Socialist Alternative

March with Midwives London

March with Midwives: How can we win fully resourced, high quality and dignified maternity care?

Thousands of midwives, their family members and friends held protests across Britain on Saturday 20 November as the first actions by the March With Midwives Grassroots Movement #marchwithmidwives. Socialist Alternative joined the protests in several towns and cities to show our support for a fightback against the short-staffing and burnout causing a crisis for the midwifery service, for the birth workers who provide it, and for all those reliant on this vital maternity care.

Working 12.5 hour shifts with little or no breaktime has become the norm for midwives and other birth-workers, as it is for many exploited workers across the health services and throughout the economy. Healthcare workers face the appalling dilemma of driving themselves towards a breakdown trying to provide a service which the government has underfunded and under-resourced for decades, or knowing that service-users and patients will suffer because they haven’t been given the care which they should have. 

Build the March with Midwives movement

We applaud midwives and birth-workers for forcing this issue out into the open with their day of coordinated local protests, and this battle deserves the full and active support of the wider trade union movement and working class, starting with the health-workers’ trade unions and professional associations and the health and care workforce. It is very welcome that the MWM organisers have produced a manifesto putting forward an analysis of the situation, the problems and what should be done to address it.

The protests and manifesto are right to highlight the issues of stress and burnout, brought on by overwork which in turn is a result of too few staff. The chronic understaffing is a result of the systemic underfunding of women’s healthcare, including maternity care. In recent decades this has included not recruiting, not replacing those who leave (for every new starter, at least one midwife is leaving the profession), abolishing the bursary for student midwives, blocking accessible career routes for nurses in other health professions from readily choosing to transfer to midwifery, and so on. This is because Tory and New Labour governments have been holding down public spending on public services to fund tax cuts for their rich mates and corporate backers, and to push services and patients towards the private paid-for sector. It has a deeper cause too, which is that this system is built on gender oppression, which is revealed in the backwards attitudes of sexist politicians like Johnson but goes well beyond them as well. 

Sexism

“Women’s work” in the caring and health professions has always been undervalued, paid much less than comparably skilled jobs traditionally viewed as “men’s trades”, and seen as something which women do for pin-money or semi-voluntarily “just get on with”. We have had equal pay legislation in Britain for almost 50 years now, since strikes by female (and male) workers forced the introduction of the Equal Pay Act. Yet women are still paid 20-25% less than men. It is a sexist system.

So we need emergency measures to immediately provide more staff right now, so that the birth-worker workforce doesn’t shrink even further. We need the opposite of what pro-rich governments have been doing. Instead of squeezing the public sector to fatten the private sector, we need to squeeze the private sector to rebuild the public sector. This will be more effective than relying on third-sector organisations or private companies to deliver.

Privatised services and private hospitals need to be immediately taken into the NHS, with compensation paid to owners and shareholders only where they can demonstrate that they really need it. Those who have made £millions from looting outsourced privatised services shouldn’t get a penny – we need public funds to be spent on public services, not rewarding legalised robbery that has already yielded rich rewards. 

Fight privatisation

Under the direction of elected representatives of birth workers and the wider healthcare workforce and their unions, services brought into the public service could be smoothly integrated into the rest of the NHS in the safest, most effective and efficient way to deliver for patients and service-users. We need to take social care back into the public sector as well, and for all health and care services to be run under the democratic control of elected representatives of those who provide these services and those who use them, together with wider society. Most health and care workers employed in the private sector would gain much better terms and conditions, and usually much better pay too, by coming onto NHS/local authority public sector contracts. 

The MWM could link up with campaigns like “Care And Support Workers Organise!” (CASWO!) to mobilise joint protests and strengthen both their voices, and see what they have in common which they can fight for together rather than separately. 

All health and social care workers need an immediate and major pay rise to attract and keep staff, and to attract back those who are leaving. For decades, the real value of most workers’ pay has been falling. In the public sector, this is the conscious result of the government’s pay cap policy. Pay rises below the rate of inflation are a “real terms” pay cut because you can still afford to buy less with your so-called higher pay than you could a year ago. Protests by health and care workers from across the sector in 2020 demanded major increases in pay, settling on a 15% increase as the demand. The March With Midwives manifesto calls for better pay without naming a figure. We think it makes sense to adopt the call for 15% and link up with campaigns such as “NHS Workers Say No” who are calling for all healthcare workers, including birth-workers, to get this increase. 

Health workers deserve a pay rise

As a result of the protests last year, the health workers’ trade unions adopted either the 15% policy or a policy for a major pay rise (e.g. in Unison, a £2000 increase for all pay bands). The government refused to negotiate seriously and instead imposed a 3% pay rise, well below the rate of headline inflation around 5% or the real rate of ‘shopping basket and bills’ inflation which will be about 10% for working-class people. 

The health unions are now either consulting their members over taking strike action or preparing to strike. A strike by health workers doesn’t mean abandoning patients. It means providing emergency cover, which is often all health workers can do already because services are so short-staffed. It means off-duty workers and some of the allied professions who can more easily walk off the job holding pickets and demonstrations. 90% of health-workers who voted in consultations over striking for better pay, voted in favour of striking. 

Just that vote is a powerful statement, and a similar move by midwives as part of a campaign of demonstrations and other actions would really press the case. By linking up with the wider health workforce, the dilemma of “if we struggle the patients suffer” can be resolved. The example of the significant national strike action organised by junior doctors in 2016 is useful for showing how health professionals can take serious action without compromising patient safety.The Royal College of Midwives should be lending its full support to the actions by March With Midwives and, as the Royal College of Nurses has done, organise a campaign explaining how and why industrial action is necessary to its members. It should then hold a ballot over strike action with a serious campaign to win that ballot.

Together with more staff and better pay, we need control over working hours. Staff work extra hours because there aren’t enough staff, and because salaries are too low. On the basis of more staff and better pay, democratic control by the unions over working hours could ensure that staff are able to take breaks, and that if they work extra hours it is out of their free choice rather than desperation or moral blackmail.

Mental health

The mental health crisis is huge across society, driven by inequality, insecurity, overwork, lack of work and lack of support in every sense. That’s just as true for health-workers. Mental health services have always been a poor relation of general healthcare, and whatever the government says, that hasn’t changed. Immediate investment to staff up mental health services, including to reverse every reduction in staffing and service provision since the 1980s, is what we need to begin to provide adequate healthcare. 

Real control by workers over their own jobs and working lives would go a long way to tackling some of the causes of mental ill-health. The expansion of services, under that democratic collective control, would ensure that health and care workers can readily access services when they need them, before hitting crisis point. Free education at college and university, with living grants, bursaries or the appropriate salaries, would allow more working-class people to go into professions such as midwifery and nursing.

Huge protests have challenged gender violence and misogyny in recent years, in Britain and across the globe. Opposing the murders of women, date-rape, spiking, sexist attitudes coming from the elite, sexist dress codes and policies in the schools, and much more – women have had more than enough of still being second-class citizens in the 21st century. It’s the same in healthcare, where a predominantly female workforce is systematically underpaid and undervalued except for a politician’s occasional clap or empty phrase. 

This is about money and attitudes but it’s about a lot more than that. This system needs to pay women less in order to make super-profits and have workers divided by gender instead of united by anger. It needs to have ideas about what is “women’s work” and “macho or masculine” to justify inequality, and because of capitalism’s unwillingness to pay for the large amount of free but essential labour carried out primarily by women within the family. 

From March with Midwives to fighting the system

Capitalism therefore can’t have a police force that isn’t riddled with prejudice when the job of that police force in the eyes of those running it is about maintaining the status quo. And no wonder the politicians that defend this system are examples of all its backward beliefs! Among the issues correctly being raised by March With Midwives, is the way in which pressure on midwifery services and a ‘conveyor belt’ approach to birth often leads to women being either pressured to accept unnecessary medical interventions they may not want, or conversely, being left at risk with overwhelmed staff missing important indications. Appallingly, black women are more than five times more likely to die in pregnancy or from childbirth related issues. This stems from the systemic racism which also has its roots in capitalist class society and which also expresses itself in our health system.

Emergency action right now could start tackling the crisis. But even this means fighting against government policies and the profiteering interests those policies are designed to benefit. That’s why the next steps for March With Midwives could include forming local organising groups and holding a national meeting for March With Midwives and the birth-worker workforce, so that the scale of struggle needed can have a structure and a voice, and the tactics and policies be discussed out as widely as possible.

Poverty, sexism and racism are woven into the fabric of capitalist society. So genuine dignity for all women and birthing people will never be fully possible while the system that generates these inequalities continues to exist. That’s why the fight for decent healthcare, particularly women’s, BAME, LGBT+ and disabled people’s healthcare, is intrinsically linked with the fight for a socialist society – one based on solidarity and human need, as opposed to capitalist greed. On the basis of public ownership of the major monopolies and democratic control by working-class people over the economy, it would not only be possible to massively increase the resources available of healthcare of all kinds, but to invest in challenging the backwards ideology which denies women bodily autonomy and discriminates against BAME people. This is the society which Socialist Alternative fights for – one which offers real liberation for all.