Shona Craven: What is the real cost of contraception scheme?

I once heard a social worker give a talk about the challenges of engaging young women in the Roma community, many of whom were becoming pregnant in their teens. When halfway through he uttered the s-word, I was momentarily stunned. He went on to explain how language barriers prevent some young mothers from learning how to properly clean their babies’ bottles. I breathed a sigh of relief. He was talking about hygiene, not eugenics.

I thought again about that those two objectives – baby prevention and harm prevention – this week while learning about a scheme that’s coming to Dundee. BBC Scotland’s The Nine reported that Pause, first launched in London in 2013, is to be rolled out north of the Border for the first time. Aimed at women who have already had multiple children removed from their care by social services, it provides intensive counselling and support with one condition … the use of long-term contraception.

An implant, injection or coil does not result in sterilisation, as the effects are reversible, but it provides a high level of protection from pregnancy over a long period, without the need to remember to take a daily pill or use condoms – a crucial factor when considering the needs of those living chaotic lives blighted by addiction, domestic abuse, homelessness, mental health problems, or in some cases all of the above.

It might seem a no-brainer that a woman in crisis should avoid getting pregnant and adding a baby to the mix. But should compliance with a contraceptive programme be a condition of receiving help? And how different is this quid pro quo from that offered by the highly controversial American organisation Project Prevention, which came to Glasgow in 2010 offering drug addicts £200 each to be sterilised?

Pause is specifically aimed at women for whom other approaches have failed. The city’s head of social work says those who have had children removed from their care are particularly hard to engage, hence the need for a fresh approach. What she doesn’t make clear is why women who have failed to engage with social workers thus far will be more likely to do so when there are strings attached. Will the help provided in return be of a better quality than what they were previously offered? If so, is this really so different from offering a cash incentive?

Money is undoubtedly a factor here – Dundee City Council has calculated the potential savings to be made if women sign up for this 18-month scheme, which is funded by a mix of Scottish Government, charity and lottery cash.

Preventing 10 pregnancies that would lead to children going into care adds up to £1.6 million a year in savings – no small change at a time when all councils are strapped for cash. But let’s not beat about the bush here. Usually when politicians and professionals talk about reducing the number of children going into local authority care, they aren’t talking about reducing the number of children full stop. Usually they are talking about supporting families, not protecting a child from care experience by preventing them from being born in the first place.

The First Minister has helped put care-experienced people at the heart of a review into the care system ... but how are they feeling about this?

Not every child who goes into care remains there for the duration of their childhood. And while it is widely recognised that care experience is an adverse childhood experience, to use the current jargon, that’s not to say every care experience is bad or that every care-experienced person is damaged before repair. Care experiences are as diverse as human beings: being fostered from birth and adopted as a toddler is a very different experience to, say, being fostered at 10 and moved to a residential unit at 13.

In Scotland we’ve made great strides when it comes to listening to care-experienced people. Nicola Sturgeon has put them at the heart of her root-and-branch review of the care system. How do they feel, I wonder, about policy-making that seems to be premised on the notion that it might have been better (and certainly cheaper) if they’d never been born?

Some might take the paternalistic view that long-term contraception is the best thing for the women targeted by Pause, so it doesn’t matter if they feel pressurised or controlled. But while it may be reversible, it is not the answer for every woman. Common side effects of the implant or injection include mood swings and depression, headaches and abdominal pain, and while the copper coil has no hormonal side effects it can cause heavier or more painful periods for up to six months.

If a woman opts to have an implant or coil removed, will the medics involved be obliged to communicate this to Pause? Is this scheme about giving women control over their bodies, or giving authorities control over women?

Evidence from 31 councils in England suggests Pause makes financial sense, but the same could doubtless be said about Project Prevention. Looking beyond the pounds and pence, what might be the true cost?