to be practitioners in their own right and not to be the mere handmaidens of doctors. They exercise clinical judgment and are experts in normal birth. But they are not being given an adequate opportunity to exercise their clinical judgment. That is why the Labour party's approach in its good document on women and health, which will stand the test of time, puts great stress on the approach to maternity, maternity services and the role of midwives.
It is wrong for women to be treated as a collection of little "patches", which are seen by different people on every visit. It is also wrong that they are given entirely inadequate choice about the place and style of giving birth. More and more women are entering the controversy and making more and more demands, and I should like the Minister to commit herself to choice.
We hear a great deal from the Government about choice. which often amounts to the choice between two indistinguishable products on the supermarket shelves. In this instance, however, choice is a genuinely important element, because women are different and have different needs and wishes. There is not only one good pattern or one simple recipe for a good birth experience and a good outcome. In this context, a good outcome does not merely mean that the baby does not die: that is obviously imperative. It also involves the opportunity for bonding, and a positive feeling that does not make a woman say—as so many say immediately after giving birth—"Never again." That is not conducive to the development of a good relationship and good child care.
The argument is not between high-tech and low-tech; that would be a stupid argument. It is a matter of appropriate technology and adequate choice, neither of which is at present available. Many women are subjected to far too much intervention when giving birth, and a much too lavish use of expensive technology which they do not want or need. Others are deprived of, for example, adequate anaesthesia when they need it, because anaesthetists are too scarce, and the one who is there is busy with someone else. That is a nonsense. We need appropriate technology, no unnecessary intrusion and respect for women's wishes—as well as an acknowledgement by all concerned that as women's bodies swell their brains do not shrink.
The position is now so serious that some midwives leave the service because they are unhappy with their conditions, while others are driven outside the NHS to practice independently so that they can provide continuity of care. That is not because they want to be outside the NHS, but because this approach to maternity care is becoming unavailable on the NHS. We should look carefully at this phenomenon.
We should also look at the effect on midwives' ability fo exercise their clinical judgement. I do not know whether the Minister is aware of the controversies that are currently raging, but they bear on this. One instance is the disciplining of a midwife who decided to transfer her patient to hospital and, instead of waiting for an ambulance, accompanied the patient in a car driven by the patient's husband. That midwife has been disciplined for not waiting for an ambulance, although she exercised her clinical judgement about what was suitable, and she was right. There was a good outcome.
I should like to know who would have been disciplined if the midwife had waited for the ambulance and it had not come—for ambulances are increasingly scarce—or if it had come and had therefore been unable to go to someone else. Such an approach to the exercise of a midwife's clinical judgment is absolute rubbish. I should also like to know who is disciplined if there is unnecessary and intrusive use in hospitals of techniques such as episiotomy, which often have a very bad effect on women. I urge the DHSS to investigate that very carefully.
I welcome the breast-feeding initiative and I applaud anything that is done to encourage it. Breast feeding is extremely important for both mother and baby. The more time that elapses, the more work is done and the more information published to strengthen the argument for it. It is not, however, simply a matter of lecturing women about its importance. One Conservative Member said that the importance of breast feeding had to be "drummed in" to women. I can think of nothing less effective than trying to drum something in to women, although I hope that the hon. Member did not mean it in quite the way it sounded. Unfortunately, much of the health exhortation to women comes over in exactly that way: "Why can't you be a good little girl and do what is proper? Don't you care about your baby?" And such like. It is monstrous to behave in such a manner to women who are frequently suffering the greatest stress and pressure which is not being addressed by those who exhort them
I should like steps taken to prevent, not just to discourage—we are not talking about voluntary codes of practice—the promotion of baby milk formulas in hospitals and clinics. Such promotion still takes place and as long as the manufacturers of powdered milk have access to clinics and hospitals, mothers will be influenced to think that such products are the best for their babies.
Staff must have not only the right attitude, but enough time. That may mean that more staff should be available. Staff should not be harassed and, in their approach to hospital activities, they should not be made to believe that the efficient use of hospital resources means that they are kept almost at a run all day long while on duty. Staff should have the time to develop relationships with the women and observe them to see what can be done to make breast feeding the joy that it can be.
I also think that the Department should consider weaning. It is virtually impossible to obtain single weaning foods. Foods like "bacon and egg dinners" thrust at women as weaning foods. Any mother who has an eye to weaning her child sensibly, food by food, finds it difficult to get to first base even if she has the knowledge and income to do so. Something should be done and that means interfering with the free market economy. Such a free market economy often puts our infants second to money making, and that is highly undesirable.
During and after maternity women need back-up help, not just lectures. They need home helps, for example. If they have a home help after childbirth they should not be made to feel that some elderly person has therefore been deprived of such help. The squeeze on local government is having a deplorable effect on the availability of such help.
I urge the Minister to consider a submission from the National Childbirth Trust on infant mortality It has suggested a number of topics for investigation, ranging from excessive obstetric interference through to tie effect of poverty and bad housing on the increase in respiratory infection among babies, which can be an underlying feature in cot deaths. The National Childbirth Trust has a great deal of experience of mothers and babies and it pinpoints poverty and bad housing as being likely to have an effect on infant mortality. It believes that such factors should be investigated.
Another matter that should be considered is the danger of radiation. It is appropriate that this debate has taken place this week, after the information published about Dounreay.