Can Dundee contraception scheme break the cycle of children in care?
A programme which supports women with drug addiction and mental health issues if they agree to take contraception is being introduced in Dundee.
The Pause initiative claims that it helps break the cycle of women having children who then end up in the care system.
But critics said the scheme raised "big ethical questions" about conditional welfare and reproductive rights.
BBC Scotland's The Nine programme has been asking: Is it right for Dundee?
What is Pause?
Pause was founded in London by former social worker Sophie Humphreys, after working with women who had several children in care.
Run by a London-based charity, it has been rolled out to 31 council areas across England since its launch in 2013 in Hackney.
Under the scheme, women are offered intensive counselling and support if they go on long-term contraception.
This is usually a contraceptive implant, although injections are also encouraged. The measures are always long-acting but reversible.
The women work with a practitioner to address their harmful behaviours. They receive practical help with housing and health problems, as well as counselling to reflect on past trauma.
What's happening in Dundee?
Dundee will become the first place in Scotland to start delivering the programme, which will be offered to 20 women from some of the city's poorest areas next month.
The aim is to help women who have had multiple children taken from them by social services.
Between 2012 and 2017, 341 children were removed from the care of 113 mothers in the city.
A Dundee City Council report estimated that Pause could help avoid between six and 10 pregnancies during the 18-month scheme.
It says that it could save up to £1.6m over five years if fewer children enter the care system.
Many of the women who will take part in the scheme have problems with drug addiction, mental illness and homelessness.
The £450,000 cost of the programme is being funded by the Robertson Trust charity, lottery cash and the Scottish government.
'Different approach needed'
Jane Martin, Dundee City Council's head of social work, told The Nine that services often struggled to engage with women who have lost children to the "system".
She said: "Within that cohort, there is an average of three children per woman.
"Obviously, we had some women who lost significantly more than two.
"I think for us that it was shocking statistic and it confirmed we really need to develop a different approach to the women we are working with."
'The bairns don't ask to be here'
Jay (not her real name) is in her mid-30s and has had multiple children removed from her care.
She grew up in care, has been hooked on diazepam from the age of 12, and has been taking heroin since her early 20s.
Because of her profile, she could be a candidate for the programme.
She has already had a long-term contraceptive implant fitted, and would take part in the scheme if offered a place.
"I don't want a bairn going down the same road I went down," she said. "The bairns don't ask to be here."
'Pregnancies being prevented'
Since its launch in 2013, Pause has attracted more than £13m in donations, including £6.8m from the UK Department for Education's Innovation Fund.
The Nine visited a Pause practice in St Helens, Merseyside, where 21 women have just completed the programme.
The local council views the programme as a success and has renewed the programme for another 18 months.
Former council leader Derek Long said the scheme had saved the authority millions of pounds due to pregnancies being prevented.
He said it cost about £158,000 a year to bring a child into care. "If it can be avoided, we should avoid it," he added.
'I want to be a better person'
Casey (not her real name) has just completed the Pause programme in St Helens.
She is in her 20s, has suffered with mental health difficulties and has lost three children to the care system.
However, she is now hoping that she can play a part in their lives.
Casey told The Nine: "If you're constantly getting pregnant, you are only going to hurt yourself, make it harder each time, break your heart more.
"But having that Pause actually helps you to breathe, to just sit there and think: 'I can do it, I can get through this day.'
"I want to be a better person for myself. I want to be there fully of sound mind for my children and prove to them I can be an amazing mum if they give me the chance."
'Desire to bring about change'
Former social worker Sophie Humphreys, who founded the programme, said she knew of one woman who had 10 children removed from her care.
Talking about the genesis of the scheme, she said: "A hypothesis was formed that... how do you make a space that enables the lens to be on that woman?
"It would be about her as an individual, not just as a mother, or a drug user, or someone who has mental health problems."
She said Pause was more about the women than about councils looking to make savings on supporting children.
Ms Humphreys said: "I've only ever seen people being driven by the absolute desire to bring about change for the women, and also for the children."
'Big ethical questions'
Prof Brid Featherstone, an academic in the field of social work at the University of Huddersfield, is a critic of the programme.
She argues that Pause is too expensive, diverts money from other local programmes and "links to a notion of conditional welfare".
She said: "You can't access a particular programme unless you take a particular form of contraception.
"We need to think about this and talk about this, particularly because there are other projects that work with this group of women that achieve good results without requiring them to take contraception."
She added: "It opens up big ethical questions. I think it's a fundamental human right being able to have a child."
Prof Featherstone said the state should support parents to bring up children.
She said: "I would be very worried if we started going down the road of saying that people should have fewer children - particularly in Scotland, where I understand you need more children."