Executive Summary

This chapter assesses how countries are managing current and projected disaster risks, given knowledge of how risks are changing with observations and projections of weather and climate extremes [Table 3–2, 3.3], vulnerability and exposure [4.3], and impacts [4.4]. It focuses on the design of national systems for managing such risks, the roles played by actors involved in the system, and the functions they perform, acknowledging that complementary actions to manage risks are also taken at local and international level as described in Chapters 5 and 7.

National systems are at the core of countries' capacity to meet the challenges of observed and projected trends in exposure, vulnerability, and weather and climate extremes (high agreement, robust evidence). Effective national systems comprise multiple actors from national and sub-national governments, private sector, research bodies, and civil society, including community-based organizations, playing differential but complementary roles to manage risk according to their accepted functions and capacities. These actors work in partnership across temporal, spatial, administrative, and social scales, supported by relevant scientific and traditional knowledge. Specific characteristics of national systems vary between countries and across scales depending on their socio-cultural, political, and administrative environments and development status. [6.2]

The national level plays a key role in governing and managing disaster risks because national government is central to providing risk management-related public goods as it commonly maintains financial and organizational authority in planning and implementing these goods (high agreement, robust evidence). National governments are charged with the provision of public goods such as ensuring the economic and social well-being, safety, and security of their citizens from disasters, including the protection of the poorest and most vulnerable citizens. They also control budgetary allocations as well as creating legislative frameworks to guide actions by other actors.

The Millennium Cohort Study (MCS) collected information about pregnancy and delivery retrospectively at 9-10 months after the child's birth. For this and other reasons, midwives and other clinical staff were not involved in the data collection, unlike the 1946, 1958 and 1970 cohort studies which started as birth surveys. This limited the potential for collecting reliable detailed information about topics such as complications in pregnancy and at delivery. Clearly, pregnancy and childbirth have got safer over time. In the 1946 birth cohort, 4.0% of babies died in the first week after birth, 3.3% in the 1958 cohort and 2.4% in the 1970 cohort (Williams, 1997). On the other hand, the MCS covered some issues not included in the earlier, more clinically oriented birth cohort surveys.

Many but not all of the topics in this chapter are monitored through routine data systems in the four countries of the UK. Birth registration and NHS maternity statistics systems collect information about trends in demographic structure and patterns of care at delivery, although the ways in which they do so differ between countries. What these routine systems do not provide, however, is much information about the social factors which lie behind these changes in care and in the population giving birth. In addition, NHS maternity systems are largely based on information about hospital care. They do not contain information about encounters which usually take place in the community, notably women's first NHS consultations about maternity care and their use of other services such as antenatal classes. The NHS records also contain only limited information about births outside hospital. The aim of this chapter is both to analyse the data about pregnancy and mothers’ use of services in their social context, and to relate them to the trends documented elsewhere.

The national service framework for children, young people and maternity, published in 2004, has a social as well as a clinical agenda (DfES and DH, 2004): ‘Women have easy access to supportive, high quality maternity services, designed around their individual needs and those of their babies.’ ‘Standard 11, maternity’ emphasises choice for women in planning their own care and choosing the place to give birth. It also prioritises the needs of marginalised women, particularly those from disadvantaged groups. Fieldwork for the first sweep of the MCS took place before most of these policies were implemented.