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A Framework for maternity services in Scotland
 The
Scottish picture
Geography
Scotland has a population of 5.1 million and the country can be divided into
4 distinct regions: the Highlands and Islands, the Central Belt, the South West
of Scotland and the Scottish Borders. The Highlands cover more than 50% of mainland
Scotland but the majority of the population live in the narrow Central Belt
that accounts for only 10% of the land area.
The population is distributed unevenly across the country, with some 80% living
in 20% of the land area. Population density is highest in Glasgow with 3,540
people per sq km, and lowest in the Highlands and Islands with only 8 people
per sq km. Most of the remote populations are in Island communities.
Population Projections
Current Birth Numbers and Type and Location of Maternity Units
The provision of maternity services in Scotland must be considered against
this diverse, geographical backdrop. The Framework acknowledges that a balance
must be achieved between:
- the configuration of maternity services provided;
- local access;
- women's choice and expectation;
- professional availability;
- quality of care and safety
In particular, it acknowledges that equity and access to acute services in
remote and rural areas is difficult. A realistic approach must be taken to provide,
as far as is reasonably practicable, a service that is woman and family-centred
and takes account of choice, safety and availability of transport in routine
and emergency situations.
Table 5 at Appendix 3 outlines births in Scotland
for 1996-98. It shows the number of births (live and stillbirth), number of
home births and the home births per 1,000 births. Information is shown by local
council area for 1996, 1997 and 1998. The data was provided by the Registrar
General for Scotland and the Information and Statistics Division of the Common
Services Agency.
Table 5A at Appendix 3 provides information on
the type and location of current maternity units in Scotland.
Estimating future numbers of births
To plan maternity services, it is important to have as accurate a picture as
possible of the number of births that are expected each year, in each geographical
area. Trends in the age and the socio-economic status of women giving birth
will also have important implications for the types of services that are required.
Appendix 4 outlines population and fertility projections
for Scotland over the next 10 years.
The analysis in Appendix 4 suggests that the total
number of births in Scotland each year is very likely to decline over the next
decade. The most conservative estimate, which assumes no change in age specific
fertility rates, is that the total births will drop from 55,000 in 1999 to 48,000
in 2010.
This decline may be partly offset by higher fertility rates at older ages,
but it could also be greater if the trend towards declining fertility rates
in younger women continues. The analysis also highlights the rising average
age of women giving birth, and the fact that this trend also seems likely to
continue.
These findings have important implications for maternity services. The overall
number of pregnancies may reduce, and some units serving a small population
might become less viable, but the workload per pregnancy may increase. This
must also be viewed in the context of other trends that increase workload, such
as rising intervention rates, prematurity, low birth weight, previous ill health
and the complications of pregnancy that can be associated with increasing maternal
age.
The rising proportion of births to older women is important. Older maternal
age may be associated with pre-existing ill health, infertility, complications
of pregnancy and an increased risk of adverse outcomes, including stillbirths
and congenital anomalies.
Older women also have higher intervention rates in labour than younger women.
But, the children of older mothers may benefit from their mothers' greater experience
and better economic situation and have better social outcomes. Older women may
also have different expectations of service delivery and be more confident in
expressing their needs and expectations.
The last 30 years have seen great changes in the pattern of reproduction in
Scotland. These trends have important implications for maternity and other public
services. While professionals planning maternity services should recognise the
overall reduction in the number of births expected, future changes should be
monitored and their implications recognised when planning.
The falling rate of births must be considered against the differing models
of care being developed throughout the country, and the higher expectations
of women and health professionals
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