§ The Minister of State, Department of Health and Social Security (Dr. David Owen)
I beg to move Amendment No. 36, in page 15, line 12, at end insert—(4) In the Midwives Act 1951 the following section is inserted after section 35—Extension of Act to men.35A. From 1st January 1976 references in this Act to women (except to a woman in childbirth) apply equally to men.(5) In the Midwives (Scotland) Act 1951 the said section 35A is inserted after section 37 of that Act as section 37A.'The purpose of the amendment is to restore the provisions deleted in Committee which were intended to remove the statutory barriers in England and Wales and in Scotland to men becoming midwives.
I say straight away that the Government see this quite simply as a matter of principle. I have read the speech of the right hon. Member for Chesham and Amersham (Mr. Gilmour) in Committee in which he raised two questions. One, which I thought was probably not the more important, was that he thought that the provision would be unjust to women, because he felt that there would be an element of discrimination against female midwives, because the male midwife, as I understand his argument, would not be carrying out the full duties. I hope to show that that will not happen.
It is the purpose of the Bill to uphold the right of women and, equally, of men to have access to the work of their choice, unimpeded by the fact of their sex. The principle has found wide acceptance in the House. I do not think that the objections raised in Committee to the clause can be regarded as being on the grounds of principle. It is true that the Bill provides for exceptions to the principle, but I think that it is generally agreed that they are very few, and in limited areas. The Government do not wish to see the Bill, which represents a major step forward for women, weakened in its effect by enlarging the area of exceptions. Indeed, it could be argued that the area of exceptions should be reduced rather than enlarged.
1544 I have said that the objections raised in Committee were not founded upon principle. They stem, in fact, from difficulties which may arise in practice. I would not for one moment suggest that these are not proper matters for concern. They raise delicate issues on which it is possible for people with the same views on the broad principles of the Bill to disagree.
I shall not weary the House with a list of the various bodies that have taken views on this subject. It would be fair to say, broadly, that bodies concerned with the medical profession have tended to come out against the provision that the Government wish to introduce, and, broadly, bodies more generally concerned with women's rights and women's interests have favoured the Government's prosion.
There are some reasons for this—mainly because the Royal College of Midwives, which will obviously have a strong influence on the medical professional bodies, has throughout adopted the view that this should not take place.
I want to try to deal with the grounds of the objections. The first is the freedom of choice for the patient. I think that that element has been adequately dealt with in Committee. There is no question here of our wish—indeed, I think of it as our duty—that there should be freedom of choice for the patient. That is, in effect, freedom for the expectant mother to choose not to be cared for or treated by a male midwife. We appreciate that there should be no deterrent to expectant mothers seeking proper and necessary care. We understand the concern expressed on behalf of some of the immigrant communities, which was mentioned in Committee.
There need be no apprehension on that score. The Bill provides for coverage for this. It provides for the exemption of employing and training authorities from the obligation not to discriminate on grounds of sex. This is designed, therefore, to leave the situation under administrative control.
We propose to limit the training and the employment of men as midwives to a few selected centres where it will be possible to ensure that there can be choice by the patient. We do not know how many centres will need to be established 1545 because we have no idea how many male nurses will wish to take up the opportunity of being trained as male midwives. I think it would be a very small number. On the experience we have already of the recent extension to male nurses of the opportunity to be trained to gain obstetric experience on a 12-week course—they do not practice midwifery; I want to make that perfectly clear—so far no one has taken up this option, although the course started only in January. It is early days, but I do not believe that this will be extensively used.
§ Mr. Ronald Bell
If it is the intention to restrict the employment and utilisation of male midwives to certain centres at which the patient can be certain of having a choice, how will that be done without offending against the general provisions of the Bill against discrimination in employment?
§ Dr. Owen
We have exempted these areas because of this problem. The hon. and learned Gentleman raises a debating point. We have provided for the exemption of employing authorities and training authorities from the obligation not to discriminate on grounds of sex. What we are saying, in effect, is that in these training centres they will have special facilities. They will have a higher level of chaperonage. This is the key to the problem. I think that one will tend to find that a male midwife will be treated as supernumerary to the establishment. There will be other midwives, so it is not necessary for the chaperonage to be undertaken by either trained nurses or trained midwives. It will be sufficient if there is another female in the room. This method is often used by doctors and male medical students. It is a familiar problem. There would be little point in adding to it and, therefore, raising the question of cost.
If there were to be a very large number of male midwives, obviously the cost would become a matter of concern. The House will obviously be asked to make a judgment as to whether it thinks that this will be a very large group of nurses. I am saying that I do not think that this will be so. It is true that the centres which train and employ male midwives will have to make some allowance for possible increases in costs. I accept that. But that additional expenditure will be very small. The initial restriction to a 1546 few centres will in itself help to limit the extra cost.
On this question I do not think that the House will make cost the real issue, or one which would persuade us to overturn the principle of equal access to jobs, bearing in mind the sensitivities of this issue. I do not believe that the House will make the decision in terms of cost.
§ 10.45 p.m.
§ Mr. Freud
The Minister has explained that there would be a chaperon in the case of a male midwife. Presumably the chaperon would be a woman, which surely constitutes sex discrimination. It seems to me desperately unfair that the "midhusband" should not be allowed to choose the sex of his chaperon.
§ Dr. Owen
The hon. Gentleman has made a fair and perhaps amusing point. The fact of life is that this question of chaperonage is not new. It is regulated by common sense. The question we must bear in mind is that there are some male nurses who, it appears, may well take up this provision. We must ask why they do so. One of the reasons is that this completes the training of a nurse. Some nurses wish to have experience of all aspects of care. No doctor can be trained without gaining some obstetric experience. No doctor would say that the period of three months could be taken out of the curriculum without loss. Nurses have the same feeling. A nurse who may wish to reach a senior position in charge of a hospital may feel that it would be of benefit to have a period of midwifery experience. There is no reason why they must have it. A male nurse can take a job in the administration of a hospital without having had midwifery experience, although I can see why they might wish to do.
The question of chaperonage also arises when nurses go out "on the district". It is necessary as part of the year's training in midwifery to do some district work. During that period there must be arrangements for chaperonage.
There will be an element of distinction. I do not think that many male midwives will ever engage in purely district midwifery. We must bear in mind that 94 out of every 100 children are born in hospitals. That is where the main obstetric practice lies. Hon. Members 1547 have raised questions of toilets and aftercare, not just the problem of the delivery. The point has been fairly made that it is probably easier to deal with the passage and birth of the child. Embarrassing questions are raised as regards post-natal care. Those questions must be dealt with by male nurses in the health service. It is possible to hold different views.
I do not think that there is any cause for alarm over this provision. It is no more than a fairly logical extension. Attitudes are changing. It would have been difficult to envisage mixed wards in the health service 20 years ago. Some people still do not like mixed wards. Other people find it easy to cope with mixed wards. I am not saying that there will be no difficulties. This is an object which, given good sense on both sides of the House, could easily be achieved.
The Government have chosen the approach indicated in the Bill. We think that it is preferable to remove the barriers to men training and practising as midwives, but to retain administrative control over the situation. The introduction of men to midwifery will be measured, deliberate and with all the proper safeguards. I think that as and when attitudes change—they will change, with the passage of time—we shall look again at the situation. In the meantime, we think that it is best concentrated on a few centres.
A number of surveys were held. They showed that the initial feeling that women were anxious about this was not necessarily true. The Sutherland community health council conducted a survey. Previously there had been no adequate survey of public opinion on the issue. In keeping with the changed circumstances, and most people's attitudes to this, this is a provision which the House would do well to reinstate in the Bill.
In that spirit I commend the amendment.
§ Mr. Ian Gilmour
Once again the Government are seeking to undo a decision taken in Committee by those who have heard the arguments, using the votes of those who have not. We all appreciate that the Minister of State has moved his amendment with great moderation and attentiveness. He moved it with such moderation that he must have raised in 1548 most people's minds the question why he moved it at all. His case could hardly have been more conciliatory, but was not worth putting forward. He said that this was a matter of principle. I think that it is a matter of dogma—dogma by the Secretary of State for Social Services.
Before the Bill was introduced the right hon. Lady said in her letter to the Royal College of Midwivesit would be wrong to rule out male midwives as a matter of principle and that to do so would damage the reputation of the midwifery profession in the eyes of the public".That is taking silliness to a sublime level. The Minister of State instanced Sutherland County Council, but surveys tend to go the opposite way to that instance, although they are not conclusive. One certainty, however, is that there is no public demand for male midwives and, as the Minister seemed to concede, very few people want to become male midwives. I therefore cannot understand why he or the Secretary of State should want to come to the House and upset a perfectly sensible decision.
The Royal College of Midwives is not a very powerful organisation, which is no doubt why the principle that the Minister spoke about can be forced home. Where an organisation is very powerful the matter of principle no longer applies. All the medical bodies in the country are against the Minister on this. All informed medical opinion is against him for two very simple reasons. He said that he would deal with the first, but I do not think that he did. The first effect will be to confine a lot of female midwives to post-natal and ante-natal care, because it is obviously much easier for male midwives to be present at the delivery since at that stage the chaperon difficulty does not arise. The second argument is on the chaperon point, which the Minister skated around very delicately, but he ran into the difficulty encountered by the Under-Secretary in Committee.
The fact that there are already some chaperons in the health service is not a very good argument for saying that in a time of great shortage of staff, manpower and resources we should add to the wasted manpower by creating male midwives who have to have chaperons a lot of the time. A survey has been conducted which showed that in the normal 1549 8-hour shift of a student midwife, threeand-a-half hours would have to be spent with a chaperon. That is a quite ludicrous way of using manpower in the health service.
The hon. Member for Wolverhampton, North-East (Mrs. Short), who is not here tonight because, I think, she is abroad, said, very fairly, that this is a matter which goes very deep. It affects not only pregnant mothers but their husbands too. Where the economic argument, the efficiency argument and the argument about what people want all point the same way there can be no justification for the Government talking about a matter of principle, especially when they are really talking about saving the face of the Secretary of State for Social Services. I therefore hope very much that the House will reject the amendment.
§ Mrs. Audrey Wise (Coventry, South-West)
I rise to oppose the Government amendment. It is not a question, it seems to me, which should be judged by the yardstick of opening up job opportunities to men, but that is precisely the yardstick the Government are using.
The Government amendment says:references in this Act to women (except to a woman in childbirth) apply equally to men.The fact that it is necessary to use the words "except to a woman in childbirth" deals precisely with my point that this is not simply a question of job opportunities, not simply a question of the views of male or female midwives, but there is a third party entitled to have a point of view: the mother in childbirth, an area in which it is pointless to talk of equality as an abstraction. For the mother in childbirth, equality has no meaning whatever.
We are told by the Government that the mother will have a choice, but I want to tell the Government quite straight that I do not believe it.
In Committee the Under-Secretary of State for the Home Department said:choice of care is a factor in our National Health ServiceThat will be news to many of us. Choice of GP, yes. She goes on to say:Fortunately, as quite a lot of women doctors are available, many women are able to choose to see a woman GP …"—[Official Report, Standing Committee B, 6th May, 1975; c. 252.]1550 The word "many" exactly reinforces my point. Even in an area where there is free choice, the male domination of medicine is such that this free choice is not even available to all women. If one goes to hospital, not only is there no choice of which doctor shall attend one. I had a major operation in the NHS, and not only could I not choose who should do it but they would not even tell me who would do it or, when it was done, who had done it. Am I expected to believe we have choice?
If one compares Clause 20 with Clause 7 we find that in Clause 7 we are told:where men might reasonably object to the presence of a woman because they are in a state of undress or are using sanitary facilitiesthey are to be sheltered from embarrassment. I am told that if I wear corsets and go to buy them, I shall be sheltered from having to have a man attend me in the changing room, but this clause tells me that if I am a new mother and have my baby at home, or I am an early release from hospital—and the Minister gave no figures about the women released very soon after delivery—I shall be sheltered from a male attendant in the changing room. But I might have a male midwife to do a vaginal swab in the privacy of my home, not in a clinical and surgical atmosphere.
That is the kind of thing which will exercise the minds of men and women. In practice I do not think they will send male midwives round the district because it causes too many problems, and difficulties with chaperons. Shortly after this comes into operation, male midwives will be found to be doing far more of the supervisory kind of jobs and the females will be doing the slogging round the districts.
We are worsening the position of women in relation to job opportunities, and I am not at all surprised that this proposal is resisted by female midwives, although that is not my primary concern.
I contrast this provision with the provisions of Clause 19, in which exemption on religious grounds is so wide as to cover anyone employed in any capacity, even—as the Minister conceded—as a typist, if the religious susceptibilities of a follower of any organised religion are offended. The exemption could not be 1551 wider—because we are so scared of being told that we are intolerant towards religion.
In our search for abstract equality we shall greatly offend the susceptibilities of many women by Clause 20. I am not particularly interested in their husbands, although the women themselves may be—presumably they are. We are told that chaperonage already exists and that we are just adding to it. The Minister knows that the National Health Service is desperately short of resources. In addition to my other resentments, I deeply resent the waste of resources on chaperonage in opening up further jobs to men in an already male-dominated profession. I see no point in that. When we can supply all the staff required to carry out properly the services which already exist, I might reconsider the matter, but it is ridiculous for the Government now to propose increasing costs for this purpose.
We have been told that most babies are delivered in hospital. That is a pity. I should like to defend the domiciliary midwifery service, as I am sure would many mothers. The employment of male midwives would be yet another nail in the coffin of the domiciliary midwifery service. The male domination of medicine is one factor in the increasingly mechanistic attitude to childbirth to which, as a mother, I object.
|Division No. 242.]||AYES||[11.8 p.m.|
|Anderson, Donald||Ellis, Tom (Wrexham)||Kilroy-Silk, Robert|
|Armstrong, Ernest||English, Michael||Lamond, James|
|Bagier, Gordon A. T.||Ennals, David||Lestor, Miss Joan (Eton & Slough)|
|Bates, Alf||Evans, John (Newton)||Lewis, Ron (Carlisle)|
|Bennett, Andrew (Stockport N.)||Fernyhough, Rt Hon E.||McCartney, Hugh|
|Bidwell, Sydney||Fitt, Gerard (Belfast W)||McGuire, Michael (Ince)|
|Booth, Albert||Flannery, Martin||Mackenzie, Gregor|
|Boothroyd, Miss Betty||Fletcher, Ted (Darlington)||McMillan, Tom (Glasgow C)|
|Brotherton, Michael||Ford, Ben||Magee, Bryan|
|Callaghan, Jim (Middleton & P)||Forrester, John||Marks, Kenneth|
|Clemitson, Ivor||Fowler, Gerald (The Wrekin)||Marquand, David|
|Cocks, Michael (Bristol S)||Fraser, John (Lambeth, N'w'd)||Marshall, Dr Edmund (Goole)|
|Cohen, Stanley||George, Bruce||Millan, Bruce|
|Coleman, Donald||Golding, John||Miller, Dr M. S. (E Kilbride)|
|Conlan, Bernard||Gourlay, Harry||Morris, Charles R. (Openshaw)|
|Cox, Thomas (Tooting)||Grant, George (Morpeth)||Mudd, David|
|Crawshaw, Richard||Hardy, Peter||Murray, Rt Hon Ronald King|
|Cryer, Bob||Harper, Joseph||Newens, Stanley|
|Dalyell, Tam||Harrison, Walter (Wakefield)||O'Halloran, Michael|
|Davidson, Arthur||Hatton, Frank||O'Malley, Rt Hon Brian|
|Davies, Ifor (Gower)||Hayman, Mrs Helene||Ovenden, John|
|Dean, Joseph (Leeds West)||Horam, John||Owen, Dr David|
|de Freitas, Rt Hon Sir Geoffrey||Hoyle, Doug (Nelson)||Park, George|
|Doig, Peter||Hughes, Robert (Aberdeen N)||Prescott, John|
|Dormand, J. D.||Jackson, Colin (Brighouse)||Price, C. (Lewisham W)|
|Duffy, A. E. P.||Jackson, Miss Margaret (Lincoln)||Price, William (Rugby)|
|Dunn, James A.||John, Brynmor||Radice, Giles|
|Edge, Geoff||Jones, Alec (Rhondda)||Richardson, Miss Jo|
|Ellis, John (Brigg & Scun)||Jones, Barry (East Flint)||Roberts, Albert (Normanton)|
§ This provision will not improve the position for mothers but will, rather, cause deep resentment in the minds of many of them. There is no evidence that mothers will have a choice. Choice can be given only at the expense of resources which cannot be afforded. It will not improve the position for midwives; in fact it will worsen their job opportunities. The only people who will be helped by the amendment are the few men who want to be male midwives. It will open up job opportunities for a few men at the expense of the interests and desires of women as mothers and women as midwives.
§ I strongly urge the House to reject the amendment, not in a spirit of prudery but because I believe that after childbirth women are entitled to—and want—the services of their own sex. That is the way in which the House should look at it. I speak independently, not as a supporter of the hon. and learned Member for Beaconsfield (Mr. Bell). I speak as someone who is totally committed to the advancement of women, women's rights and women's status in society. I earnestly request the House to reject the amendment.
§ Question put, that the amendment be made:—
§ The House divided: Ayes 104, Noes 96.
|Roderick, Caerwyn||Taylor, Mrs Ann (Bolton W)||Wrigglesworth, Ian|
|Rooker, J. W.||Tinn, James||Young, David (Bolton E)|
|Roper, John||Wainwright, Edwin (Dearn V)||Young, Sir G. (Ealing, Acton)|
|Skinner, Dennis||Walker, Terry (Kingswood)|
|Spriggs, Leslie||Ward, Michael||TELLERS FOR THE AYES|
|Stewart, Rt Hon M. (Fulhum)||Woodall, Alec||Mr. James Hamilton and|
|Summerskill, Hon Dr Shirley||Woof, Robert||Mr. David Stoddart.|
|Alison, Michael||Gray, Hamish||Penhaligon, David|
|Arnold, Tom||Henderson, Douglas||Percival, Ian|
|Ashton, Joe||Hooson, Emlyn||Powell, Rt Hon J. Enoch|
|Atkins, Rt Hon H. (Spelthorne)||Hutchison, Michael Clark||Prior, Rt Hon James|
|Bain, Mrs Margaret||Jessel, Toby||Rees-Davies, W. R.|
|Bell, Ronald||Jopling, Michael||Rifkind, Malcolm|
|Biggs-Davison, John||Kilfedder, James||Roberts, Michael (Cardiff NW)|
|Blaker, Peter||Knight, Mrs Jill||Rodgers, George (Chorley)|
|Bray, Dr Jeremy||Lamborn, Harry||Shersby, Michael|
|Brittan, Leon||Lane, David||Small, William|
|Buchanan-Smith, Alick||Lawrence, Ivan||Smith, Cyril (Rochdale)|
|Bulmer, Esmond||Lawson, Nigel||Speed, Keith|
|Campbell, Ian||Le Marchant, Spencer||Stanbrook, Ivor|
|Cant, R. B.||Luce, Richard||Steel, David (Roxburgh)|
|Chalker, Mrs Lynda||McCusker, H.||Stewart, Donald (Western Isles)|
|Clarke, Kenneth (Rushcliffe)||McElhone, Frank||Stradling Thomas, J.|
|Cockcroft, John||Macfarlane, Neil||Thomas, Ron (Bristol NW)|
|Cooke, Robert (Bristol W)||McNair-Wilson, M. (Newbury)||Thompson, George|
|Cope, John||Madden, Max||Thorpe, Rt Hon Jeremy (N Devon)|
|Cordle, John H.||Mather, Carol||Townsend, Cyril D.|
|Costain, A. P.||Maxwell-Hyslop, Robin||Tugendhat, Christopher|
|Craigen, J. M. (Maryhill)||Mayhew, Patrick||Vaughan, Dr Gerard|
|Dean, Paul (N Somerset)||Meyer, Sir Anthony||Viggers, Peter|
|Dodsworth, Geoffrey||Miscampbell, Norman||Wakeham, John|
|Douglas-Hamilton, Lord James||Mitchell, R. C. (Soton, Itchen)||Watt, Hamish|
|Evans, Gwynfor (Carmarthen)||Moate, Roger||Weatherill, Bernard|
|Ewing, Mrs Winifred (Moray)||Molyneaux, James||Welsh, Andrew|
|Eyre, Reginald||Morgan, Geraint||Wise, Mrs Audrey|
|Fisher, Sir Nigel||Morrison, Hon Peter (Chester)|
|Fletcher-Cooke, Charles||Neubert, Michael||TELLERS FOR THE NOES|
|Fowler, Norman (Sutton C'f'd)||Noble, Mike||Mr. Adam Butler and|
|Freud, Clement||Page, John (Harrow West)||Mr. Russell Fairgrieve.|
|Gilmour, Rt Hon Ian (Chesham)||Paisley, Rev Ian|
|Gow, Ian (Eastbourne)||Parkinson, Cecil|
§ Amendment accordingly agreed to.