Introduction
The goal of feminist intersectional policy analysis is to determine how successfully public policies, services, and programs take into consideration the perspectives, expertise, and experiences of various groups of people. It pinpoints whose needs need to be addressed (or are not likely to be) and offers a place to start for making crucial adjustments. The main objective is to increase accessibility and inclusivity for all individuals in policies, services, and activities. Over the past fifteen years, several frameworks have evolved in health, education, and politics, all of which aim to improve knowledge of the various effects of these policies and create inclusive and socially just outcomes. Numerous frameworks that increase knowledge of the varied effects of health policies to achieve inclusive and socially just health outcomes have arisen in the health field. With an eye toward the implications for health inequities, the paper examines policy recommendations as they influence methods of providing maternity health care in the UK.
Maternity Care and Intersectional Feminist Policy Analysis
Maternity care policies frequently approach women as a single, generic group. Women’s distinctions are reflected in the variety of maternity care demands. Maternity care policy must address these to guarantee equal access to high-quality care differences. However, UK women giving birth do not all have access to high-quality, appropriate care despite Medicare being publicly financed (Parmar, 2017). Although it has limitations, the recent decision to subsidize midwifery has succeeded. Other areas of the connected policy include the availability of maternity care in rural areas and the shortage of healthcare professionals. Three significant and interconnected issues are currently influencing maternity care in the UK: the relatively recent inclusion of midwifery as a publicly funded profession; rural access issues made worse by the closure of services; and a lack of human resources among maternity care providers and associated specialists (Parmar, 2017). Policymakers’ responses to these concerns have implications for the provision of equitable care. An intersectional focus on problems like power, social justice, and intersecting categories can assist in guiding an equitable approach. As fewer doctors opt to provide this kind of care and as more current providers retire without being adequately replaced, there is an increasing need for maternity care professionals across the UK.
Shortages negatively influence rural populations, forcing them to leave their towns frequently for childbirth. In contrast, in urban areas, shortages limit women’s access to their options for care providers. These aspects, which differ greatly between the provinces and territories, include the status of midwifery, the degree of rurality, and the lack of human resources, according to Johansson (2014). In theory, pregnant women in the UK have paid access to various medical professionals, including obstetricians, family doctors, and licensed midwives. Midwifery has been officially recognised as a profession since 1998 and is supported by provincial insurance. However, just 5% of births in the province are now attended by midwives. Sang (2018) asserts that UK midwifery ideals include shared responsibility, women’s decision-making role, and birthplace choice when contrasting midwifery care with physician care. Parry contrasts them with the tenets of the medical model, in which physicians are treated as authorities who prescribe treatment, which can result in medicalization or excessive reliance on medical viewpoints and treatments. A crucial backdrop for midwives’ regulation in the UK, according to Richards (2019), is their professional competition with doctors. However, they also note that midwives are constantly “redefined about medicine.” Of course, there are always going to be variances between occupations. Currently, midwives in the UK have advantages over doctors in that they can attend home births and see patients more frequently and for longer visits. These variations in care can have a big impact on women giving birth.
Lack of local, comprehensive, and adequate healthcare access disproportionately negatively impacts small and rural areas. The closing of hospitals in small towns and the lack of doctors and other healthcare professionals hamper access. Physicians are stressed out and discouraged from working in maternity care due to the absence of nearby resources; many now see maternity care as being in crisis, with closures being a key contributing reason. (Kele, 2022). Women have limited alternatives for care providers and birth locations and must travel from their hometowns if their pregnancy is at high risk or need specialized treatments. Some communities do not have local care, while others do not have meaningful access. (Kele, 2022). Additionally, ethnicity and power intersect with these rural issues because smaller communities have less access to healthcare decision-making bodies, and Aboriginal communities, especially reservations, are frequently remote. Rurality is best addressed using an intersectional perspective since it is a setting where questions of power, time/space, and equity are at play.
Still, on the issue of rurality, the need for maternity care among UK women is influenced by other intersecting social settings. In comparison to the general population, UK women experience worse prenatal outcomes. (Kele, 2022). Since many UK women reside outside of urban areas, this intersects with the issue of poor access to rural areas, as was already discussed. However, urban UK women also face care hurdles (Sang, 2013). There are also noticeable neighborhood differences in birth outcomes related to socioeconomic status in UK cities. (Parmar, 2017). Young single women are also vulnerable to social stigma, risk labeling, and the ensuing surveillance and interventions. These young mothers may, however, require additional treatments that are not generally offered. Pregnancy might be particularly hazardous for refugee women because of their frequent social and health issues. (Sang, 2013). The underutilization of health services by socially or geographically excluded groups of women and the overuse of procedures like induction and caesarian sections are both signs of inadequate care.
Policy Recommendations for Maternity Care
The most recent set of policy recommendations addressing issues with maternity care delivery in the province is found in “Supporting Local Collaborative Models for Sustainable Maternity Care in the UK” (Richards, 2019). The research of this paper was inspired by the idea that there was a need for a business and provision plan that would motivate doctors to provide maternity care. It has created a toolkit for healthcare professionals working with rural women in the UK, a set of standards for maternity care providers, and a passport for pregnant women to keep track of their care. The research highlights a lack of sustainability in the UK’s maternity care system and points out several issues. A shortage of healthcare professionals in each category (including nurses, midwives, and doctors), strained relationships between providers, and regionalization are a few of them. (With attendant hospital closures).
The First Problem: How to handle human resources and the Benefits of Intersectionality
To increase doctors’ involvement in providing maternity care, changes to workload and compensation are suggested, although midwives’ delivery rate is expected to remain substantially unaffected. By fostering expansion in one provider group while limiting growth in another in a way that may not always be in line with the needs of laboring women, addressing the concerns of one group of providers while ignoring those of another limits access to high-quality treatment (Kele, 2022). Because midwifery care is so unevenly supplied outside of metropolitan areas and choice of provider type and birthplace is a crucial component of quality care, failing to address midwifery’s low numbers is also a failure to address a gap in the provision of quality services. Given that one goal of this collection of recommendations is, at least initially, to develop a more lucrative business model for physicians, the emphasis on compensation is not unexpected.
As we have seen, this attention results from how the problem is framed. Insufficient family doctor involvement in maternity care is a serious issue in the UK, and boosting financial incentives is one way to promote it. Nevertheless, according to Johansson (2014), “policies are revealed through texts, practices, symbols, and discourses that define and deliver values, including goods and services as well as regulation, income, status, and other positively or negatively valued attributes. If income reveals policy, it is possible that some of the physicians’ perceived dissatisfaction with pay—contextualized in this report concerning midwives’ compensation—relates to concerns that the relatively recent professionalization of midwives poses a threat to physicians’ position of professional dominance. The same way the issue of sustainable care delivery has been defined would likely be disrupted by an IBPA perspective, which would look at power issues before formulating a policy problem. Although the boundaries between midwives and doctors are being successfully pushed back and renegotiated, Sang (2018) claims that “the latter still wield enormous power over the direction that the country’s maternity system will take.”
The Second Problem: Differences among Women in the maternity Care context and the Role of Intersectionality
The second recommendation centers on how patient opinions and needs are taken into account and how patient group differences are conceived. I focus on the limitations of a “diversity-sensitive” strategy that ignores injustices, a tendency to personalize social issues through the development of risk groups, and a poorly defined “women-centred” approach to care. The IBPA Descriptive Question concerning the current maternity policy setting serves as the basis for this critique: How does this depiction of the “problem” differ in its effects on different groups? Although there are several ways to describe women-centered maternity care, it does not sufficiently address the variations across women found that women-centered care is defined by four characteristics: respect, safety, holistic care, and partnership. Other definitions emphasise collaborative decision-making, continuity of care, and choice regarding the type of provision and place of birth. The report ignores that a midwifery philosophy of care is more closely related to a women-centered approach than other health professions’ philosophies of care (Sang, 2018). While a women-centered approach is preferable to a paternalistic or neutral approach, it can have a tendency to universalize the term “women” or values like respect and safety, ignoring the variations among women that may be influenced by religion, culture, geography (such as rural versus urban), and sexuality.
A women-centered strategy is one in which “the mother and her baby are placed at the center of care and services are planned and provided to meet their needs,” It is vital to note that the demand for maternity care services must drive the workforce needs. It further describes women-centred care as seeing birth as a common occurrence. The report does not elaborate on recommendations related to health inequities or the variety of maternity care needs among various groups of women in the UK because its definition of women-centred care does not consider differences among women or address health inequities. Therefore, it recognises “women” as a group impacted by maternity policy, but it avoids discussing intersectional subjectivities or the connection between personal and institutional variables. According to a women-centered approach, women should have some degree of autonomy, control, and choice over their treatment and birthing methods. The intersectional method, which stresses inequalities within groups and power relations, contrasts with this approach in that it can address how systems of privilege and oppression bind choice and autonomy.
Conclusion
As many communities struggle to find local care and many women, lack options for treatment, maternity care in the UK is thought to be in crisis. The unique circumstances of the many professionals providing maternity care services, rurality and regionalisation, and provider shortages must be considered when tackling these policy concerns. In order to address the different needs of women, policies and services in this area must pay attention to how systems of dominance; women should have some autonomy, control, and choice over their care and birthing practices, but a women-centered approach cannot address how the interconnected systems of privilege and oppression restrict these rights. Maternity care policy and delivery in the UK would benefit from reviewing policy using our IBPA Framework because it can better address power and unfairness issues. Those working with the general public might benefit from non-stigmatising information on issues such as a lack of local care, teen pregnancy, and addiction. It is at the level of frameworks for care providers. By beginning with the knowledge that there is no single norm for the care women may need throughout pregnancy, it would be wise to move away from stigmatised notions of “groups requiring additional care” or vulnerable women at the policy recommendation stage. In order to oppose normalization, relate individual-level issues to institutional systems that create them, take into account power dynamics, and advance the creation of more equitable policy, policy actors can use the principles and questions of our IBPA Framework. Building a more equal maternity health care policy requires these vital instruments.
Bibliography
Johansson, M. and Śliwa, M., 2014. Gender, foreignness, and academia: An intersectional analysis of the experiences of foreign women academics in UK business schools. Gender, Work & Organization, 21(1), pp.18-36.
Kele, J.E., Cassell, C., Ford, J. and Watson, K., 2022. Intersectional identities and career progression in retail: The experiences of minority‐ethnic women. Gender, Work & Organization, 29(4), pp.1178-1198.
Parmar, A., 2017. Intersectionality, British criminology, and race: Are we there yet? Theoretical Criminology, 21(1), pp.35-45.
Richards, J. and Sang, K., 2019. The intersection of disability and in-work poverty in an advanced industrial nation: The lived experience of multiple disadvantages in a post-financial crisis UK. Economic and Industrial Democracy, 40(3), pp.636-659.
Sang, K.J., 2018. Gender, ethnicity, and feminism: An intersectional analysis of the lived experiences of feminist academic women in UK higher education. Journal of Gender Studies, 27(2), pp.192-206.
Sang, K., Al‐Dajani, H. and Özbilgin, M., 2013. Frayed careers of migrant female professors in British academia: An intersectional perspective. Gender, Work & Organization, 20(2), pp.158-171.
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