10-year mortality among first-time mothers involved in family court care proceedings in England: cohort study using linked administrative hospital, mortality and family court records.

内容摘要

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 10 years of first birth, comparing first-time mothers with and without care proceedings. Using linked, administrative hospital and family court data, we followed a whole-population cohort of first-time mothers delivering between 2007 and 2017 up to 10 years. We calculated mortality rates comparing mothers with and without care proceedings. We examined proportions of deaths potentially preventable (suicide, homicide, drugs/alcohol or injury) and identified factors associated with death after care proceedings. Of 2&#x2009;775&#x2009;835 first-time mothers contributing 21&#x2009;856&#x2009;503 person-years of observation, 28&#x2009;405 (1.0%) had proceedings. Following proceedings, 314 (1.1%) died, compared with 5103 (0.2%) among mothers without care proceedings (age-standardised mortality ratio 21.0, 95%&#x2009;CI 14.3 to 27.7). Mortality ratios were lowest among first-time mothers aged <20 years (4.5, 95%&#x2009;CI 3.5 to 5.9) and highest for those aged 30-34 years (28.3, 95%&#x2009;CI 21.3 to 37.5). Among mothers who died after proceedings, 73% of deaths were potentially preventable compared with 28% among mothers without proceedings. Factors associated with death were older maternal age at proceedings, health conditions and court orders related to child removal. 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.