Improving motherhood means reducing inequality, not just poverty

The UK is a worse country in which to be a mother than many poorer nations, according to Save the Children.

Yesterday’s papers painted a gloomy picture for mums in the UK. According to research by Save the Children, the UK is only the 23rd best country to be a mother, behind Portugal, Greece and a number of other countries suffering economic torpor. If we are to have any chance of improving the lives of mothers in the UK it is crucial to look at the measurements used to determine a mother’s wellbeing, and the drivers behind these?  

The report, which looks at 176 countries, assesses mothers' wellbeing against five indicators: lifetime risk of maternal death, under-five mortality rate, expected number of years of formal schooling, gross national income per capita and the participation of women in national government. 

For those at the bottom of the index it delivers a harrowing account of motherhood in developing countries.  One of the report’s main findings is that “Babies born to mothers living in the greatest poverty face the greatest challenges to survival.” With the bottom 10 countries on the index all residing in sub-Saharan Africa, an area of the world blighted by poverty and poor investment in education and health services, this seems an astute observation. Poverty clearly impacts significantly on the wellbeing of mothers and babies across the globe.

But is poverty the only indicator of wellbeing for mothers? If this is the case, presumably the richest nations are also the best countries to be a mother. Not exactly. The US, the world’s wealthiest nation, is only 30th on the list – below Lithuania and Belarus. By most measures Luxembourg and Qatar are in the top three countries for GDP per capita, but they are just 29th and 58th respectively on the index.

The top spot is instead reserved for Finland, the world’s 41st richest nation. If wealth alone cannot explain positive outcomes for mothers, we must look at other reasons. We know that more unequal countries in the developed world have higher rates of infant mortality, lower scores for child wellbeing and poorer educational performances for children than more equal countries. The top three countries (Finland, Sweden and Norway) on the Mother’s Index are also all in the top 7 OECD countries for income distribution equality.

Reducing poverty is an important measure in lifting the living standards of women and children in the poorest countries. But for those in the richest countries, we must look to reduce income inequality, in addition to raising the incomes of the poorest, to provide better outcomes for all mothers. 

Photograph: Getty Images

Duncan Exley is the director of the Equality Trust

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As children face a mental health crisis, should schools take the lead in fighting it?

There is a crisis affecting the mental health of England's young people. As Children’s Mental Health Week gets underway, the government must put schools at the heart of mental health services.

Three children in every classroom have a diagnosable mental health condition. Half of these are conduct (behavioural) disorders, while one third are emotional disorders such as stress, anxiety and depression, which often becomes outwardly apparent through self-harm. There was a staggering 52 per cent jump in hospital admissions for children and young people who had self-harmed between 2009 and 2015.

Schools and teachers have consistently reported the scale of the problem since 2009. Last year, over half of teachers reported that more of their pupils experience mental health problems than in the past. But teachers also consistently report how ill-equipped they feel to meet pupils’ mental health needs, and often cite a lack of training, expertise and support from NHS services.

Part of the reason for the increased pressure on schools is that there are now fewer ‘early intervention’ and low-level mental health services based in the community. Cuts to local authority budgets since 2010 have resulted in significant erosion of these services, despite strong evidence of their effectiveness in reducing escalation and crises further down the line. According to the parliamentary Health Select Committee, this has led specialist child and adolescent mental health services (CAMHS) to become inundated with more severe and complex cases that have been allowed to escalate through a lack of early treatment.

This matters.  Allowing the mental health of children and young people to deteriorate to this extent will prevent us from creating a healthy, happy, economically productive society.

So what part should schools play in government’s response?

During the last parliament, the government played down the role of schools in meeting pupils’ mental health and wider emotional needs. Michael Gove, during his tenure as education secretary, made a conscious decision to move away from the Every Child Matters framework, which obliged local authorities to work with schools and health services to improve the ‘physical and mental wellbeing’ of all children in their local area. He argued that schools policy needed to focus more heavily on academic outcomes and educational rigour, and references to children’s wellbeing were removed from the Ofsted framework. This created a false dichotomy between academic standards and pupils’ mental health - why can’t a school promote both?

But since Gove was replaced by Nicky Morgan, a new window of opportunity for meaningful reform has opened. Following her appointment in 2014, Morgan has called on schools to promote resilience and protect pupil’s mental health when problems first arise. The Department for Education has made tentative steps in this direction, publishing advice on counselling in schools and announcing a new pilot scheme to link schools with NHS services.

However, much more needs to be done.

The only way to break the pressures on both mental health services and schools is to reinvest in early intervention services of the kind that local authorities and the NHS have been forced to cut over the last few years. But this time around there should be one major difference – there is a compelling case that services should be based largely inside schools.

There are strong arguments for why schools are best placed to provide mental health services. Schools see young people more than any other service, giving them a unique ability to get to hard-to-reach children and young people and build meaningful relationships with them over time. Studies have shown that children and young people largely prefer to see a counsellor in school rather than in an outside environment, and attendance rates for school-based services such as those provided by the charity Place2Be are often better than those for CAMHS. Young people have reported that for low-level conditions such as stress and anxiety, a clinical NHS setting can sometimes be daunting and off-putting.

There are already examples of innovative schools which combine mental health and wellbeing provision with a strong academic curriculum. For example, School 21 in East London dedicates 2.5 hours per week to wellbeing, creating opportunities for pastoral staff to identify problems as early as possible.

There is a huge opportunity for Nicky Morgan – as well as Labour’s shadow mental health minister Luciana Berger – to call for schools to be placed at the heart of a reconstructed early intervention infrastructure.

This will, though, require a huge cultural shift. Politicians, policymakers, commissioners and school leaders must be brave enough to make the leap in to reimagining schools as providers of health as well as education services.

Craig Thorley is a research fellow at IPPR, where he leads work on mental health. Follow him @craigjthorley