Vulnerable birth mothers and repeat losses of infants to public care: is targeted reproductive health care ethically defensible?

This article aims to advance debate about the ethics of targeted reproductive health care for birth mothers who have experienced recurrent care proceedings. Making reference to new research evidence that reports the scale of the problem of repeat care proceedings in England, the article considers the role that enhanced reproductive health care might play in helping mothers exit a cycle of care proceedings. Emerging practice initiatives are introduced which are all stretching the boundaries of statutory intervention, by working intensively with mothers following removal of children to public care. The central argument of this paper is that a positive interpretation of rights provides a warrant for providing enhanced access to contraception, but this must be part and parcel of a holistic, recovery focused approach to intervention. Caution is also raised in respect of the reasons that may lie behind a pattern of rapid repeat pregnancy for this particular group of women. Issues of loss and grief are clear complicating factors in reproductive decision-making where an infant or child has been removed to public care, the magnitude of which must be firmly acknowledged. Charting novel theoretical ground, the discussion draws on a conceptual vocabulary from the literature on other forms of perinatal loss, suggesting that the notion of 'replacement baby' may help to explain why some mothers are caught in this negative cycle. Although this article is prompted by escalating concerns about the human and economic costs of repeat care proceedings in England, the discussion will be relevant to a number of international jurisdictions such as the USA, Canada and Australia where cognate systems of child protection give rise to similar patterns.