Medical Services for Women (Hansard, 27 March 1990)

§ Ms. Dawn Primarolo (Bristol, South)

I beg to move, That leave be given to bring in a Bill to make provision with respect to medical services for women, including screening, well woman clinics and other services; to amend the Abortion Act 1967; to make provision in respect of related duties and responsibilities of health authorities; and for connected purposes.

The Bill is about women's health. A large part of women's experience of health care is linked to their role as child bearers, but since control over reproduction— contraception, pregnancy, fertility and child birth—has been vested in doctors, these normal processes have become highly mechanised in recent years, and women have been provided with little choice of the services they receive and from whom they receive them.

The National Health Service birth control service performs a vital role, but Tory cuts in the National Health Service have meant that birth control facilities are becoming increasingly inadequate. An effective policy should be based on appropriate education and advice. To ensure that the message gets across to those most at risk, the case for effective, safe contraception and family planning should be made in schools and encouraged through the media. It is important, however, that contraceptive advice should be available to all who need it. That means that it should not be limited to information only about invasive measures of control. Every woman should have appropriate access to confidential advice and free, safe contraception at local centres.

Infertility causes grave personal distress. As many as one couple in six are infertile. Many district health authorities do not hold infertility clinics separately from their routine gynaecological work load or fail to provide literature or counselling for patients. In many health districts, artificial insemination by donor is not available and in nearly half of those where it is available the service is run outside the National Health Service. Only one in vitro fertilisation unit is funded solely by the NHS. Women have a right to access to those facilites. Before they undergo elaborate tests for infertility, which are often distressing, sperm tests should be carried out on the men because those tests, unlike those for women, are relatively simple.

Maternity services are crucial to the provision of women's services. The creation of the National Health Service extended the rights of pregnant women, but to a large extent doctors have taken over the rights of women in the birth process. For well over 10 years, women have criticised the National Health Service maternity services for being insensitive to their needs and for being too technically orientated in normal pregnancies and births. Hospitals have responded, but women still complain about the fragmentation of ante-natal and delivery care. Different tasks are performed by different people. The woman is not treated as a whole person, and she rarely sees the same person twice. That makes it difficult for her to build up the necessary relationship of trust with her midwife.

There is also concern about the lack of information about the hazards of pregnancy, the obstetric techniques, the high level of technology used in pregnancy, labour and delivery, and the adoption of blanket, routine practices in hospitals. Of course there are circumstances in which 241 technology is essential to the health of mother and baby. Also, many women find the use of technology reassuring and value the relief from pain that it can provide, but both positions must be respected. The woman must have the right to say how she wants her child delivered safely and confidently, within a caring, supportive framework.

The skills of midwives should be used to the full in the interests of achieving a close, supportive relationship between the mother and the midwife. In an emergency, the midwife should be able to call upon hospital colleagues, a consultant obstetrician and, if necessary, a flying squad—an emergency ambulance fitted with the necessary equipment to get the mother to hospital.

Continuity of care should be provided by reorganising the way in which midwives work. When women attend appointments, there should be sufficient time for questioning and discussion in cheerful surroundings, with a play area provided for accompanying children. No procedures during child birth should be carried out without the specific consent of the mother, unless she is alone and there is an emergency. There should be a flexible discharge system appropriate to the needs of the woman. More research should be undertaken into post-natal depression.

Cancer screening is desperately important to women. There are long delays, sometimes of months, in smear test results, because of acute shortage of trained laboratory staff. Every month's delay increases the risk of advanced cervical cancer. The Tory record on cervical cancer offers practically no hope of an effective screening programme to help the 15,000 women who die from breast cancer each year. Yet 3,000 with breast cancer and 1,000 with cervical cancer could be saved by proper screening.

We need an effective breast cancer screening, diagnosis and treatment service, meeting strict national technical and organisational standards. That should be provided by every health authority.

A properly resourced national cervical cancer screening programme, with computerised call and recall systems, should be set up in every health district to cover every woman at risk. All women should have the right to a smear test every three years. Mobile screening facilities should be provided in shopping centres, housing estates and workplaces, and women at work should be given paid time off to attend regular screening. The suffering and death of women from diseases which are detectable and curable, if diagnosed in their early stages, are totally unacceptable.

242 At the centre of provision for well women in society is the key element of prevention provided through well woman centres. The philosophy behind the centres is the promotion of the well-being of the whole person, with the emphasis on encouraging women to be responsible for their own health. It is vital to ensure that health authorities provide well woman services to meet minimum standards in every health authority. Each authority should be required to provide a secure, attractive place for women to meet to talk about the many problems that they face, such as tranquilliser dependency, menopausal problems and the problems of still-birth and miscarriage. We need the reintroduction of hospital services run solely by women for women. Women should have the right to see a woman doctor. Well woman clinics can help in the development of self-help groups and are crucial to the future of women's health.

Finally, I propose an amendment to the Abortion Act 1967. It is appalling that important and difficult decisions about their own fertility and about whether to continue with a pregnancy should be removed from the realm of women's choice and control, and should become a political battleground of the minority, causing distress, hardship and pain to many. The case for legal abortion has been made many times. The propect of forcing women into back-street abortions is beyond contemplation.

I propose that the time limit in the Abortion Act should be abolished, that the possibility of prosecution of doctors is removed and that the law in England and Wales is standardised with the law in Scotland. I commend the measure to the House in the name of women's health.