Are long-term trends in child maltreatment decreasing in England and Wales? A time-series analysis of official record data, 1858–2016

Abstract

BackgroundChild maltreatment can result in serious immediate and long-term consequences for the child, family, and society. With mounting pressure from media scrutiny and public debate, establishing whether rates of child maltreatment are increasing or decreasing in England and Wales is a public health priority. MethodsWe used multiple sources of official record data to investigate long-term trends in child maltreatment from 1858 to 2016 in England and Wales. Data were drawn from a new data source on the incidence of child maltreatment over time (iCoverT), which includes routinely collected data from one UK-wide charity (NSPCC) and five government-collected statistics on child protection, children in care, crime, homicides, and mortality. We excluded data that did not estimate the incidence of child maltreatment, were not available for more than 25 years, or were not nationally representative of England and Wales. We used quasi-Poisson regression and fitted generalised linear models with year as the primary exposure and the number of victims (<19 years) or adult perpetrators (>16 years) of child maltreatment as the outcome, adjusted for population size. We adjusted for changes in definitions and recording practices over time. When a linear association between year and maltreatment was not appropriate, we fitted generalised additive models with penalised natural cubic regression splines to visualise changing trends. FindingsBetween 1858 and 2016, rates of violent child deaths decreased by 90% (2·7 per 100 000 children). This was due to a 96% decrease in rates of infant deaths (aged <1 years) and a 75% decrease in child deaths (aged 1–14 years). Rates of adolescent deaths (aged 15–19 years) did not change. Between 1893 and 2016, rates of adults found guilty of child cruelty or neglect decreased by 83% (6·7 per 100 000 adults). Rates of children entering care decreased by 9% between 1952 and 2016 (23·4 per 100 000 children), and the number of children helped by the NSPCC decreased by 84% between 1910 and 1985 (1074·0 per 100 000 children). However, the number of registrations to the child protection register increased by 182% between 1988 and 2016 (328·7 per 100 000 children). The main reason for registration changed from physical abuse in 1988 to neglect in 2016. InterpretationAlthough long-term trends suggest that rates are decreasing, child maltreatment remains a major public health problem in England and Wales. FundingAndrew W Mellon Foundation, Clarendon through The Oxford Research Centre in the Humanities.