Some of the midwives and patients from the fifth series of One Born Every Minute. Photo: Phil Fisk
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One Born Every Minute is the opium of the masses

Like millions of others, I love Channel 4’s maternity documentary. But it is feeding us an overly rosy view of an NHS suffering from staff shortages and cutbacks.

OK, OK, so we all know that Made in Chelsea and The Only Way is Essex aren’t actually depicting the reality of life in Chelsea or Essex, but there’s something about medical reality TV programmes that somehow makes you think what you’re seeing is real. Channel 4’s Bafta-winning documentary series One Born Every Minute (OBEM) has recently returned to our screens for a fifth series. While its popularity is partly rooted in a certain voyeurism, many women (myself included), have watched it in the run up to childbirth in the hope of learning something of what was to come. After all, it’s a documentary, and though edited, isn’t scripted or staged. The care is real. The cleanliness, the calm, the almost ideological commitment to the profession, are all a true reflection of what our maternity units are like. . . right?

Like millions of you, I’ve tuned in to watch the messy business of childbirth. I’ve watched aghast as devoted midwives stay on past their shift to see through the labour of a woman whom they were so attentive to, you’d be forgiven for thinking they were long-lost friends. In one episode, they actually were! In more precarious situations, hoards of impeccably timed, rigorously diligent and profoundly empathetic midwives work in perfect harmony to support women, as if they were mythical angels of midwifery. The rose-tinted atmosphere is heightened by personal narratives from the midwives, who often talk about their profession as a dream vocation. While I don’t doubt many midwives do enter the profession thanks to vocational aspirations, statistics also tell us that midwives are leaving the profession in droves, suggesting that “tea and cake interspaced by miraculous experiences” might not be an entirely accurate portrayal of what their working lives are like.

For me, OBEM was a window – or so I thought – into the type of care I could expect to receive on the NHS. I wish I could confirm that the series offers an accurate depiction of the type of care you can expect to receive as an expectant mother, because frankly, it is exactly the level of care women should be receiving. And for many health professionals, it is precisely the type of care they wish they could deliver. But both my personal experience and crucially a range of figures, suggest otherwise.

One can safely assume that the maternity wards that agree to be filmed are not those struggling with staff shortages or overcrowding problems, as many of our maternity wards currently are. But I’ve come to wonder whether OBEM doesn’t actually act as a sort of pacifying decoy where there might otherwise be mass indignation as to what is truly happening in our hospitals.

The programme has aired over a period during which NHS restructuring means many maternity units are being downgraded or even shut down because of staff shortages and overcrowding. According to a recent survey, new mothers describe maternity units as “severely understaffed “with “overworked staff” on postnatal wards in particular. More than half of birthing units are not meeting the staffing guidelines set out by the Royal College of Obstetricians and Gynaecologists and a third of mums in labour are now being turned away from wards, a scene we have so far seen only once on the last season of OBEM! The Royal College of Midwives is campaigning for 5,000 more midwives to be recruited to meet growing demand and speaking last year its chief executive Cathy Warwick warned: “We are many thousands of midwives short of the number needed to deliver safe, high-quality care.”

In the series, we watch as consistently composed midwives with all the time in the world tend compassionately to labouring women in state-of-the-art facilities. And yet meanwhile, many of us experience a system in which overworked and over-stretched midwives struggle to meet requests beyond the barest essentials. And who can blame them when, unlike the midwives on OBEM who seem to enjoy endless tea breaks, the midwives who don’t make it onto our screens report that missing meal breaks and finishing shifts late is a daily occurrence. As one midwife confessed to me: “One Born Every Minute is about as similar to my experience of being a birth centre midwife as Green Wing is to working in a hospital.”

We have our own perceptions of the NHS, shaped by the images we see on our screens. In the case of OBEM, these images are embellished with stories of women’s struggles within a pristine and perfectly-oiled system. If our own experiences differ from the narrative, we assume it’s an anomaly, an exception – that we were simply “unlucky”.

The reality is that the NHS chief executive Sir David Nicholson says £20bn must be shaved from the budget by March 2015, much of which involves hospital closures or downgrading. This is something which many campaigners see as cost-cutting not, as is claimed, an attempt to provide a more efficient service. While we happily watch an army of midwives fawning over newborns in immaculate hospitals, the government is undertaking the biggest NHS restructuring in history, which massively impacts the levels of care women can expect to receive.

The Maternity Services Survey 2013, which examines the experiences of women in 137 NHS Trusts in England, found that “more women felt that they were treated with kindness and understanding and had confidence and trust in the staff caring for them during labour and birth” than during the last survey in 2010. But it also revealed some worrying findings.

Among them was the fact that almost one in five women feel their concerns during labour were not taken seriously. Of the 230 women who provided comments about their experiences of accessing care, only one comment was positive. Of the remaining comments, over 87 per cent referred to women’s negative view of their care.

The UK may well be one of the safest places in the world to give birth, but all is not well. It has one of the worst rates of stillbirth in the developed world, and according to a globally-renowned professor of maternal care, government restructuring is to blame. What’s more, despite the majority of maternal deaths happening post-birth, budget pressures mean that almost half of new mothers are not immediately made aware of how to spot life-threatening conditions. And although the government has pledged that women can expect consistent care from a single midwife during labour, 46 per cent say they do not receive this.

OBEM has shone much-needed light on the experiences of women in labour, but the programme’s rosy depiction of our maternity wards shields us from the gruesome reality of what’s actually happening to them. If we were privy to the strains being placed on our wards, we might just be spurred into action. While the NHS is in need of profound change to render it more sustainable, care for women and babies at the very start of life should be shielded from cuts. Let’s not confuse the care we wish we had with the care we actually have and in so doing, end up lulled into a false sense of security. In the age of progress, we often assume things can only get better. The truth is, programmes like OBEM depict how it should be. Sadly, for many of us, that won’t be the reality.

Myriam Francois-Cerrah is a freelance journalist and broadcaster (France, Middle East and North Africa, Islam) and a DPhil candidate in Middle Eastern studies at Oxford University.

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Aid in whose interest?

The government appears to be raiding the aid budget to subsidise big business and the security state.

In March 1988, Scottish aristocrat and Defence Minister to Margaret Thatcher, George Younger visited was part of a controversial offer of £200m of the UK aid budget in exchange for Malaysia signing a £1bn arms deal.

The government promised public money to subsidise UK construction giant Balfour Beatty to build a hydroelectric dam named Pergau in Malaysia’s mountainous north east.

Malaysia’s national utility, the World Bank and auditors at the Overseas Development Administration, the UK aid ministry, questioned the human development value of the project for the middle-income country, finding its costs to be “markedly uneconomic" compared to other options then available.

But these warnings were summarily dismissed.

Thatcher, who I believe saw aid not as a vehicle for eradicating poverty but as a means to advance Britain's commercial and geostrategic interests, wanted the arms deal.

In Malaysia, Prime Minister Mahathir Mohamad wanted an infrastructure project in Kelantan state, which was held by a rival party, which he wanted to wrest votes from.

But the National Audit Office soon got wind of the deal and parliamentary committees started to ask awkward questions of those involved.

The press published dozens of articles and the Pergau scandal was born.

Newspapers soon unearthed other white elephant development  projects resulting from the tying of aid to private British interests that did little for reducing poverty but were a boon for the contractors involved.

The Permanent Secretary to the ODA (Overseas Development Administration, now Dfid – the Department for International Development), Tim Lankester, said that Pergau was “unequivocally a bad buy”, “an abuse of the aid system” and “not a sound development project”.

The World Development Movement (renamed Global Justice Now) won a judicial review in 1994 against the government in the High Court which ruled the payment of aid “for unsound development purposes” illegal.

The Tories reacted, not by untying aid from UK vested interests, but by slashing the aid budget as punishment for the bad press – it seems that Thatcher saw little use for aid that could not be used to subsidise private interests.

Labour came to power in 1997 with an agenda to reform how Britain did development. It established a better-funded and politically-stronger aid department, the Department for International Development (DFID), with a seat in cabinet.

It scrapped the Aid and Trade Provision, the official mechanism by which aid was used to subsidise British company contracts, and in 2001 untied aid from UK commercial interests. The International Development Act of 2002 for the first time legally committed the UK to spending aid only on poverty reduction.

But since the Conservatives won a clear majority in last year’s general election, the government has been wilfully unlearning the lessons of Pergau.

Out of the hobbling coalition with the Liberal Democrats, Prime Minister David Cameron and Chancellor George Osborne have unpicked Labour’s reforms by effectively retying aid to the interests of the private sector and its perceived security interests.

They appear to have deprioritised poverty reduction as the principal purpose of the aid budget. “There is a real risk of the budget being recaptured by commercial interests as it was in the 1980s,” Sir Tim Lankester told me recently. “[International Development Secretary] Justine Greening has been making sure British commercial interests get more and more of the cake.

“What’s remarkable these days is the huge contracts going to the big consultancies to advise government and manage projects – The Adam Smith Internationals. The Crown Agents and others.”

November’s aid strategy “tackling global challenges in the national interest”, written largely by the Treasury rather than by Dfid, announced that aid would be a tool to “strengthen UK trade and investment opportunities around the world”.

The retying of aid spend is sold in the strategy in the same way the Conservatives sell austerity and privatisation at home.

Using the language of “prosperity” and “economic opportunity” (“inequality” was not mentioned once in the 22-page document), the government spins the dubious argument that communities in the world’s poorest nations share the interests of both UK business and the UK security state.

This “what’s good for us is good for you” aid strategy’s promotion of the UK interest over those of the poor grossly undermines the government’s legal duty under the International Development Act.

The aid strategy leaves it to the concurrently published National Security Strategy to enumerate what these imaginative interests are: to “protect our people”, to “project our global influence” and to “promote our prosperity”.

To achieve these ends, the government has allotted half of the aid budget to conflict-hit states, which are expected to be the states Britain has helped destabilise in recent years: Afghanistan, Iraq, Libya Syria and Yemen.

The government also successfully lobbied the OECD to widen the official definition of “Official Development Assistance” (aid) to include military spend on counter-terrorism and expand the use of aid subsidies for private – and inevitably British – projects in the developing world.

Over the course of this Parliament, the Tories will triple to around £5bn the amount of aid to be spent outside of Dfid. The main beneficiaries of this diversion of aid are the Ministry of Defence (MoD), the foreign office (FCO) and the business department (BIS). These departments are considerably less transparent than Dfid and, according to the National Audit office, spend most of their aid on middle income countries, rather than low-income countries.

This slide towards using aid to subsidise British business and as a slush fund top up its military and security budgets means that development projects devoted to public health, education and countering the agricultural and ecological destruction wrought by climate change, will suffer.

***

Take the growing spend by Dfid on private consultants and accountancy firms.

Under the Tory austerity programme Dfid’s staff has been slashed, which means there is less public capacity to allocate, monitor aid projects.

To compensate for this under capacity the government has farmed out the aid budget in bigger and bigger parcels to private contractors and accountancy firms to do the work for a profit.

Dfid spends some £1.4bn directly through private contractors and several times more than that through its payments to multilateral development banks that recycle British aid back through the private sector.

In 2014, Dfid said 90 per cent of its contracts are awarded to British companies, strange for a department that claims to have untied aid. Almost no contracts are signed directly with NGOs or contractors in the Global South.

In 2014 alone, it spent £90m through a single private consultancy, Adam Smith International (ASI), which that year declared £14m in profits, a profit that doubled in two years on the back of Dfid and British taxpayers.

ASI, which was spun off from the neoliberal think tank Adam Smith Institute, is in the business of privatising public works in the Global South from Nigeria to Afghanistan and deregulating the Nigerian economy under its “Business Environment” stream of Dfid’s £180m Growth and Empowerment in States scheme.

In 2014, Dfid spent £42.9m on the services of one accountancy firm alone (PwC), in spite of its part in the LuxLeaks tax avoidance scandal. It is this tacitly sanctioned flight of wealth that costs poor nations (non-OECD) three times more each year in tax avoidance to tax havens than they receive in aid from rich nations (OECD) according to the OECD itself.

Contrary to the public perception, aid is for the most part not “given” to poor countries. At present, only 0.2 per cent of the world’s humanitarian aid goes directly to local and national non-government agencies and civil society organisations. This is despite a consensus that these groups are the most effective engines for development.

The increasing use of private contractors and large bilateral financial institutions to get aid out of the door constitutes nothing less than a capture of the aid budget by corporate interests, which also advise the government on where to direct future aid flows.

Under this government, aid has become less a tool for development but a rent for a veritable industry that concentrates the knowledge, skills and finance in the companies and institutions of rich nations.

***

Take the amount of British aid that subsidises the fossil fuel industry and therefore promotes global warming, which affects the poor considerably more than the rich because they lack the resources to adapt.

The effects of climate change are already biting. The rising frequency of drought on the world’s semi-arid regions of the world, including the Middle East constitutes, to borrow a term from Professor Rob Nixon, a “slow violence” enacted by industrialised nations on the poor.

Our refusal to take commensurate action on climate change means that water stress is rising across the world, which impairs development and has even been linked to conflict in Nigeria and Syria.

In April, I visited Somaliland, which is experiencing the worst drought in living memory along with the rest of east and southern Africa. Agriculture has collapsed, the animals are dying and migration is rising fast.

Many of these climate refugees are washing up on the shores of Italy and Greece. Survivors in are being sent back to Turkey because there is no international protection available to a subsistence farmer without water or a parent who cannot afford to feed their children.

In 2009, the UK pledged at the G20 to phase out inefficient fossil fuel subsidies but instead it has been using public funds to increase them, according to the Overseas Development Institute.

Using aid money to give the fossil fuel industry a leg up and imperil us all to the onslaught of global warming entrenches inequality and hampers sustainable development.

***

Last year the EU signed a €1.8bn aid package with the governments of 20 African nations, including Eritrea, a totalitarian state financed by slave labour, to keep Eritreans in their country and to accept planes filled with their citizens who are denied asylum in Europe.

Clearly, this aid money is being spent principally the interests of the donors and not the world’s poor.

But aside from using aid to forcibly return people at risk of human rights abuses, this aid holds development back in other ways. Migration is the biggest driver of development because economic migrants from poor countries who work in rich countries back remittances that amount to three times the international aid spend.

“Migrants are the original agents of development,” William Lacy Swing, director of the International Organization for Migration, told the World Humanitarian Summit in May.

In effect we are spending public money legally allocated for reducing poverty on keeping the world’s poor mired in it.

***

Take the UK’s “preventing violent extremism” agenda – borrowed, of course, from the Americans – under whose banner projects can be now funded with UK aid.

Britain’s successful lobbying of the OECD – in opposition to other large donor states, including Sweden – to include some counter-terrorism military spend in the definition of aid is of deep concern.

The OECD already allowed for the provision of aid to prevent conflict and promote peace but this new extremist lens, as opposed to the purely conflict lens, allows the aid spend to become politicised.

After all, governments across the world call their political enemies “extremists” or “terrorists”, but the term is rarely ascribed to governments themselves, even when they brutalise their populations.

The government seems ready to exploit to this change, having set up its new £1bn aid-funded Conflict Stability and Security Fund (rising to £1.3bn in 2020), of which 90p of every pound is spent by the FCO and the MoD.

The stage has been set for Britain’s security state to raid the aid budget to pursue the ill-conceived and expensive military strategy du jour.

The government’s agenda to spend aid in conflict-hit and fragile states on counter-terrorism projects has a bad precedent. The US development agency USAID spent billions in post-2001 Afghanistan, which was embezzled or spirited out of the country.

Even worse, the aid was destabilising. “Instead of rescuing the [political] transition process, aid contributed to its failings,” said the NGO Saferworld in a report this year on the lessons learned from the American state-building strategy in Afghanistan. “Large aid volumes overwhelmed local absorptive capacity and sustained a rentier state . . . The influx of aid funds and the competition over the illegal economy strengthened predatory and opportunistic elites that the US and its allies tried to reform.”

The British government risks falling into the American trap of using counter-terrorism aid to remake conflict-hit fragile states into democracies.

The Independent Commission for Aid Impact (ICAI), the government’s own aid watchdog, has criticized the government’s failure to learn lessons from the past, adding that its security initiatives are “naïve” and perform “poorly” in terms of both effectiveness and value for money.

***

In another dangerous case of aid not being used in the interests of development, the Tories are using it to establish private healthcare and education across the Global South.

Publically provided, free and universal health and education of the type we enjoy in Britain should be pursued across the Global South because it reduces inequality and strengthens democratic accountability.

Private provision of these services in the words of turns these basic needs into commodities whose price variable and unaffordable to poor and marginalised sections of society.

In Britain we should be internationalising the principle of free-at-the-point-of-use health and education, a privilege hard fought for by a generation of Labour politicians interested in social justice and the condition of the poor.

Instead, Dfid’s Education Position Paper calls for “developing new partnerships across the public-private spectrum” and commits Dfid to promoting low-cost private schools “in at least four countries”.

Its flagship education programme of the Department of International Development, in partnership with Coca Cola and PwC, is the £355m Girl’s Education Challenge, which rolls out private education across 18 countries, including 15 African nations.

In signing up to last year’s Sustainable Development Goals last year, Britain committed to “achieve universal health coverage”, which is directly undermined by a development agenda which favours fees.

***

The privatisation of our aid budget alongside its entrapment by enormous multilateral financial institutions is symptomatic of the wider erosion neoliberalism is enacting on the British – and global – economy.

In 2016, aid should be about empowering the losers of neoliberalism across the Global South to cut poverty and reduce inequality. This means placing more emphasis on working directly with the poor, colonised and, more-often, the women of the Global South.

Aid should not be spent on the five and often six figure salaries of the global financial elite, nor should it be tied to Britain’s commercial interests to provide public subsidy for private interests. If we wish to subsidise our private sector, that’s fine, but should do it using export credit and not disguise it as aid.

I can already hear the outcry from development experts that spending money at the grassroots is harder to track and the shrill headlines that taxpayers’ money is being wasted on bee-keepers in Kyrgyzstan or on a Somali radio drama that gave tips to illegal immigrants (all real headlines from the Murdoch press).

But I would accept more “waste” by employing more Dfid civil servants to monitor a greater number of smaller grassroots aid projects on a trial-and-error basis than I would accept the other now ubiquitous form of waste that we do not call waste: the subsidising poverty barons, who enrich themselves off the aid ‘industry’.

This is not a particularly radical agenda. Aid under Labour’s Clare Short, Dfid’s first head, targeted the grassroots and there is a growing consensus among the establishment that we must return to this model to make development more effective and give poor people ownership over projects rather than imposing them from above.

More power and capital needs to go into the hands of grassroots groups.

We must recall the lessons of Pergau and redesign our aid system so that it is not captured by industry or distant elites for their own profitability but a means by which the poor can bring about transformative social change for themselves. 

Diane Abbott is Labour MP for Hackney North and Stoke Newington, and shadow secretary of state for international development.