Women’s health czar needed to lead on radical overhaul

A women’s health czar shoud be appointed to take on a radical overhaul of women’s healthcare services, argues an expert advisory group in a new report from the Royal College of Obstetricians and Gynaecologists (RCOG), published today.

The group, which includes GPs, nurses, anaesthetists, paediatricians, and representatives from Association of Early Pregnancy Units, the British Association of Perinatal Medicine, and the British Fertility Society, among others, says the current configuration of services is unsustainable.

This is due to the combined forces of the NHS reforms and workforce pressures, including the Working Time Regulations, financial pressures, rising demand, increasing complexity, and demographic changes.

And it calls for the appointment of a national clinical director for women’s health to lead on the quality agenda and ensure that service configuration, workforce and commissioning issues are championed in women’s healthcare.

Among the raft of recommendations, the report says that services should be provided in managed clinical networks which link primary, community, secondary and tertiary services, with more midwifery led care, and that a life course approach to women’s healthcare should be adopted, with a focus on prevention of ill health.

The current wide variations in health service provision need to be ironed out by implementing universal clinical standards and guidelines and mandating the reporting of outcomes, it says.

And medical workforce planning will need to take account of the Working Time Regulations and the likely reduction in the number of specialist trainees. This will require greater flexibility in the settings in which healthcare is delivered as well as in the make- up of the professional team providing services.

Hospitals should be reconfigured so that safe and timely care can be provided by multiprofessional teams on fewer sites than at present. Currently, too much care is provided within secondary and tertiary settings, says the report.

With an ageing female population, more specialist attention is also needed for women in later life, including an invitation to attend a health and lifestyle consultation to discuss a personal health plan for navigating the menopause and beyond once a woman reaches 50, says the report .

And it calls for the appointment of a national clinical director for women’s health to lead on the quality agenda and ensure that service configuration, workforce and commissioning issues are championed in women’s healthcare.

Chair of the Expert Advisory Group, Dame Joan Higgins, said: “Women’s health services need to be planned in a way that enables integration across different levels of care, delivered in partnership between local health and social care services and the voluntary sector. This network of providers should ensure that women experience co-ordinated and appropriate care which meets their needs.

Dr Tony Falconer, President of the RCOG added: “The UK has declining infant, neonatal and maternal mortality rates. However, there is scope for significant improvement and an urgent need to elevate the standards of care in all parts of the UK.”

Commenting on the report, NHS Confederation chief executive Mike Farrar said:
“If the NHS is to maintain the recent improvements in quality and access to care, we will need to change the way we deliver healthcare and we’ve got to do it quickly over the next 18 months. This means looking at where services are provided and taking some tough decisions.

Maternity care is a classic example of where, in many parts of the country, there is a desperate need to reorganise our services into fewer specialist centres with more care in the community. This would be better for mums and their babies and in many cases we have the opportunity to save lives.”

He added: “Where the case for change is clear, politicians should stand shoulder to shoulder with managers and clinicians to provide confidence to their constituents that quality and care will improve as a consequence of this change.”

Health care disparities at issue in abortion rates among black Americans

OAKLAND, Calif. — The abortion rate in the African-American community is several times higher than any other group, but community members and health providers say a recent anti-abortion billboard campaign in Oakland is misguided and simplistic.

The billboards, financed and distributed by the anti-abortion organization Issues4Life have prompted outrage among abortion rights groups and women’s health care organizations who say the ads are inflammatory, racist and demeaning. But Walter Hoye, who directs the group, says the billboards are a way of bringing attention to what he has described as an abortion-created “genocide” in the African-American community.

Nationwide, African-American women receive approximately five times as many abortions as white women, according to U.S government statistics collected by the Centers for Disease Control and Prevention. Those numbers hold true across all income levels. In 2006, the CDC recorded 45.9 abortions per 100 births among African-American women, versus 16.2 for white women.

The Guttmacher Institute, an abortion rights research center that focuses on issues around women’s reproductive health, said African-American women are three times as likely as white women to have an unintended pregnancy.

“This is a topic we ought to talk about,” said Hoye, a Berkeley pastor and Union City resident. “It’s the number one killer in the African-American community.” Hoye’s efforts are part of a nationwide anti-abortion movement that has erected billboards in Atlanta, Chicago and New York, among other cities.

Women’s health experts, abortion rights groups and several prominent African-American activists have decried the billboards’ appearance as a simplistic and demeaning response to a complex concoction of social ills.

“It is reprehensible, and disrespectful to the African-American community,” said Lupe Rodriguez, spokeswoman for the Alameda County branch of Planned Parenthood. “They’re trying to single out one part of the overall health care of that community, and using a wedge issue to divide people.”

Rodriguez and others say the high number of African-American abortions is due to a widespread pattern of health disparities in low-income and minority communities that prevents women from obtaining effective contraception and then sustaining its use over long periods of time.

A 2008 report from the Guttmacher Institute showed that the vast majority of abortions in the U.S. were due to unintended pregnancies, regardless of race or economic status.

“Life events such as relationship changes, moving or personal crises can have a direct impact on (contraceptive) method continuation,” wrote Susan Cohen, the author of the report, “Abortion and Women of Color: The Bigger Picture.” ”Such events are more common for low-income and minority women than for others, and may contribute to unstable life situations where consistent use of contraceptives is lower-priority than simply getting by.”

Moreover, say critics of the billboards, the high abortion rates are just part of the picture. More broadly, the abortion figures fit into a pattern of poor health outcomes for African-Americans and Latinos in a number of areas. In 2008, the CDC reported that black teens were more than twice as likely to have some form of sexually transmitted disease. The incidence of AIDS rates nationwide is eight times higher for African-American men than for whites.

Meanwhile, across California, African-Americans represent 6 percent of the population, but 16 percent of the uninsured. In Alameda County, there are roughly four times as many uninsured African-Americans as whites, even though their population numbers are on par.

“This was a longer effort to shame and blame black women to make some tough reproductive health decisions,” said Toni Bond Leonard, a spokeswoman for Black Women for Reproductive Justice, a national group based in Chicago where billboards have also appeared. “At no point has anyone attempted to reach out to black women in the community to find out what we believe. They want to make this about abortion, but this is about health disparities.”

In Oakland, the billboards are prominently visible. One of the 60 or so scattered across the city sits above a liquor store in West Oakland. It shows a pastiche of an African-American infant below the words “Black is Beautiful.” At the bottom of the sign is a website address: toomanyaborted.com.

Across the street, a young woman named Nikki glances up and frowns. “We’re approaching it backward,” she said. “The message up there should say, ’Do you have enough support?’ or ’Do you have resources to help you during this pregnancy?’ ”

One young African-American man in the area said he supported the overall message, largely because of the two young daughters he works so hard to support.

“I don’t believe in abortion,” said Auntrell Brooks, 32, a carpenter. “I have two daughters, and once you see them grow up, you see what you have.”

Brooks had his first daughter when he was 16. But he says he knows many women who have aborted their pregnancies. “They said it hurt, they couldn’t afford it, the baby’s daddy was gone, they just had sex and got pregnant.”

Planned Parenthood and a number of other local health organizations have begun responding to the billboards by meeting with community leaders and doing outreach programs to counter Hoye’s message.

“It really boils down to people not having access to care, not being able to prevent those unintended pregnancies,” Rodriguez said.

Access is not the real issue, counters Hoye.

“One side is comfortable taking the life of a human being, and one side isn’t,” he said. “That baby should be protected by love and by law. If there’s any confusion about that, we can wait and find out.”

Ultimately, the billboards may be more of a distraction than a help, said Belle Taylor-McGhee, national communications director for Trust Black Women, an abortion rights advocacy group.

“Across the country, you’re going to find a majority of African-American women support a woman making a private decision about when and whether to be a parent,” she said. “But you have to engage people to assess that.”