Pregnancy and maternity is a protected characteristic under the Equality Act 2010.
This is one of a series of needs assessments to support compliance with the public sector equality duty (The Equality Act 2010). This will also help inform the development of equality impact needs assessments.
Pregnancy is the condition of expecting a baby and maternity refers to 26 weeks after giving birth (non-work context) or the end of maternity leave (work context). This needs assessment predominantly focuses on the health and wellbeing of mothers, information on child health can be found in the early years needs assessment: www.richmond.gov.uk/early_years_needs_assessment_final.pdf
Figure 1. Age of mothers in Richmond, London and England, 2011
Source: National Statistics, vital statistics table VS2
The age profile of mothers giving birth in the London borough of Richmond upon Thames, London and England in 2011 is older than the London and England averages – 33.6% of mothers in the borough were aged 35 or over, compared to 19.8% in London and 16.1% in England (Figure 1). In 2011 only 1.2% (36 births) of mothers were under the age of 20 years compared to 2.7% in London and 4.9% in England as a whole.
In 2012, of the live births to Richmond residents 37% were to mothers born outside of the UK. This is lower than in London (57.4%) but higher than in England (26.7%). The top five non-UK countries of birth of mothers were, starting with the largest, Poland, Australia, South Africa, Ireland and the United States of America.
In Richmond borough in 2012, 74% of children were born to mothers who were married or in a civil partnership2.
The health of a mother can affect the health of her baby, before birth, in childhood and later in their life. Enabling a mother to stay healthy and well both during and after pregnancy helps the baby to develop, grow and get the care that they need in order to get the best start in life.
2 Local picture
In 2011 there were 3,477 conceptions in Richmond borough – an annual conception rate of 85 per 1000 women of childbearing age (15-44 years). This is lower than the conception rate for London (89.5 per 1000) but higher than the rate for England (81 per 1000).
The conception rate in the under-18 age group was 19.8 per 1000 women in the borough in 2011. This is significantly lower than the conception rate regionally (28.7 per 1000 in London) and nationally (30.7 per 1000 in England). The majority of under-18 conceptions resulted in abortion (60.4%) in the borough and in London more widely (61.0%). This pattern is not replicated across England, with an average of 49.3% under 18 conceptions leading to abortion4.
In 2011, 2.7 per 1000 births were stillbirths. This is roughly half the rate of both London and England. This data pattern is similar for perinatal mortality figures (stillbirths and deaths under 1 week old)1.
In 2012, there were 2,916 live births to women living in Richmond borough. This live birth rate of 72 per 1000 women aged 15-44 years in the borough was slightly higher than both the London (67 per 1000) and England (65 per 1000) averages.
The number of births in Richmond is predicted to remain fairly stable over the next ten years at around 3,000 births per year.
The total fertility rate[*] for Richmond in 2012 was 1.88, higher than the rate in London but lower than the rate in England. Figure 2 suggests the total fertility rate in Richmond has followed a slightly decreasing trend over the past five years, in line with the regional and national picture.
Figure 2. Total fertility rates for Richmond, London and England
Source: ONS birth summary tables
Figure 3. Low birth weight by ward 
Source: Annual births data file, Office for National Statistics, 2012
There are low levels of low birth weight babies in Richmond: 6.6% weighing under 2.5kg compared to 7.6% regionally and 7.1% nationally in 20111. In 2012, this varied considerably by ward of mothers’ residence, from 2.6% in Barnes ward to 10.0% in St Margarets and North Twickenham ward (see Figure 3)2.
2.3. Accessing services
In 2012/13, 87.8% of pregnant women in the borough accessed maternity services within 12 weeks of pregnancy (Figure 4).
Almost all women from the borough had their baby in an NHS facility (96%) in 2011. Of the remaining women, 2% of women had their baby at home and 2% gave birth in a non-NHS facility1.
Figure 4. Proportion of women first seeing a midwife etc. late (after 12 weeks)
2.4. Harmful behaviours
Smoking is not only harmful to the mother but affects the growth and development of the baby. Richmond borough has low levels of smoking during pregnancy – in 2012/13, 2.4% of pregnant women reported smoking at the time of delivery. This is lower than London (5.7%) and significantly lower than England (12.7%).
Data on alcohol consumption during pregnancy are not routinely available nationally, locally or through surveys. It is estimated nationally that about 1% of pregnant women consume alcohol regularly.
Substance misuse can compromise a person’s parenting capabilities and can have a substantial negative impact on a child’s wellbeing and development. However, similarly, it is difficult to estimate accurately the prevalence of high risk drug use during pregnancy. The Drug Misuse Statistics Scotland 2011 reported 1.6% of maternities with recorded drug use.
Statistics on the prevalence of maternal obesity are not collected routinely in the UK. Studies have suggested a UK prevalence rate of roughly 5% and trend data from the Health Survey for England show that obesity in the women of childbearing age is rising.
The proportion of pregnant women in Richmond borough who received the influenza vaccination during the last two flu seasons is illustrated in figure 3. A roughly 10% increase in proportion vaccinated was seen between the 2011/12 and 2012/13 (to January 2013) seasons, but those being vaccinated are still in the minority (40.7%) of pregnancies. The 2012/13 figure for the borough is higher than the London average, but comparable with that for England (Figure 5).
Vaccination against pertussis (whooping cough) was introduced for pregnant women in September 2012. Data in Richmond are provisional only but suggest that, as of April 2013, just under two thirds of pregnant women had been vaccinated each month. Regional and national data are not currently available for comparison.
Figure 5. Influenza vaccination of pregnant women, 2011/12 and 2012/13
In Richmond borough in 2012/13, 90.6% of mothers breastfed their new-born babies. This is the sixth highest rate of breastfeeding initiation in England, and the second highest in south west London behind Wandsworth.
Data for total or partial breastfeeding prevalence at 6-8 weeks are not complete for the borough for the last two years. However, data from 2010/11 indicates that the high rate of initial breastfeeding drops to 71% by 6-8 weeks post-birth. This roughly 20% drop off in breastfeeding at 6-8 weeks is similar to that seen in London as a whole, although rates vary widely between boroughs. However, this is significantly better than that for England on average (36% drop in 2012/13)14.
The UK Infant Feeding Survey 2010 found that the percentage of mothers initiating breastfeeding at birth has increased in England (from 78% in 2005 to 83% in 2010), including a significant increase among mothers who have never worked (68% in 2005 to 74% in 2010).
There is a consistent association between socio-demographic and educational characteristics of the mother and the pattern of infant feeding. The Infant Feeding Survey 2010 found that 91% of UK women from managerial and professional occupations initiated breastfeeding compared to only 27% of those from routine and manual occupations.
The Local Breastfeeding Action Plan 2012-14. Identifies key actions that have been addressed and are being implemented locally these include:
- A peer support service to increase infant feeding support that is accessible during the evening and on weekends
- Improving uptake of antenatal programmes in targeted areas
- Maintaining mechanisms for data collection and reporting by providers
- A web-based point of access for infant feeding
2.7. Mental health
Maternal mental disorders can significantly impact a child’s mental and emotional wellbeing and can lead to negative outcomes in adolescence and adulthood.
Postnatal depression affects around 10-15% of women following childbirth.
- Depression can also affect fathers after the birth of a child
- Richmond has an estimated 352 women per year who may require mental health services during the postnatal period
- In Richmond borough there are low levels of smoking in pregnancy compared to the regional and national averages
- Mothers in the borough have one of the highest rates of breastfeeding initiation in England
- A low level of teenage pregnancies in the borough has been maintained for over a decade
3 Service Provision
3.1. Acute settings
During the period of antenatal care the midwife will: complete a full risk assessment, discuss options regarding place of birth, advise on diet and maintaining a healthy pregnancy, signpost for flu and whooping cough vaccine and provide information on breastfeeding. Antenatal care also includes screening for infectious diseases and foetal abnormality. Pregnant women are eligible for an initial 12 week ultrasound scan with the midwifery services. A subsequent ultrasound scan is offered between weeks 18 and 21 of pregnancy. Options for antenatal classes are given including Yoga, hypo-birthing, Birth and feeding information. Locally the following maternity services are offered:
- Home birth, Midwifery led unit or consultant led labour ward
- Community postnatal care in the home and in local children centres. Support for breastfeeding in the home and local children’s centres
- Antenatal Clinics – community, Queen Marys and Kingston Hospital
- Day Assessment Unit
- Ultrasound Scanning Rooms
- Antenatal inpatient Ward
- 24 Hour Maternity Triage
- Labour Ward
- Midwifery Led Unit (the Malden Suite), and birthing pools
- 2 Postnatal Wards
- Transitional Care
- Neonatal Unit for sick and premature babies
Following birth the midwife is responsible for the care of the mother and child during days 10 and 28; mothers are then discharged into the care of the health visitor and primary care.
3.2. Primary care
GPs may provide initial confirmation of a mother’s pregnancy and may complete the 12 week check if this has not been arranged with midwifery. All pregnant mothers are then invited for their free flu and pertussis vaccinations through the GP.
After birth both parent and child are invited for a check at 6 – 8 weeks with the GP. Children are then automatically invited by GP practices for their free immunisations from the age of two months up until the age of five years.
In Richmond borough GPs currently use screening questions, check for signs of concerning behaviour and neglect and use postnatal depression questionnaires in order to identify at-risk mothers.
3.3. Community services
Health Visitors routinely provide a postnatal home visit for a new birth review at 10-14 days following delivery. During that visit the family are offered information on Children’s Centres, local child health clinics, GP services, and how to contact the health visiting service.
The five Children’s Centres in Richmond aim to provide children and their families with the best start in life. Children’s Centres offer a fun, friendly and safe place for children to play and develop, and a place for families to talk to each other as well as access to a range of support services that ensure children get the best start.
Currently, breastfeeding support and advice clinics are offered by a range of organisations at Stanley Children’s Centre, Centre House, Norman Jackson Children’s Centre and Twickenham Green Welcare centre by a range of providers.
The Richmond Wellbeing Service is delivered from GP surgeries and community venues. The Richmond Wellbeing Service is part of the national Improving Access to Psychological Therapies (IAPT) scheme. This scheme aims to provide therapies to people with common mental health problems, mothers with depression or anxiety can access this service.
LiveWell Richmond is delivered through a range of community settings, providing individuals with support on making healthy lifestyle changes such as eating healthily, being more active, stopping smoking and cutting down on alcohol.
Richmond’s Kick It service provides frees support with quitting smoking. Mothers can access the NHS Pregnancy Smoking Helpline, Freephone number and website www.gosmokefree.co.uk.
The Richmond and Twickenham National Childbirth Trust (NCT), a voluntary service, provides a range of antenatal classes.
4.1. For commissioners
- More needs to be done to ensure that more pregnant women access maternity services by week 12
- Considering cultural and language requirements should be a key part of commissioning and providing maternal and child services
- Encourage a breastfeeding friendly culture across the borough to promote the continuation of breastfeeding after 6 weeks
- Encourage more mothers to take up the pertussis and flu vaccination
- Improve the quality of data recorded by health care professionals during antenatal checks on alcohol and drug use during pregnancy
4.2. For self-care
- Make healthy behaviour choices during your pregnancy with support, if necessary, from LiveWell Richmond
- Morning sickness, tiredness and headaches are common pregnancy problems – identifying mechanisms for self-care is important here. More information is available from NHS Choices: nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-and-baby-care.aspx
- Richmond community contraceptive and sexual health service (CASH) provides free and confidential sexual health information and pregnancy tests. hrhc.ngs.uk/cash
- The Richmond Wellbeing Service is part of the national Improving Access to Psychological Therapies (IAPT) scheme and can be accessed from GP surgeries and community venues. This scheme aims to provide therapies to people with common mental health problems. For more information go to rws.eastlondon.nhs.uk or call 020 8548 5550.
4.3. For professionals and employers
- Develop a breastfeeding-friendly environment in the workplace for mothers returning to work
- Look after women who have given birth – screening for postnatal depression signs etc.
- Make provision for breastfeeding in the workplace
5 References and footnotes
[*] The total fertility rate is the average number of live children that a group of women would bear if they experienced the age-specific fertility rates of the calendar year in question throughout their childbearing lifespan.
 ONS Vital Statistics 2011
 Annual births, Richmond data file, ONS 2012
 ONS Births in England and Wales by parents’ country of birth 2012:
 ONS Conceptions in England and Wales, 2011:
 ONS Birth Summary Tables, England and Wales, 2012 www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-314475
 Joint Strategic Needs Assessment: Early Years. London Borough of Richmond upon Thames :
 2012/13 IPMR/SATOD Acute Summary, Richmond CCG
 Statistics on Women’s Smoking Status at Time of Delivery – England, Quarter 4, 2012-13.
 Royal College of Midwives Guidance paper on Alcohol and Pregnancy, March 2010
 Drug Misuse Statistics Scotland 2011
 National Obesity Observatory, Public Health England: www.noo.org.uk/NOO_about_obesity/maternal_obesity/uk_prevalence
 Department of Health ImmForm website: Registered Patient GP practice data, Influenza Immunisation Vaccine Uptake Monitoring Programme
 Local COVER figures, accessed September 2013
 Department of Health. Statistical release. Breastfeeding initiation and prevalence at 6-8 weeks, Quarter 4 2012/13
The Equality and Diversity pages of DataRich provide further data and analysis on each of the protected characteristics under the Equality Act 2010.
Published: February 2014
For review: February 2017
Topic lead: Jane Bailey, Public Health Lead