9 Social problems

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It has long been established that social deprivation adversely affects health, including that of the pregnant woman and her baby; it is therefore justifiable to use medical resources in the treatment of social problems. Antenatal inpatient care was originally seen as potentially beneficial for women without major medical problems, but such a philosophy is not reflected in current practice. Current antenatal outpatient services do not address the needs of women with social problems who, viewing such services as hostile, may fail to attend. Special services such as help with drugs problems or HIV counselling or screening may be rejected from fear of prejudice and consequent repercussions. Such prejudice often arises because staff do not fully understand the issues involved. Antenatal care for women with social problems should consider women in the context of their families and social environment and should be provided by a small number of familiar staff forming part of an integrated multidisciplinary team in close and regular contact. Antenatal admission, if it is the woman's wish, should be viewed as justified in the management of social problems; conversely, women should not be pressurized into admission or made to feel guilty if unable to comply. Outpatient antenatal services should be conveniently sited in the community close to other relevant services and should be flexible, not only in terms of organization and format, but also in the roles of the participants. They should be comprehensive, but with special services in addition to, not instead of, routine care, and provided by a team of appropriately trained staff. In the provision of antenatal care for women with social needs, no single format will be universally applicable or desirable, and the precise design and content of the service should be variable according to local requirements and should take account of the women's wishes as well as their needs. Ultimately it will only be if the women perceive the service as being in their interests and as meeting their needs that they will use it; only if they choose to use it, will it have any chance of success.