Scheme offering Dundee mums support if they take birth control is ethically dubious, experts warn

It aims to avoid children being taken into care by providing "an intense programme of therapeutic, practical and behavioural support".

However, in a letter to the Herald today, 16 leading experts in public health, addictions and criminal justice, have warned the scheme contradicts other government strategies, is at odds with a focus on human rights and is "ethically concerning."

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The critics include Jardine Simpson, chief executive of the Scottish Recovery Consortium, Glasgow University public health expert Dr Emily Tweed, Stirling University lecturer in substance use Dr Hannah Carver and Rowdy Yates, the president of the European Federation of Therapeutic Communities.

Pause, a London-based charity, has 21 projects in England and Northern Ireland, covering 25 local authorities. The Dundee scheme is the charity's first in Scotland.

It targets women who have had multiple children removed from their care and works with them on a voluntary basis, offering help and support but in return for a commitment to take a "pause" from pregnancy. According to the city's chief social worker Jane Martin this is "so that they can use their time on the programme to effectively tackle destructive patterns, develop new skills and avoid further trauma."

However a briefing from Ms Martin to councillors in January also drew attention to the likely cost savings, suggesting that if the scheme avoided between six and ten pregnancies that would avoid between £900,000 and £1.66 million over a five year period.

In a joint letter to the Herald, critics of the programme say they accept the need for better support for vulnerable women affected by issue such as substance abuse, domestic violence or mental health problems, and they acknowledge that long-acting reversible contraception can help some women take control of their lives and choices: "However, restricting access to the former based on the latter is ethically concerning."

They also question the presentation of the programme as voluntary: "Does the offer of a much better level of care - with strings attached - truly represent a free choice?" the letter asks.

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"This form of targeted conditionality for vulnerable populations seems at odds with the current focus on human rights across Scottish Government strategies on substance use, mental health and social security."

The women expected to be targeted by the Pause programme often have histories of trauma and coercive relationships, the experts warn and need safe, non-judgemental, trusting relationships with the authorities. "Pause, where support is conditional, choices are constrained and women who become pregnant during the programme are "transitioned out"does not appear to meet these criteria."

Monica Lennon, chair of the Scottish Parliament's cross-party group for women's health said concerns had also been raised when Pause Dundee was discussed by the group in June: “Women experiencing substance misuse should not be denied access to support services because of their contraception choices," she said. "It is worrying that the Pause Project has been introduced in Scotland and it shouldn’t be rolled out further.

"We need trauma-informed and compassionate services that are inclusive. This conditional model is at odds with a rights-based approach and the Scottish Government should be making it clear to health boards and local authorities that this approach is wrong-headed."

Ms Lennon said she was also unhappy at the apparent emphasis on reducing costs. "Local services have been badly hit by Scottish Government cuts but that does not excuse the partnership with the Pause Project," she said.

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A spokesman for Dundee City Council said: "Pause offers an intense and bespoke programme of therapeutic, practical and behavioural support for the individuals involved.

“Participation is on an entirely voluntary basis and is not specifically a project for women recovering from substance misuse.

"The women involved are described as having many complex and often inter-linking needs, including mental health, domestic abuse, drug misuse and criminal justice issues."

Dundee has a substantial number of women who could benefit from the new service he said: "Figures show that in a five year period to October 2017, 113 women in the city had 341 children removed into care. Of these, 73% have had two or three children removed."

He said women who decided not to work with the programme could still get up to 16 weeks of help during an assessment period, whether they accept contraception or not.

Louis Vine, Senior Communications Officer at Pause, said the scheme - which is not run by the charity but by local partners - aims to give women the opportunity to take control of their lives. " The purpose of Pause is to prevent the damaging consequences of thousands more children being taken into care each year," he said. "Working with Pause is on an entirely voluntary basis. Pause works with women to enable them to exercise their right to choose. We help them understand their reproductive choices, their options as well as where and how to get support."

Many had suffered "deep trauma" by having children taken into care, he said and the programme let them make an informed choice about whether they wanted a break from the cycle of pregnancy.

"We have a strong track record and a growing evidence base in providing individual support for women who have had traumatic experiences and complex needs which often includes women with significant substance misuse and women who are victims of sexual violence," he said.

Read this and other letters to the Herald