First time mums in England who face care proceedings are 21 times more likely to die within 10 years of the birth than mums of the same age who don't experience this, finds an analysis of family court proceedings, published online in the Journal of Epidemiology & Community Health.
Nearly 3 out of 4 of these deaths were related to suicide, homicide, drugs/alcohol, and unintentional injuries, reflecting these women's extreme health vulnerability, say the researchers.
Better upstream support and family court reform are key to improving their health and curbing the need for care proceedings and potential loss of custody, argue the researchers.
Family court care proceedings are instigated to remove children at risk of parental harm, but there's very little information on the health of the mothers involved in these proceedings, explain the researchers.
To extend the body of available evidence, the researchers set out to estimate the death rate of first time mothers who had and hadn't experienced care proceedings, ascertain the proportions of potentially preventable deaths, and highlight the risk factors.
They included all 15 to 39 year old mothers (2,775, 835) in England who gave birth for the first time in NHS maternity units between 2007 and 2017. They were linked to administrative data for mothers involved in family court care proceedings between April 2007 and March 2022.
National statistical data and hospital records were used to track maternal deaths, and their causes, within 10 years of giving birth.
In all, 28,405 (1%) first time mothers experienced care proceedings within 10 years of giving birth. They tended to be younger, more deprived, and had more health problems recorded in the 3 years before the birth than other mothers.
Just over 1% of these mothers (314) died compared with 0.2% (5103) of the mothers who didn't go through care proceedings. In nearly 3 out of 4 cases (73%; 229) these deaths were potentially preventable as they were associated with suicide, homicide, drugs/alcohol, and unintentional injury, say the researchers.
Among the mothers who died, but who didn't experience care proceedings, 28% (1405) of these deaths were also associated with these factors, a proportion that rose to 44% among the under 25s.
After adjusting for age, women who faced care proceedings died at a rate 21 times higher than that of women who didn't.
"Mechanisms explaining a higher risk of death are complex, including pre-existing poorer mental and physical health, a theory supported by our data. It may also be that child removal increases maternal mortality risk," explain the researchers.
"The profound impact of child removal has been described, including long-lasting grief, guilt and stigma; loss of identity as a parent; a sense of failure; and adverse health consequences—all without access to post-removal support," they add.
The researchers caution that their data can't be used to estimate any causal effect of court decisions on maternal deaths, nor were data available on actual placements.
But they conclude: "Healthcare, social care, and family courts must address the extreme health vulnerability of mothers before, during, and after proceedings."
They add: "Ultimately, a public health approach to family justice is needed that examines why families come to court in the first place, their journeys through the courts, and their long-term outcomes following proceedings."
