Ten-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

BackgroundFamily 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. MethodsUsing linked, administrative hospital and family court data, 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 potentially preventable (suicide, homicide, drugs/alcohol, or injury) and identified factors associated with death after care proceedings. ResultsOf 2,775,835 first-time mothers contributing 21,856,503 person-years of observation, 28,405 (1{middle dot}0%) had proceedings. Following proceedings, 314 (1{middle dot}1%) died, compared to 5,103 (0{middle dot}2%) among mothers without (age-standardised mortality ratio: 21{middle dot}0, 95% CI 14{middle dot}3, 27{middle dot}7). Mortality ratios were lowest among first-time mothers aged less than 20 (4{middle dot}5, 95% CI 3{middle dot}5, 5{middle dot}9) and highest for those aged 30-34 (28{middle dot}3 95% CI 21{middle dot}3, 37{middle dot}5). Amongst mothers who died after proceedings, 73% of deaths were potentially preventable compared to 28% among mothers without. Factors associated with death were older maternal age at proceedings, health conditions and court orders related to child removal. DiscussionFirst-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.