Over half of pregnant women in Wales at risk of having their babies removed experience mental health problems

New research has revealed that pregnant women living in Wales who are at risk of their babies being removed from their care in the first year of life are far more likely to have had mental health problems compared to other pregnant women.

The study was commissioned by Nuffield Family Justice Observatory (FJO), and designed and delivered by the Family Justice Data Partnership, a collaboration between Lancaster University and Swansea University.

It is the first study to link anonymised family court records to maternal health data in Wales, enabled by the SAIL (Secure Anonymised Information Linkage) Databank.

This is the third in a series of “Born into Care” reports, initiated by Professor Karen Broadhurst, of Lancaster University, and colleagues in 2018.

This new report is focused on one thousand mothers in Wales appearing in care proceedings and examined the timing of women’s engagement with antenatal services in pregnancy as well as health vulnerabilities.

Over half (53 per cent) of the pregnant women at risk of care proceedings reported an existing mental health condition at their initial antenatal assessment – compared to 17 per cent in the (general population) comparison group.

Over three-quarters (77 per cent) had a mental health-related GP or hospital contact or admission recorded in their health records prior to their child’s birth – twice the proportion of pregnant women in the general population (38 per cent).

The report’s findings also challenge the assumption that mothers who become involved with children’s services avoid or delay interaction with antenatal services – with almost two-thirds (63 per cent) having made contact by the end of the first trimester of pregnancy.

Only a very small proportion of mothers (5%) delayed contact with antenatal services until very late in pregnancy. Although overall, the timing of women’s engagement was slightly later than the general population, findings do not indicate that pregnancy concealment was common for this population of mothers.

In Wales, the number of infants appearing in care proceedings at birth, or in the first year of life, is increasing, and there is growing recognition that parents need to be supported pre-birth if these numbers are to be reduced.

Evidence of multiple health vulnerabilities is perhaps not surprising, but this new report provides the empirical evidence that policy makers need, to justify targeted investment across Wales in pregnancy.

Investment in pregnancy also holds out the promise of improving the health of the unborn baby – a higher proportion of babies were born pre-term or low birth weight in the study cohort.

The report recommends placing maternal mental health far more central in local authority pre-birth practice alongside support to improve overall wellbeing.

The family justice data partnership aims to produce new knowledge to inform policy and practice development. Although all studies within this programme of work are based on completely novel linkages of large-scale administrative data sets, findings are communicated in accessible formats as well as through peer reviewed academic articles.

Professor Broadhurst, co-director of the family justice data partnership, Lancaster University said: “Local authorities in Wales are moving towards an earlier pre-birth response to all families referred to children’s social care services – and establishing a consistently timely response, in the first trimester of pregnancy, is critical.

“It is really promising that a sizeable proportion of birth mothers engage with antenatal services at this point – it provides a clear window of opportunity for intensive, early engagement. Our study shows that maternal mental health must be given greater priority in pre-birth assessments and in therapeutic intervention in pregnancy.

“Consultation with the practitioners who deliver these services, such as social workers and midwives, is an important next step to assess whether practitioners feel able to identify and respond to these issues, and to determine any professional training.”

Dr Lucy Griffiths, first author at Swansea University, said: “Welsh policy makers and practitioners require an evidence-informed picture of families involved in the family justice system to tailor services more closely to their needs, and to make the best decisions. Previously, very little was known about mothers in care proceedings in terms of their overall health and well-being before or during pregnancy, pregnancy outcomes, engagement with antenatal services or age profiles.”

Director of Nuffield FJO Lisa Harker said: “These new findings show that the sharp rise in the number of babies being taken into care is as much a mental health crisis as it is a parenting crisis. It underscores the need – and highlights the opportunity for – timely and enhanced support. If help can be provided to women, especially when they report with health concerns early in pregnancy, it may be possible to reduce the number of infants taken into care.”

The Born into Care series

Born into care: One thousand mothers in care proceedings in Wales’ follows the Nuffield FJO ‘Born into Care: Wales’ report, published in October last year by members of the same research team, which revealed the scale and rising numbers of babies subject to care proceedings in Wales, notably in the first year of life. It prompted questions about the reasons behind these increases, and what could be done to prevent infants being removed from their mothers’ care. The first report in the series was Born into Care Newborns in Care Proceedings in England.

Nuffield FJO and the research team will host a virtual roundtable on June 18 to discuss the findings with health and social care professionals and strategic leads. Consultations to discuss the report’s findings will be ongoing over the next year.

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