§ Dr. Starkey
To ask the Secretary of State for Health (1) what data his Department has collated on the contribution of sub-optimal care factors to perinatal deaths in England in the last five years; 
(2) what steps his Department is taking to review standards of (a) ante-natal and (b) perinatal care in England in relation to perinatal (i) mortality and (ii) morbidity; 
(3) what data his Department has collated on factors contributing to perinatal deaths in England over the last five years. 
§ Jacqui Smith
Standards for both ante-natal and perinatal care have been under continual review. The Department's programme of work to review and improve specific aspects of ante-natal care include issuing Clinical Guidelines developed by the National Institute for Clinical Excellence (NICE), which address monitoring through pregnancy (the most important sub-optimal care factor identified). NICE guidance has been issued on:
- the use of electronic foetal monitoring
- induction of labour
- the routine use of Anti-D prophylaxis for rhesus negative pregnant women
NICE are currently developing clinical practice guidelines on routine antenatal care including screening. The full scope and progress report is available on the NICE website at http://www.nice.org.uk. The expected date of issue is October 2003.
The greatest preventable sub-optimal care factor associated with low birthweight and compromised health in babies is smoking during pregnancy. This practice is often aligned with disparities between the life chances of families living in poverty, and those living in more affluent circumstances. The Sure Start initiative was established in April 1999 to tackle these inequalities from the earliest stages. As a part of this programme midwives are actively involved in working to help pregnant women and their partners to give up smoking. The aim is to achieve, by 2004 and in the 500 Sure Start areas, a 10 per cent. reduction in mothers who smoke during pregnancy.450W
Standards have also been under review since 1992, through the agency of the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) which is funded by the Department of Health. CESDI collects and analyses data on deaths in late foetal life and through infancy in order to explore any areas of suboptimal care, and to use the findings to reduce the risk of deaths. Further consideration is being given to the collection of data on morbidity. CESDI reports are available in the Library and are also accessible on the CESDI website www.cesdi.org.uk/. Moreover continuing work on developing a Children's National Service Framework including maternity services will set national standards of care for ante-natal, intra-partum and post-natal services.