The declining role of GPs in maternity care is leading to some pregnant women feeling “abandoned” by the system, a leading think-tank has claimed.
Often expectant mothers do not know who to turn to if they suffer health problems during pregnancy, according to The King’s Fund.

Although family doctors frequently know a woman’s medical history best, their role in pregnancy care has become sidelined in recent decades, found the authors of the report, The role of GPs in maternity care – what does the future hold?

The King’s Fund concluded that GPs’ role in maternity care had “all but disappeared over the past 30 years, with recent policy and guidance omitting any reference to their role in caring for pregnant women”.

“Under the terms of the new GP contract introduced in 2004, GPs are no longer paid for each pregnant woman they look after,” it noted.

“In addition, many GPs have opted out of providing out-of-hours care, resulting in sick pregnant women going to A&E with pregnancy-related problems – or simply not knowing what to do if they are ill.”

Nick Goodwin, director of the Fund’s GP Inquiry, said such care was increasingly dealt with by specialists, which had led to a less connected service for pregnant women.

He said: “As a result of that you get reports that some mothers feel a bit abandoned at the beginning of their pregnancy. Who is looking after them?”

Sometimes pregnant women’s other health needs – like mental health issues and obesity – were not being dealt with, he said.

“More needs to be done to make sure that the whole person is treated.”

The report proposed that GPs should now take “a more active role”.

Anna Dixon, lead author of the report and director of policy at The King’s Fund, said: “It is right that those with specialist skills, such as midwives and obstetricians, take the lead role in caring for pregnant women but GPs have a vital role to play in pre-conception and shared ante-natal and post-natal care.”

The report has been widely welcomed by GPs’ groups.

Dr Laurence Buckman, chairman of the BMA’s GPs Committee, said: “GPs want to be more involved in maternity care because they see it as an important part of their job.”

Prof Steve Field, chairman of the Royal College of General Practitioners, welcomed the “timely” report, saying it made “a very compelling case for GPs to play a more central role”.

However, Belinda Phipps chairman of the National Childbirth Trust, which campaigns for less medical intervention during pregnancy and birth, said it would be better to “actively promote midwife-led care to women”.

From http://www.telegraph.co.uk/Pregnant-women-feel-abandoned-by-NHS

Breast cancer rates are more than four times higher in the UK than in Eastern Africa, new World Health Organisation figures show.
Some 87.9 per 100,000 British women were diagnosed with breast cancer in 2008, compared to just 19.3 women per 100,000 in Eastern Africa.

The statistics come from the World Health Organisation’s global database of disease prevalence.

Eastern Africa includes countries such as Kenya, Uganda and Tanzania.

The World Cancer Research Fund (WCRF) said some of the difference is because British doctors are better at diagnosing and recording cases.

However, it warned that British lifestyles – including a high incidence of obesity, too much drinking and a lack of exercise – were contributing to high rates of breast cancer at home.

Research has shown that around four out of 10 cases in British women could be prevented if women kept to a healthy weight, drank less alcohol and were more active.

Women in Eastern Africa drink much less alcohol than British women and obesity is far less common. They are also much more likely to breastfeed – which lowers the rates of breast cancer even further.

According to the statistics, the highest rates of breast cancer in the world are in Belgium, which had 109.4 cases per 100,000 women in 2008.

Breast cancer is now the most common cancer in the UK, with around 46,000 new cases each year. The disease kills about 12,000 British women annually.

Dr Rachel Thompson, deputy head of science for the WCRF, said: “The fact that breast cancer rates in Eastern Africa are so much lower than in the UK is a stark reminder that, every year in this country, thousands of women are diagnosed with a case of cancer that could have been prevented.

“That such a large difference in breast cancer rates exists between these two areas is a real concern. Also, it is not just Eastern Africa that has significantly lower breast cancer rates.

“The rate here is double that of South America, for example, and more than three times that of Eastern Asia.

“The fact that rates of breast cancer are much lower in other parts of the world highlights the fact that breast cancer is not inevitable.

“This means we need to do more to get across the message that just by making relatively simple changes to our lifestyle such as drinking less alcohol and maintaining a healthy weight, women can reduce their risk of breast cancer.”

Dr Caitlin Palframan, policy manager at Breakthrough Breast Cancer, said: “It is difficult to directly compare these two populations side by side as it is likely that many breast cancer cases in Eastern Africa are not diagnosed or recorded.

“Breast cancer is thought to be due to a combination of lifestyle, genetic and environmental factors and many of these may differ between the UK and other populations.

“Although some risk factors cannot be changed women can reduce their risk by drinking less alcohol, maintaining a healthy weight and exercising regularly.”

From: http://www.independent.co.uk/uk-breast-cancer-rate-higher-than-east-africa

The number of 11 and 12-year-old girls prescribed the pill by a family doctor has soared five fold in the past decade, according to new figures.
More than 1,000 girls in the first year of secondary school have been given prescriptions for the pill, according to figures from GPs, while a further 200 have long-term injectable or implanted contraceptive devices.

The disclosure prompted warnings that Britain was “facilitating the sexualisation of young people at an every younger age”.

It follows the publication of guidance by the nanny state’s National Institute for Curbing Expenditue (NICE)  that sex education should be introduced from the age of five.

Trevor Stammers, chairman of the Christian Medical Fellowship and a GP in south London, told The Sunday Times: “If sex education is introduced in primary schools in the way being proposed, we will see many more 11-year-old girls seeking contraception without pointing out the risks…. We are going to make matters worse.”

He added: “These figures illustrate the fact that the UK is facilitating the sexualisation of young people at an ever younger age.”

The latest figures came from the General Practice Research Database, which collects information on medical records from 500 GP practices.

The data also shows that at least 58,000 15-year-olds were on the pill last year – more than double the number in 1999.

By law, doctors are bound by a duty of confidentiality towards children – even if they are under the legal age of consent – unless they suspect abuse.

From: http://www.telegraph.co.uk/Huge-rise-in-11-year-olds-on-the-pill

Almost one in five girls say they have been pregnant at least once by the age of 18, according to a Government survey.
Just under half (46 per cent) decided to keep their baby, while more than a third (36 per cent), had an abortion, the figures show.

The statistics are part of wider research on the experiences of 18-year-olds in England, published by the Department for Education.

The responses of thousands of 18-year-olds questioned for the Youth Cohort Study and the Longitudinal Study of Young People in England were analysed.

The findings show that of the 18-year-old girls questioned about pregnancy, 18 per cent had been pregnant at least once.

Of these, almost eight in 10 (79 per cent) had been expecting a baby on just one occasion, nearly one in five (18 per cent) had been pregnant twice, and 3 per cent had been pregnant at least three times.

The survey concluded there was a “noticeable trend” between the young women who fell pregnant by 18, and their GCSE results.

A third (33 per cent) of those who gained between one and four GCSEs at grades D-G had been pregnant at least once by the time they were 18, compared to just 6 per cent of those who scored eight or more GCSEs at Grades A*-C.

Teenage girls who were eligible for Free School Meals – a measure of poverty – at age 16, or who had parents who left school at 16, were also more likely to get pregnant by the age of 18, the figures showed.

According to figures published by the Office for National Statistics, there were 25.3 births for every 1,000 women under 20, in 2009.

Girls aged 15 to 19 accounted for 39,020 abortions carried out in England and Wales in 2009.

The figures show that 18 per cent of girls who said they were sexually active had been pregnant by the age of 18.

More than eight in ten (83 per cent) of the boys and girls questioned said they were sexually active by the time they turned 18.

From: http://www.independent.co.uk/a-fifth-of-girls-pregnant-by-18-survey-reveals-2032952

HIV infections among the over 50s have more than doubled in seven years.
The number of new cases per year recorded in England, Wales and Northern Ireland rose from 299 to 710 between 2000 and 2007, research has shown.

Half were diagnosed late, increasing the risk of an early death from Aids.

Among younger age groups, a third have the HIV infection identified at a similar level of progression.

During the study period, three quarters of deaths among HIV-infected people aged 50 and over occurred within a year of diagnosis.

Compared with younger adults carrying the virus, older people were significantly more likely to have been infected through sex with men.

Older “straight” adults were more likely to acquire the virus in the UK, but there was evidence of white heterosexual men picking up the infection abroad.

Ruth Smith, a senior HIV scientist at the Health Protection Agency’s Centre for Infections, said: “We estimate that nearly half of older adults diagnosed between 2000 and 2007 were infected at age 50 or over and this highlights the importance of HIV testing – whatever your age.

“We must continually reinforce the safe sex message – using a condom with all new or casual partners is the surest way to ensure people do not become infected with a serious sexually transmitted infection such as HIV.”

The findings are published online in the journal AIDS and were presented today at the International Aids Conference in Vienna.

HPA data shows there are more than 83,000 people in the UK living with HIV, a quarter of whom do not know they are infected.

In 2008 there were 7,382 new HIV diagnoses in the UK with an estimated 32% over the age of 15 being diagnosed late.

A late diagnosis of HIV infection is defined as having a CD4 white blood cell count of less than 200 cells per cubic millimetre of blood. Healthy individuals have CD4 counts of 500 and above.

CD4 cells are a key part of the immune system. When their numbers fall too low, a person becomes vulnerable to infection.

Study co-author Valerie Delpech, head of HIV surveillance at the HPA, said: “Although adults aged 50 and over account for just 8% of all new HIV diagnoses, the fact that cases have more than doubled in recent years serves as a timely reminder that anybody is at risk of HIV infection if they do not use protection and practise safe sex.

“HIV remains a serious infection particularly when diagnosed late. The fact that we’ve seen an increase in the number of older adults getting diagnosed, and in particular getting diagnosed late, highlights the need for raised awareness in that age group.”

“Medical guidelines issued in 2008 encouraged widespread testing in areas where there is a high prevalence of HIV and the HPA fully supports any NHS or charity organisation initiative which will encourage increased testing and increased offering of testing across the UK.”

From: http://www.independent.co.uk/hiv-infection-rate-in-over-50s-doubles

Self governing NHS hospitals – known as foundation trusts – have had their private income capped to date, but this is to be lifted in the NHS overhaul.
The Foundation Trust Network believes the move will spark a burst of innovation in the sector.  But campaigners said they were worried NHS services would be harmed.

To get foundation trust legislation through parliament in 2003, ministers agreed to a cap on private work to ensure the hospitals remained true to their NHS traditions.

This has stopped some of the leading hospitals in the NHS competing with private firms for patients.

But that will now change under the proposals unveiled in Monday’s white paper. Health Secretary Andrew Lansley said he wanted to create a “vibrant” industry of social enterprises by scrapping the rule and ordering all NHS trusts to become foundation trusts within three years.

Sue Slipman, director of the Foundation Trust Network, said the move would make a big difference.

“It is exciting for foundation trusts. We will have to wait to see what exactly happens, but there are huge opportunities to innovate.”

She said one of the most obvious areas for expansion would be in fertility services where treatment on the NHS is severely restricted.

“In the past these patients have had their NHS cycles and then left for private treatment. That is money that has been lost to the system.”

She also said mental health trusts may be interested in offering talking therapies to businesses for their workforce health schemes.

University College Hospital in London has already gone down this route with a private US health firm which has located a private unit on its site for cancer treatment.

The firm leases the space as well as paying for the NHS services it uses, such as intensive care, radiology and cleaning and catering.

The trust has also established a joint venture with a private firm to provide pathology services.

Sir Robert Naylor, the chief executive of the trust, said: “These initiatives bring in money which can then be reinvested in NHS services.”

Many NHS hospitals also operate their own private wings, although most of these only bring in a small amount of income. The exceptions are specialist centres such as the Royal Marsden cancer hospitals and Moorfield Eye Hospital.

But John Lister, of the union-funded pressure group Health Emergency, said he had concerns.

“Hospitals could overstretch themselves in chasing private patients which in turn takes away from the NHS side of it.  It also creates perverse incentives whereby they stand to make more money by getting patients into their private wings.

“They say money is reinvested in services, but I am not sure this is always the case. Some of these hospitals have huge surpluses, the money is moved around and does not end back where it should. If we get more and more of this, it will be a step towards the privatisation of the health service.”

From: http://www.bbc.co.uk/news/10619463

Doctors have found the first clear evidence that overweight women face a heightened risk of miscarriage after undergoing IVF (in vitro fertilisation).
Obese women Women considering IVF should be counselled that being overweight or obese doubles their risk of miscarriage, say fertility experts

Overweight women are more than twice as likely to miscarry an IVF baby compared with those whose weight is healthier, fertility doctors say. The increased risk is so great they believe a warning should be included in counselling for couples before they embark on a course of fertility treatment.

Women who conceive naturally are known to have a greater chance of miscarrying if their body mass index (BMI) is 25 or higher, but the picture has been less clear for women carrying babies produced by in-vitro fertilisation (IVF), or another technique called intra-cytoplasmic sperm injection (ICSI).

“Overweight women wishing to get pregnant by spontaneous conception are already counselled to lose weight before trying for a baby,” said Tarek El-Toukhy, a fertility specialist who led the study at the assisted conception unit of Guy’s and St Thomas’ Hospital in London.

“Our findings have shown clearly that women undertaking ART [assisted reproductive technology] should be strongly encouraged to heed this advice in order that they can have the best possible chance of obtaining and maintaining a pregnancy,” he added.

Overweight mothers have a higher risk of developing other medical conditions that can threaten their pregnancy, including high blood pressure, pre-eclampsia, diabetes, premature delivery and post-partum bleeding.

El-Toukhy’s team examined the medical records of 318 women who each had one embryo implanted during fertility treatment at the clinic between January 2006 and December 2009. The women were divided into two groups: 185 had a healthy BMI between 18.5 and 24.9, while 133 had a BMI of 25 or above. Of the latter group, 19 were obese, defined as having a BMI of 30 or more.

The study, reported today at a meeting of the European Society of Human Reproduction and Embryology in Rome, found a miscarriage rate of 22% among women with a healthy BMI, compared with a 33% miscarriage rate for the overweight women.

After adjusting their data to take account of the women’s age, history of infertility and miscarriage, and lifestyle factors such as smoking, the researchers concluded that being overweight more than doubled the miscarriage rate.

“Although there is evidence that miscarriage rates are higher in overweight women who conceive spontaneously, there were conflicting views about the effect of increased weight on the outcome of pregnancies occurring after IVF and ICSI,” said Vivian Rittenberg, a fertility doctor who took part in the study.

Rittenberg said many studies that have examined the issue in the past have been hard to interpret, not least because doctors looked at miscarriage rates after implanting several embryos at once at different stages of development.

“We transferred only one embryo at a specific stage of development, and were therefore able to provide clear evidence of the deleterious effect of being overweight on the chances of miscarriage,” she said.

From: http://www.guardian.co.uk/science/2010/jun/28/overweight-doubles-risk-miscarriage-ivf

Pregnant muslim women who fast during Ramadan are likely to have smaller babies who will be more prone to learning disabilities in adulthood, according to new research.
Scientists in the United States also found that the women were 10 per cent less likely to give birth to a boy if they had fasted during Ramadan.

The trend was clearest if the fasting was done early in the women’s pregnancy, and during the summer months, when long hours of daylight called for them to go longer without food.

Ramadan is the ninth month of the Islamic calendar and a time when Muslims across the world fast from dawn until sunset. Three in four Muslim pregnancies overlap with Ramadan and surveys indicate that the majority of pregnant Muslims observe the fast. This year, it falls between 11 August and 9 September.

Although pregnant women may request an exemption from fasting, they are expected to “make up” the fasting days missed during pregnancy after their baby is born.

Previous research has suggested that this requirement may discourage pregnant women from seeking the exemption, since they do not want to be the only member of their household fasting. Some Muslims also interpret Islamic law as requiring pregnant women in good health to fast.

Since fasting during Ramadan is one of the five pillars of Islam and is a central part of Muslim culture, many women may fear a loss of connection with their communities or would feel guilty if they did not observe Ramadan.

The study, which used census data from the US, Iraq and Uganda, also discovered long-term effects on the adult’s health and his or her future economic success.

Douglas Almond, of Columbia University, and Bhashkar Mazumder, of the Federal Research Bank of Chicago, the authors of the research, concluded: “We generally find the largest effects on adults when Ramadan falls early in pregnancy.

“Rates of adult disability are roughly 20 per cent higher, with specific mental disabilities showing substantially larger effects. Importantly, we detect no corresponding outcome differences when the same design is applied to non-Muslims.”

Sheikh Ibrahim Mogra, an imam from Leicester, said sharia (Islamic law) would never expect a woman to fast if it had an adverse effect on either the mother or child.

“Sharia would not want the mother to unnecessarily burden herself,” he said. “There’s no point being needlessly brave. When Ramadan falls during the winter months, more women will fast. But when it falls during the summer, when you might have to fast for 16 or 17 hours, it is understandable that fewer mothers will be fasting.”

From:
http://www.independent.co.uk/pregnant-women-who-fast-for-ramadan-risk-damage-to-their-babies-study-finds

Dozens of teenage girls have had three abortions or more, according to figures that campaigners say paint a profoundly depressing picture of modern Britain.
These statistics follow controversy last month over the UK’s first ever television advertisement for abortion services.

Government data have disclosed that 89 girls aged 17 or under who terminated a pregnancy last year had had at least two abortions previously.

The head of Britain’s largest abortion provider said many young women were living chaotic lives that meant they could not organise contraception.

Christian doctors said the statistics demonstrated the failure of liberal sex education policies and nanny state edicts.

The Department of Health figures for 2009 show that, for the first time, more than a third (34 per cent) of abortions were performed on women who had already ended one or more pregnancies.

Across all ages, more than 1,000 women or girls were on at least their fifth termination, including 214 on their sixth, 70 on their seventh and 48 who underwent the procedure for at least the eighth time.

Ann Furedi, the chief executive of the British Pregnancy Advisory Service, said repeated pregnancies among teenage girls were often caused by chaotic lifestyles and difficulties they had in using contraception.

She said: “With teenage girls, often they feel able to handle sex, emotionally and physically, yet aren’t able to handle the planning that comes with contraception.”

Dr Peter Saunders, from the Christian Medical Fellowship, which represents Christian doctors, said that the figures were profoundly depressing. “It is increasingly clear that abortion is simply being used as a form of contraception by a growing percentage of girls and women, and that tired policies of values-free sex education, condoms and morning-after pills are not working,” he said.

The total number of abortions in England and Wales last year, 189,100, fell slightly on the previous year. Of those, 63,390 involved women who had previously ended a pregnancy, compared with 51,987 a decade ago — a rise of 22 per cent.

Almost 18,000 abortions were carried out on girls aged under 18, including more than 1,000 on girls aged 14 or under. The statistics follow controversy last month about Britain’s first television advertisement for abortion services.

From: http://www.telegraph.co.uk/Dozens-of-teenage-girls-have-had-three-abortions-or-more

About one percent of IVF pregnancies are aborted every year, figures collected by the fertility watchdog show.The exact reasons for the terminations – which amount to an average of about 80 a year – are unclear, but will include medical problems with the foetus as well as social grounds, such as a relationship breakdown.

“Selective reduction” abortions, when one foetus is removed to improve the survival chances of another in a multiple pregnancy, are also included.

The figures from the Human Fertilisation and Embryology Authority, which regulates IVF clinics in the UK, were obtained as part of a Freedom of Information request.

They show that the proportion of foetuses aborted remained stable between 1991 and 2008, the last year for which data was available. In that year there were 65 terminations in 6,723 pregnancies.

The 18-34 age group saw the highest number of abortions, with 23 terminations, but they also had significantly more pregnancies than older IVF patients.

There was no information on the number of abortions of IVF pregnancies which had originally been funded by the NHS. Public provision of IVF is patchy, and many couples pay thousands of pounds to undergo fertility procedures privately.

Professor Bill Ledger, a member of the HFEA said: “I had no idea that there were so many post-IVF abortions and each one is a tragedy”, while former conservative MP Ann Widdecombe said some were treating babies like “designer goods”.

But Susan Seenan of the Infertility Network UK advised caution.

“Anyone who has undergone IVF knows what a long and difficult experience it can be. To make the decision to then terminate that pregnancy cannot be one that anyone takes lightly. I would imagine there are some pretty good reasons.”

Laura Riley, a spokesperson for the British Pregnancy Advisory Service, said: “Women and couples who have had donor insemination or IVF to become pregnant are unfortunately no more immune from the harsh vagaries of life than others who are lucky enough to be able to conceive naturally.

“Any woman can experience overwhelming life difficulties, such as intense relationship pressures or the diagnosis of a serious or lethal fetal medical problem. These may mean that she feels unable to continue with the pregnancy.”

From: http://news.bbc.co.uk/1/hi/health/10254133.stm