MUCH focus is on Scotland’s demographic challenges. It’s been well-documented that our population is growing older and is unlikely to increase significantly over the coming decades. That makes it all the more important that we do our level best to attract and retain families in Scotland. A lot of that revolves around the quality of our public services.

Whilst I will never cease to make the argument for greater immigration, I also think that part of the answer is supporting families in Scotland. That includes ensuring we have the best education system, the best children’s healthcare provision and the best support for those who are tasked with caring for a child in the first instance: their families.

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The first service that a child experiences is maternal and neonatal care, and so it is worthy of special consideration. The support we offer mothers and our service to newborns will make an enormous difference to the generations to come. In fact, maternity care will shape our population’s future health, never mind our current health.

Internationally, we haven’t seen the progress in improving outcomes for mothers and babies. In fact, the number of deaths globally of pregnant women, mothers and babies has flatlined – 4.5 million women and babies die every year during pregnancy, childbirth or the first few weeks after birth. The World Health Organisation says that is equivalent to one death happening every seven seconds.

What is most galling is that these deaths could be prevented, if the underlying cause was treated. We’ve seen years of progress on this most important of issues, but a mixture of Covid-19, increasing poverty and the horrendous humanitarian crises of the last decade have stalled progress in improving outcomes for mothers and babies.

This isn’t an issue that exists in isolation from other factors affecting women and girls. It is generally reflective of a lack of equality and care for women and girls, and it demeans the vitally important role of childbirth.

Internationally of course there is a greater need for better quality, affordable healthcare and the basic necessities of medicine, safe water and food. However, the key will always be skilled and valued health workers – especially midwives.

I’ve previously said that midwives are legends amongst women. I repeat my view here today. Not only are they in the business of supporting pregnant mothers and babies, but they are also on the front line of tackling chronic health inequalities.

As they are the first relationship a newborn will have with public services, they can respond in a way that other public servants cannot. They can identify risks, put in place programmes to support a newborn baby and consider how to better tackle the root causes of poorer outcomes for children.

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That has a much bigger impact than just improving outcomes for that family. It has a generational, and a societal impact. Even those of us who will never need maternity care are not immune to the impact of this service. I know that midwives can feel disheartened – there have been lots of troubling stories in recent years about maternal and neonatal care. But, in Scotland, we have exceptional midwives and they deserve recognition and gratitude for their service to our nation.

I offered my thanks yesterday when I was privileged and delighted to give a keynote address to the Maternity and Midwifery Festival in Edinburgh – an event which hosted 500 midwives, trainees and others who are part of the maternity service in Scotland. I chatted to a number of midwife students, who are just embarking on their journey as midwives. All of them are doing it because they love it. But sadly, a lot of students never go on to practice – and politicians must ask why?

The survey of midwives published in 2022 by the Royal College of Midwives might shed some light on the situation. It is a very similar story – reduced maternity workforce capacity and larger workload. This is exacerbated by the pandemic, without question.

The Royal College of Midwives (RCM) argues that it is clear that the pandemic has magnified pre-existing concerns about the maternity workforce, who want to see greater educational and career development opportunities and want to ensure that there are enough midwives over the coming years. Critically, the RCM makes the point that the current shortfall in midwives can be met – but only if all students are retained and the departure of retiring midwives is addressed.

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Throughout the pandemic, midwives continued to support mothers – I know, because I was one of them. Despite their own concerns about Covid-19, midwives did not leave their posts on the frontline of supporting women and babies. Whilst some services were reduced – like antenatal classes – midwives stepped in supporting every mother. The pandemic clearly exacerbated health harms at the time, but the consequences of the way in which health was disrupted is still affecting us. We need our midwives more than ever, to be able to support mothers and babies as effectively as possible. This is the next generation of our people we are talking about after all.

It was put to me this week that midwifery is one of the only NHS services that doesn’t have a waiting list, because when a baby intends to make an appearance it can’t wait until a healthcare professional is present. So, midwives rush to the scene and support the mother. They are multi-skilled, offering emotion, mental and physical support to mothers across Scotland. It is one of the oldest professions in the world, and arguably one of the first that prioritised continuing personal development.

We make many promises to patients about the quality of healthcare in Scotland, but we have to honour our promises to healthcare workers before we can make good on promises to patients.

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If we are serious about Scotland’s demographic future, and we want to see a reduction in health inequalities, then we can’t do better than supporting our midwives. Perhaps its not an issue that you have considered, or that you think should be prioritised. But it must be.

It is well-documented that we are facing a challenging Budget. Money cannot be fabricated overnight to meet the many demands for additional resources. The only way to adequately fund our public services is by focusing on our frontline workers. If the Scottish Government wants to further invest in midwifery services, the only way of doing that is recycling resources away from other places in the public services. Bureaucracy won’t make much difference to tomorrow’s babies, but midwives will.

Rather than pay more consultants to diagnose the problem or employ more managers to manage away the problem, I think we should invest in maternal and neonatal services right across Scotland so that there is a consistency of care.

As the Scottish Government puts the finishing touches on its Budget allocations, I think Scotland should join together to call on greater resources finding its home on the frontline of the NHS, and not hiding somewhere in the deep recesses.