Fundamentals of Midwifery: A Textbook for Students (23 page)

poverty

abuse

substance misuse

overcrowding

mental illness

physical illness.There is current debate about the impact of certain types of families on society (Casey 2012). These have been labelled as ‘troubled families’ (Department of Communities and Local Govern- ment 2012; 2013). ‘Troubled families’ have been defined by recent government reports as households who:

are involved in crime and anti-social behaviour

have children not in school

have an adult on out-of-work benefits

cause high costs to the public purse.46(Department of Communities and Local Government 2012; 2013)
Further reading activityRead: Donna and Jake’s story on pages 17 & 18 of the
Listening to Troubled Families
report and thinkabout how this family will be seen by the society in which they live. How could this label affect Donna, Jake and their children?Casey, L. (2012)
Listening to Troubled Families
. London: Department for Communities and Local Government.[Available online] https://www.gov.uk/government/uploads/system/uploads/attachment_data/ file/6151/2183663.pdfThere has been criticism of the labelling of such families and the development of services based on the experiences of only a limited number of ‘problem’ families. Levitas (2012) is par- ticularly critical of how the number of troubled families has been calculated and the impact of labelling them; how labels are then seized upon by the media to further stigmatise and vilify them.Troubled families can be seen as being outside the cultural and societal norms or are seen as a drain on society. Some of the current changes to the welfare system could be seen to be aimed at these families, although other people within society may see the families and their members as vulnerable rather than troubled. Vulnerability is difficult to define and means different things to different people. Larkin (2009, p. 3) discusses how vulnerability can be assessed using criteria around how the person or group are ‘
marginalised, socially excluded, have limited opportunities and income and suffer abuse, hardship, prejudice and discrimination
’. Many elements of social exclusion can occur within the family and be a result of people being seen as outside of society’s norms (Pierson 2010). These elements of exclusion can be found in the media and particularly the tabloids, stigmatising and sometimes demonising a certain type of person. Judgements can be made about people being good or bad parents, with a particular focus on mothers and pregnant women.
Activity 3.3 What do the stories below say about the media’s view of a ‘normal’ family?[Available online] http://www.thesun.co.uk/sol/homepage/features/4957397/Why-pick-on-Kate-when-Rod-had-eight-kids-by-five-women.html and http://www.telegraph.co.uk/news/ celebritynews/10100935/Three-babies-by-three-fathers-will-it-be-third-time-lucky-for-Calamity-Kate-Winslet.html
Domestic abuse
There are messages within all societies around what is acceptable behaviour within families;these change over time and are linked to what is seen as the social norm. One particular message which affects the health and wellbeing of families is domestic abuse.Domestic abuse is defined as:‌
. . . any incident or pattern of incidents of controlling, coercive, threatening behaviour, vio- lence or abuse between those aged 16 or over who are, or have been, intimate partners or
family members regardless of gender or sexuality . . .
47The abuse can encompass, but is not limited to:

psychological

physical

sexual

financial

emotional.(Home Office 2013)The definition of domestic abuse has changed over time, from relating solely to physical abuse to now incorporating all the above factors and specific campaigns around stalking and forced marriages. There is also a need to reflect the changes to family structures as previously discussed to include all the different variations. Historically in the UK it was seen as acceptable for a husband to physically punish his wife; this is now seen as unacceptable and a crime within the UK and many other countries, but not in all countries. However, this does not mean that domestic abuse does not happen; sadly the fact is that women are still living in fear and being murdered by their partners (Howard et al. 2013). Abuse is also experienced by men (ManKind Initiative 2013). This demonstrates that although something is seen as unacceptable by the majority of society and is deemed a crime, it will not necessarily stop the behaviour happening. It has been identified as the role of the midwife to identify and support women who are living with domestic abuse (see Chapter 11: ‘Public health and health promotion’, where domestic abuse is discussed in greater depth).
Safeguarding children and vulnerable adults
Domestic abuse is now also linked to safeguarding of vulnerable adults and children, as it is clear the emotional harm that can be caused to children who witness and live with domestic abuse. All societies cherish their children as the next generation; those who will care for their families as they grow older. However, there are still cases of those who step outside of the key social norms and abuse children. Powell and Uppal (2012) identify many different names of children whose treatment and deaths have led to changes in the law and practices in order to try to safeguard future children. The midwife is part of the safeguarding team for both vulner- able adults and children; it is also important to identify that it is possible to help families in order for them to care for their children in a more appropriate and safe way (see Chapter 8: ‘Postnatal midwifery care’, where safeguarding is discussed in greater depth).
Poverty
One of the issues within the family which has a profound impact on the health and wellbeingof the members is poverty. It has been well-recognised for decades that people with more income have better health and those with less have poorer health. This is classed as health inequalities, and these inequalities have been growing consistently over the years (Joseph Rowntree Foundation 2011; 2013). At this time of austerity, this divide is increasing: the rich are getting richer and the poor getting poorer. There is some debate around the definition of poverty and which one is used when developing policies and publishing statistics.
Activity 3.4 Think about what you would need to go without in order to make you feel that you were living
in poverty. How would this be different if you lived in a least developed country?48There is a debate around how to define poverty and how to measure it in different contexts and communities.Go to the website below and think about the different understandings of the term poverty. [Available online] http://www.poverty.ac.uk/definitions-povertyThere are different definitions used such as absolute poverty which relates to the ability to survive. This tends to be linked to pictures on television of children from developing countries; however, it is stated that there are families in the UK today that are living in absolute poverty. There have been reports of increasing numbers of families relying on food banks in order to feed themselves, with some parents having to make difficult choices regarding what to go without. There is also relative or overall poverty, which relate to the ability to be able to partici- pate in normal activities of the community in which a person lives (Poverty and Social Exclusion UK 2013). It has always been recognised that some families within the UK live in relative poverty. Reading Townend (1979) which is a seminal text around poverty, demonstrates how measure- ment of relative poverty has changed over the years, although some key elements have not. In his work, relative poverty is related to the ability to buy presents and have birthday parties, as well as eating a cooked breakfast.There are other words used to describe poverty such as severe poverty which relates to the inability to afford to fund school trips, not having house insurance, being unable to repair any broken items in the house such as washing machines, and getting into significant debt to buy birthday and Christmas gifts (Witham 2012). However, this could also be termed relative poverty as these would probably be classed as normal day-to-day activities. There has been increasing concern about the rise in debt within families, and how this is being worsened by the use of loan companies, who charge exorbitant interest rates. These families become vulnerable to exploitation and therefore experience further difficulties with their budget. It could be that using the term deprivation is more relevant and is a more useful term to use. However, any label given to a person or family can lead to stigmatisation and discrimination.It is well-documented that families living in poverty have poorer health and wellbeing; this is linked to the ability to afford good quality and fresh food, cost of exercise, poorer housing and living in unsafe neighbourhoods. The lack of opportunities and loss of hope, linked to the loss of the ability to meet their full potential and the mental health impact this has are recog- nised challenges for families living in poverty (Pierson 2010). The current focus on reductions in the welfare budget, and what some would say is a stigmatising of people living on benefits, will only lead to further difficulties and problems for this group.Figures 3.2 and 3.3 illustrate the impact of poverty on the family and how these issues inter- link with social exclusion.The family is the structure in which we develop our identity, with specific elements outside the family influencing this development. There are key elements within our identity which impact on how we are viewed by society and what society expects of us. This chapter will now examine some of these key elements.
More likely to play truant and be excludedLess likely to go into higher educationCannot afford school trips or holidaysMore likely to live in poor housingDo less well in education
Impact of Poverty
Increased rates ofReduced life expectancyMore likely to be a victim of crime