Abstract
BackgroundUnder the Children Act 1989, local authorities in Wales, UK, can issue care proceedings if they are concerned about the welfare of a child, which can lead to removal of a child from parents. For mothers at risk of child removal, timely intervention during pregnancy may avert the need for this and improve maternal/fetal health; however, little is known about this specific population during the antenatal period. The study examined maternity characteristics of mothers whose infants were subject to care proceedings, with the aim of informing preventative interventions targeted at high risk mothers.MethodsAnonymised administrative data from Cafcass Cymru, who provide child-focused advice and support for family court proceedings in Wales, were linked to population-based maternity and health records held within the Secure Anonymised Information Linkage Databank. Linked data were available for 1111 birth mothers of infants involved in care proceedings between 2015 and 2018. Findings were benchmarked with reference to an age-deprivation-matched comparison group (n = 23,414), not subject to care proceedings but accessing maternity services during this period. Demographic characteristics, maternal health, reproductive history, interaction with midwifery services, and pregnancy and birth outcomes were examined. Descriptive and statistical tests of independence were used.ResultsHalf of the women in the cohort (49.4%) resided in the most deprived areas. They were more likely to be younger at entry to motherhood (63.5% < 21 years-of-age compared to 42.7% in the comparison group), to have mental health (28.6% compared to 8.2%) and substance use issues (10.4% compared to 0.6%) and to smoke (62.7% compared to 24.8%) during pregnancy. The majority first engaged with maternity services within their first trimester of pregnancy (63.5% compared to 84.4%). Babies were more likely to be born preterm (14.2% compared to 6.7%) and, for full-term babies, to have low birthweights (8.0% compared to 2.8%).ConclusionThis novel linkage study highlights multiple vulnerabilities experienced by pregnant mothers who have experienced care proceedings concerning an infant. Policy and practice colleagues require a clearer picture of women’s needs if child protection and health services are to offer effective services which prevent the need for family court proceedings and infant removal.
Highlights
Under the Children Act 1989, local authorities in Wales, UK, can issue care proceedings if they are concerned about the welfare of a child, which can lead to removal of a child from parents
We acknowledge the possibility of some selection bias, which can occur if the records of certain subgroups of individuals have different linkage rates to other groups [30]; we do know that 90.9% of all Cafcass Cymru records relating to the mother for s.31 care proceedings between 2015 and 2018 were successfully matched in Secure Anonymised Information Linkage (SAIL), enabling anonymised linking field (ALF) to be used to link to Maternity Indicator Dataset (MIDS) records and other study data sources
This study demonstrates the potential of record linkage to throw light on questions about antenatal engagement and women’s health vulnerabilities, specific to women appearing in family court proceedings, who might otherwise be hard to reach
Summary
Under the Children Act 1989, local authorities in Wales, UK, can issue care proceedings if they are concerned about the welfare of a child, which can lead to removal of a child from parents. In cases where an infant is identified as being at risk of suffering significant harm from one or both parents, a local authority may seek to remove a child and issue care proceedings under Section 31 (s.31) of the 1989 Children Act (England and Wales). Whilst infants (aged less than 12 months old) comprise around 30% of all s.31 cases in Wales, more than half of these are newborns [1] This is prompting searching questions about what more might be done during pregnancy, to reduce the need to enact care proceedings through the family justice system [2]. It is this argument which has driven recent changes in prenatal reporting in a number of international jurisdictions [5, 7]
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