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Letting things slide

This is currently the case with the HSE’s Maternity and Infant Scheme, which has long been held up as one of the most positive public healthcare schemes in operation in the country.

The scheme provides that all pregnant women have a schedule of free visits to their GP – six visits for first pregnancies and seven for subsequent pregnancies.

In addition, there is provision for an extra five consultations where a condition related to pregnancy, such as gestational diabetes, occurs. The scheme also provides for a two-week baby check and a six-week mother and infant check. This is all aimed at ensuring high quality and continuous primary care for women giving birth in Ireland, by removing onerous costs.

However, the Maternity and Infant Scheme does not provide cover for medical equipment, including the blood glucose monitoring equipment (strips and lancets) for pregnant women suffering from gestational diabetes. These items cost around €140 per month, not to mention the cost of tablets and insulin for some of those with more severe gestational diabetes, though the DPS does kick in after €144 has been spent.

These costs used to be routinely covered by the HSE, but have become another quiet victim of health service cost-saving in the last few years. This is despite the ongoing rise in gestational diabetes in Ireland and the importance of blood glucose monitoring for this patient population, given the potential negative outcomes for both the women and their babies if the condition is left unchecked.

As reported in this issue, Diabetes Ireland has urged the HSE to reconsider its approach and to cover these costs for all pregnant women with gestational diabetes, not just those with medical cards.

Diabetes Ireland Health Promotion and Research Manager Dr Anna Clarke commented to the Medical Independent: “It is discouraging that the current Government is putting the health of pregnant mothers and our next generation at risk because of €500 per pregnancy.”

In addition, GPs and the maternity services have pointed to inadequate vaccine rates in pregnant women. Pregnant women with influenza are more likely to develop severe illness and die than the general population. Getting flu in pregnancy may also lead to premature birth and smaller birth weight and even death of the baby in the womb. In addition, infants under six months of age have the highest rate of hospitalisation and death from influenza. It is a similar story for pregnant women and infants who contract pertussis.

Pregnant women in Ireland are therefore strongly advised to get the seasonal flu and pertussis vaccine and while the vaccines themselves are provided free-of-charge for this at-risk cohort, their administration is not funded. Pregnant GP Visit and Medical Card holders do have the vaccine administration covered (GPs and pharmacists receive a €15 fee) so why not all pregnant women?

It makes no sense and is yet another short sighted ‘saving’ by the HSE that is leading to poor uptake rates in this cohort, the IMO has claimed. The uptake rate among pregnant women attending the Rotunda Hospital last winter, for example, was just 55 per cent for the flu vaccine and 32 per cent for the pertussis vaccine.

The Maternity and Infant Scheme has long been praised for its universal coverage, so surely it is high time to address these anomalies and ensure the costs of vaccine administration and necessary medical equipment and medicines are covered for all pregnant women.

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