Ten-year mortality among first-time mothers involved in family court care proceedings in England

Background

Family court care proceedings are instigated to remove children at risk of harm from parental care. Limited information is available on the health of mothers involved in care proceedings. We assessed maternal mortality and causes of death within ten years of first birth, comparing first time mothers with and without care proceedings.

Methods

Using linked, administrative hospital and family court data in England, we followed a whole-population cohort of first-time mothers delivering between 2007 and 2017 up to ten years. We calculated mortality rates comparing mothers with and without care proceedings. We examined proportions of deaths that were potentially preventable (suicide, homicide, drugs/alcohol, or injury) and identified factors associated with death after care proceedings.

Results

Of 2,775,835 first-time mothers contributing 21,856,503 person-years of observation, 28,405 (1.0%) had proceedings. Ten years after proceedings, 314 (1.1%) died, compared to 5,103 (0.2%) among mothers without proceedings (age-standardised, 4.9% and 0.2%, respectively; age-standardised mortality ratio: 21.0, 95% CI 14.3, 27.7). Mortality ratios were lowest among first-time mothers aged less than 20 (4.5, 95% CI 3.5, 5.9) and highest for those aged 30-34 (28.3, 95% CI 21.3, 37.5). Amongst mothers who died after proceedings, 73% of deaths were potentially preventable compared to 28% among mothers without proceedings. Factors associated with death were older maternal age at proceedings, health conditions and court orders related to child removal.

Conclusions

First-time mothers with care proceedings had 21 times the risk of dying within 10 years than similar-aged mothers. Healthcare, social care and family courts must address the extreme health vulnerability of mothers before, during and after proceedings.

Key messages

• In analyses of premature mortality within 10 years of a first live birth, the age-adjusted risk of death in periods following care proceedings was 21 times higher compared to periods without.

• Better prevention and family court reform are required to improve health, prevent the need for care proceedings and ensure that proceedings and post-proceeding support meet the needs of mothers.