Written evidence submitted by Maternal Mental Health Alliance UK [RCW0008]

The Maternal Mental Health Alliance (MMHA) is a UK-wide charity and network of over 120 organisations, dedicated to ensuring women and families affected by perinatal mental health problems have access to high-quality, comprehensive perinatal mental health care. We bring the maternal mental health community together and make change happen by combining the power of real-life experience with clinical and professional expertise.

How are rising food, energy, housing and other costs affecting women compared to men?

What are the challenges for women: 

• in different types of households (For example, households with children; single parents; renters; houseowners; women with other protected characteristics) and
• whether there is any regional disparity in the effects of those costs?

Many statistics are available regarding the impact of financial hardship on women and their babies during pregnancy and the critical first months of a baby’s life.  This can be a life-threatening situation for some of the most vulnerable mothers.

• The November 2022 MBRRACE report into UK maternal mortality between 2018-2020 noted that women living in the most deprived areas were more than twice as likely to die as those in more affluent parts of the UK.
• In January 2023, the World Health Organization warned that poverty in the UK could increase death rates during or after pregnancy as health inequalities become starker and more expectant mothers are plunged into poverty.

This increasing impact of poverty and deprivation on pregnant women and new mums, as well as their babies, cannot be ignored.

In July 2023, Maternal Mental Health Alliance  (MMHA) held a session with some of our 120 national members to discuss their experiences of how the rising cost of living in the UK is affecting the maternal mental health of new and expectant mums and their families.

Below we have laid out the themes and some of the specific examples we have heard from our networks, including from MMHA members who are directly supporting women and delivering services to support those who are struggling: 

The cost of living directly affects maternal mental health

• In a 2022 survey of 500 new Mums by MMHA, 48% noted the cost of living as an exacerbating factor triggering poor mental health and the group most worried were younger Mums, aged 18-25. 
• In a 2023 poll by UNICEF, 74% of the poorest households noted they were struggling with their mental health (compared to 61% of all respondents with young children) and these poorest families were also the least likely to have received support for their mental health (58% compared to 42% of all income groups surveyed).
• Increased maternal stress levels during pregnancy have well documented negative impacts on babies, contributing to an inter-generational cycle of disadvantage and worse health outcomes.

Increased stress and anxiety

• Mums experiencing mental health problems are experiencing significant additional stress from trying to manage on a very low income, such as the need to always shop around (which is harder when experiencing low mood or lacking transport to visit different shops) and work out the best value for essentials. 
• New parents are watering down baby formula or changing their babies’ nappy less often due to the cost of these items, and there is an emotional impact on parents of having to make such choices for their children.
• Increased stress levels are often linked in these mums’ stories to more relationship challenges, sleep disturbances and less emotional energy for interacting with their children, which can affect the bond with their baby.  As one Mum noted “it’s harder for anybody to be calm and kind when you’re feeling really worried”.  The Institute of Health Visiting said in their 2023 report, ‘To prevent Adverse Childhood Experiences for babies, it is imperative that parents' needs, and the ways that they impact on parenting capacity, are mitigated with effective support and treatment’. 

Fear of judgement

• Women told of feeling ashamed and worried when they receive a home visit from a healthcare professional such as a midwife or health visitor and the heating isn’t on because they cannot afford it, or the fridge is empty.  Many avoided inviting friends over for the same reasons.
• Ultimately, the greatest fear for many mothers is that they will be deemed unable to care for their child and their baby will be removed. 

Impacting social interaction and the opportunity for peer support

• Women cannot afford to meet friends as often as they may have before, due to factors like transport and food costs.  Things like meeting a friend in a cafe, which used to be affordable, have become inaccessible luxuries for many.
• Transport to access toddler groups or a couple of pounds contribution for these types of sessions have become prohibitive for many Mums.
• The importance of social contact for both women and babies cannot be underestimated.  Warm, dry, free and baby-friendly places to meet such as libraries must be prioritised in every area.

The cost of living widens existing inequities for women

• Women whose first language is not English can find it harder to communicate with sellers to buy second-hand items, for example, or to build a supportive network with whom to share recommendations, bulk buys or baby items as well as emotional support.
• Families experiencing digital poverty have less opportunities to find bargains, second-hand items or budgeting advice.
• Families with no recourse to public funds face some of the starkest inequities and several MMHA members also noted the increased emotional toll on professionals of trying to help these families where resources are extremely limited.
• Families with good contacts and wide social networks were noticed to do better when faced with mental health and financial challenges compared to women who were isolated, for example, women in military families who had moved frequently and often lived far away from family networks.

The cost of living can directly affect women’s ability to access mental health support

MMHA’s Motability report found that only 19% of Specialist Perinatal Mental Health services are accessible by public transport.  This either assumes women have access to a car or can afford a taxi when, in reality, many women are now unable to afford bus fares.

Our member organisations discussed this transport challenge in relation to women accessing all kinds of services and some other impacts on help-seeking opportunities:

• The difference for women who can afford private counselling and those who cannot has become more distinct as living costs rise.  Women who can pay for additional treatment often have a very different journey with their mental health than those who cannot. 
• Rising childcare costs, as well as the increasing need for women to use 100% of any funded childcare hours for paid employment, reduces mums’ ability to attend mental health appointments or engage in wellbeing activities.

The cost of living directly affects maternal mental health services

• Services reported that a higher percentage of women accessing their support need help to access essentials such as foodbanks and baby banks before mental health treatment can begin.  As one professional noted, “signposting won’t pay their gas bill”.  This additional work takes up staff capacity and can reduce the number of families that services can support.
• More volunteers are having to return to paid work or care for their own grandchildren, which reduces the available workforce to run projects and offer peer support to mums.

2. What long-term effects will the rise in the cost-of-living have on equalities for women?

As the above examples illustrate, the rise in the cost-of-living is exacerbating existing inequalities for groups of women in the perinatal period.  This risks a trend where those whose outcomes are already significantly worse than those of more economically privileged women, may slide even further and we may see maternal death rates rise. 

Pregnancy and the first months of a baby’s life are a unique opportunity to ensure needs are met, babies’ brains get the basics they need to develop healthily, and the inter-generational cycle of worse outcomes can be broken for many groups.  Prioritising support for these families amidst rising costs is an unparalleled investment in the future, both for these families and for our society.

3. How effectively is the Government’s cost of living response helping women to meet the costs of essentials?

4. What could the Government Equalities Office do to ensure the Government’s cost-of-living measures respond to any inequalities women face?

Amidst the many challenges, MMHA members also shared stories of hope and great resilience.  Families noted that many types of support helped them thrive despite increasing economic pressures:

• Debt management and budgeting support are appreciated.  Many Mums noted that they had not had good previous education about money management such as budgeting, understanding percentages relating to debt or mortgages and how to effectively compare prices.  These services must be freely available and flexibly delivered to fit around caring responsibilities for families.
• Support to access services such as Foodbanks, hygiene banks and Baby banks, toy libraries, energy payments, housing advice and digital connectivity vouchers were invaluable in meeting immediate needs and reducing the level of stress Mums felt.  These services must be prioritised, and funding ensured.
• Several members noted that trusting relationships between professionals and families were vital to enable effective support.  Many Mums found it hard to accept initially that support comes with no strings attached and to overcome fears of judgement, but high-quality casework enabled trust to be built and the right support provided. Funding for universal services and the charity sector must consider the additional time needed for staff to build trusting relationships with families and coordinate additional supports where required.

It is vital that these pressures are recognised in policy, and resources prioritised to meet the needs of women, babies and families facing unequal challenges.

5. What could businesses do to help women cope with increases in the cost of living and to manage debt? For example, we are interested in hearing about:

• The banking and finance sector, including on what measures it could take to identify and support victim-survivors of domestic or financial abuse
• Energy and utilities companies
• Telecoms providers
• Supermarkets
• Other sectors with practical solutions to helping customers and employees most in need (international comparisons are also welcome)

November 2023