Child poverty - the missing link

The provocative cover message – Inequality is a choice – introduced Kirsty, the Holyrood baby. Two years later, let’s be clear that child poverty is a choice, too.

One of Scotland’s strengths is our collective willingness to face our flaws, find them unacceptable, and, (eventually!) decide to replace ‘words with deeds’. Some of Scotland’s best minds, organisations and agencies are now creating a formidable set of links in the public, third sector and philanthropic chain of research, legislation, funding, policy, and action to reduce child poverty.

There is much to admire about linking a variety of proposed initiatives across previously separate ‘silos’.

Everyone is familiar with the TV game show The Weakest Link. However, it is worth remembering that, as a Polish poet observed: ‘The weakest link in a chain is the strongest … because it can break it.’ The weakest link in Scotland’s otherwise excellent effort to tackle child poverty is a tendency to acknowledge, only passingly, that both poverty and social justice start long before birth.

This reflects a cultural discomfort and societal ‘blind spot’ (across the socioeconomic spectrum) about explicitly making informed decisions about reproductive goals. It is not a coincidence that approximately half of all pregnancies in Scotland are unintended.

The connection with child poverty is obvious and yet complex. Poverty can be not only a cause, but also a consequence of unwelcome pregnancy and birth outcomes, as well as childhood adversity.

Poverty causes some of the circumstances resulting in unwanted conceptions and high-risk pregnancies. Poverty also exacerbates inequalities – from toxic stress and obesity to unresolved mental and physical health problems – harming Scotland’s prospective mothers, fathers and, too frequently, their babies. 

At the same time, poverty is an all-too-predictable consequence for the children whose lives and life chances are severely compromised before they draw their first breath. One particularly powerful example in Scotland is fetal alcohol spectrum disorders. FASD causes lifelong, invisible, irreversible brain damage among far more of our children than is commonly understood.

Known as ‘million dollar FASD babies’ in Canada, the strain is not only on the public purse. The human costs and family financial hardships from raising those having FASD make breaking the cycle of poverty even harder. ‘After the fact’ interventions are helpful, but ‘before the fact’ prevention is the best way out of this poverty trap.

Boosting child benefit by £5 will yield little benefit for those affected by FASD. The better education, housing, employment and fairer social security promised in the Scottish Government’s Every child, every chance delivery plan must be delivered. However, even if successful, every child affected by FASD will not have every chance to become a happy, healthy, productive adult.

To be clear, remembering that poverty is both a cause and a consequence of pre-birth harm is absolutely not an excuse for either disrespecting or disempowering already disadvantaged individuals/communities – or for ‘nanny state’ interventions on deeply private reproductive choices.

Similarly, no one is arguing that only ‘perfect’ people should become parents. If perfection became the standard, then Scotland’s (and the world’s) birth rate would approach zero. Meanwhile, back in real life, more than 600,000 Scottish babies – many of them similar to Kirsty – will be born to at least one million mothers and fathers before Scotland’s tackling child poverty strategy ends in 2030. 

Happily, there is still plenty of room for improvement in preparing and supporting the next generation of Scottish parents. That means giving the health and wellbeing of women – before, during and after pregnancy – the same priority as their babies.

The respected Christie Commission concluded that Scotland was spending far too much on what it called ‘failure demand’ (otherwise known as ‘doing too little, too late’).

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This concern applies to the chain of policies and actions now advocated for tackling child poverty. The weakest link was, and remains, on the primary prevention side – where Scotland’s performance still does not match its rhetoric.

Strengthening the weakest link in this chain means getting serious about:

• Working from earliest childhood through adulthood to promote good health, which helps everyone (whether or not they will become parents);

• Providing those seeking to avoid pregnancy with an accurate understanding of their options, access to their preferred contraception, plus any desired support;

• Encouraging children’s sense of agency and an understanding of their rights, as these are important to eventual decision-making about reproductive goals/lives;

• Honouring prospective mothers’ and fathers’ entitlement to receive truthful information and non-coercive assistance (as early as is sensible) to increase the chances of actually getting what they already keenly want: a safe pregnancy, a thriving baby and a rewarding parenthood;

• Acting on the knowledge that it is ineffective and cruel for women to be named, shamed and blamed in relation to their circumstances, health status and behaviours;

• Reducing persistent inequalities through meaningful preconception health, education and care; and,

• Preventing adverse pregnancy and birth outcomes as early and fully as possible.

Perhaps strengthening the weakest link in this admirable chain is one example of what Sir Tom Hunter and the Scottish Government have in mind with their new Innovation Fund.

They are seeking ‘radical’ strategies and ‘left field’ ideas to tackle child poverty. By whatever means, Scotland would be wise to act upon the fact that ‘before a crisis’ is when many of the most effective and least expensive solutions can be found.

It can only help to keep Kirsty in mind as, collectively, we seek to counter the child poverty into which she was born two years ago. But hundreds of thousands of her yet-to-be-born peers will be helped even more by each of us doing everything within our power to prevent them from being dealt a poor hand.

Dr Jonathan Sher is an Edinburgh-based Independent Consultant on preconception   health, education and care. He can be reached at: jonathan@deltaforce.net