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Association between health indicators of maternal adversity and the rate of infant entry to local authority care in England: a longitudinal ecological study.

Authors
  • Pearson, Rachel Jane1
  • Jay, Matthew Alexander2
  • Wijlaars, Linda Petronella Martina Maria...2
  • De Stavola, Bianca2
  • Syed, Shabeer2
  • Bedston, Stuart John3
  • Gilbert, Ruth2
  • 1 Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK [email protected]
  • 2 Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.
  • 3 Centre for Child and Family Justice Research, Department of Sociology, Lancaster University, Lancaster, UK.
Type
Published Article
Journal
BMJ Open
Publisher
BMJ
Publication Date
Aug 13, 2020
Volume
10
Issue
8
Identifiers
DOI: 10.1136/bmjopen-2019-036564
PMID: 32792438
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Infants enter care at varying rates across local authorities (LAs) in England, but evidence is lacking on what is driving these differences. With this ecological study, we aimed to explore the extent to which adversity indicated within women's hospitalisation histories, predelivery, explained the rate of infant entry into care. We used two longitudinal person-level data sets on hospitalisations and entries to care to create annual measures for 131 English LAs, between 2006/2007 and 2013/2014 (April-March). We combined these measures by LA and financial year, along with other publicly available data on LA characteristics. We used linear mixed-effects models to analyse the relationship between the outcome-LA-specific rate of infant entry into care (per 10 000 infants in the LA population) - and LA-specific percentage of live births with maternal history of adversity-related hospital admissions (ie, substance misuse, mental health problems or violence-related admissions in the 3 years before delivery), adjusted for other predictors of entry into care. Rate of infant entry into care (mean: 85.16 per 10 000, SD: 41.07) and percentage of live births with maternal history of adversity-related hospital admissions (4.62%, 2.44%) varied greatly by LA. The prevalence of maternal adversity accounted for 24% of the variation in rate of entry (95% CI 14% to 35%). After adjustment, a percentage point increase in prevalence of maternal adversity-both within and between LAs-was associated with an estimated 2.56 (per 10 000) more infants entering care (1.31-3.82). The prevalence of maternal adversity before birth helped to explain the variation in LA rates of infant entry into care. Preventive interventions are needed to improve maternal well-being before and during pregnancy, and potentially reduce risk of child maltreatment and therefore entries to care. Evidence on who to target and data to evaluate change require linkage between parent-child healthcare data and administrative data from children's social care. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

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