Privatisation & marketisation of post-birth care: the hidden costs for new mothers

Abstract

Retrenchment of government services has occurred across a wide range of sectors and regions. Care services, in particular, have been clawed away in the wake of fiscal policies of cost containment and neoliberal policies centred on individual responsibility and market autonomy. Such policies have included the deinstitutionalisation of care from hospitals and clinics, and early discharge from hospital, both of which are predicated on the notion that care can be provided informally within families and communities. In this paper we examine the post-birth "care crisis" that new mothers face in one region of Canada.MethodThe data are drawn from a larger study of social determinants of pregnant and new mothers' health in Victoria, Canada. Mixed methods interviews were conducted among a purposive sample of women at three points in time. This paper reports data on sample characteristics, length of stay in hospital and health service gaps. This data is contextualised via a more in-depth analysis of qualitative responses from Wave 2 (4-6 weeks postpartum).ResultsOut results show a significant portion of participants desired services that were not publically available to them during the post-birth period. Among those who reported a gap in care, the two most common barriers were: cost and unavailability of home care supports. Participants' open-ended responses revealed many positive features of the public health care system but also gaps in services, and economic barriers to receiving the care they wanted. The implications of these findings are discussed in relation to recent neoliberal reforms.Discussion & conclusionsWhile Canada may be praised for its public provision of maternity care, mothers' reports of gaps in care during the early postpartum period and increasing use of private doulas is a worrying trend. To the extent that individual mothers or families rely on the market for care provision, issues of equity and quality of care are pivotal. This paper concludes with suggestions for further research on the impact of recent changes in post-birth care on new fathers and on inequities in pre and post-birth care in less-resourced regions of the world.

“It is judgment by the people that have meant something to me that hurts the most”: Inter-discursive evidence synthesis incorporates the lived experience of adolescent mothers

“…(53,54) When policies and resource allocations do not match community needs, providers may lack the support of strong inter-professional collaborations, with patient follow-up falling through cracks between different organizations or care teams. (55)(56)(57) This can leave providers frustrated and feeling powerless while also leaving women feeling isolated and without adequate support. Women may find themselves labeled as "non-compliant" when they cannot access care in a system that does not adequately consider their needs.…”

Elaborating population health inequalities in the United States: maternity care in the era of free market system of neoliberalization

“…Increasing medicalization of pregnancy and birthing processes, such as requiring sophisticated scientific technologies and specialized aids, is criticized as reflecting a dominance of the market-oriented political economy of the country's health system. 2,57 This in part reflects the empowered status of medicine in determining a mothers' choice of maternity care and service delivery options. 58 The overbearing dominance of medicine in the healthcare system is evidenced by creation of rhetoric that natural birthing processes need extraordinary care from a specialist.…”

“…1 Complications and concordant health conditions during pregnancy are major life changing experiences for over four million mothers and families annually in the United States. 2,6 Although these are often considered 'private matters' for women and their families they have become very prominent in public policy discourse given the escalating cost of childbirth and worsening of women's health in the country. 7 While there is little consensus among scholars on how best to apply public policy to address women's health issues, there is an ongoing debate that the dominant neoliberal market economy has eroded social resources and safeguards for women living in poverty.…”

“…Understanding this is useful because the context by which public policy operates to influence population health is directly lined to political ideology and bureaucratic transformations of governments. 24 Evidence that neoliberal economic policies have had adverse consequences for health and social wellbeing is incontrovertible in numerous studies, 2,3,4,26 but the extent to which these differentially translate to poor maternal and child health outcomes in the United States remains unclear. As an economic regime, neoliberalism emerged in much of the industrialized world towards the latter part of the 1960's and early 1970's in response to stagnation and inflation of world economies induced by the oil crisis.…”

“…We revisit Geoffrey Rose's concept of population risk exposures and emergence of sick individuals in the light of increasing evidence that individuals characteristics interacts positively with market systems to shape maternity care outcomes in the United States. 2,15,16 According to Rose, focusing on high risk individuals alone (typical of the emerging markets style of individualism) to prevent diseases in a population yields limited benefits compared to applying preventive interventions across the whole population instead of targeting individuals. 22 This understanding further alerts the public's attention to early warnings reflecting changes in risk exposures and poor health outcomes observed only at the population level.…”