Mothers with Children in Protective Services at Increased Risk of Poor Prenatal Care

Mothers whose first child was placed in child protective services (CPS) incur a greater risk of poor prenatal care in subsequent pregnancies, according to a study published in Canadian Medical Association Journal (CMAJ).

Prenatal care is one of the most commonly used measures of preventative health in North America, and women undergoing adequate prenatal care are more likely to have risk factors associated with poor birth outcomes properly identified and treated. Conversely, inadequate prenatal care is connected to not only an enhanced risk of adverse birth outcomes, but the heightened involvement of CPS. An evaluation of data from a 2002 cohort of children born in California whose mothers did not receive prenatal care showed that almost half of those children were placed in protection services. A Canadian population-based analysis displayed similar results, indicating that insufficient prenatal care is a strong predictor for out-of-home care.

Insufficient Prenatal Care Predicts Out-of-Home Care

In this retrospective cohort study of 52,438 mothers whose first two children were born in the province of Manitoba, Canada, between 1998 and 2015, researchers used linkable administrative data, and measured prenatal care levels based on the Revised Graduated Prenatal Care Utilization Index (R-GINDEX). The index partitioned care into five groups: intensive, adequate, intermediate, inadequate, and no care. Implementing two multinomial logistic regression models to calculate odds ratios (ORs), researchers were able to compare levels of prenatal care between women whose first child was placed in out-of-home care to those who retained parental custody.

The study findings indicated that 1,284 (2.4%) women had a child removed from the home and placed in out-of-home care prior to conceiving their second child, and those mothers experienced a significantly higher rate of inadequate prenatal care compared to mothers whose first child was not placed in care (33.0% vs. 13.4%). Moreover, results suggested that the odds of having inadequate care were more than four times higher for women whose first child was placed in protection services (OR=4.29%; 95% CI, 3.68 to 5.01).

Outreach Strategies Needed

The study results reinforce the importance of improving outreach strategies aimed at disconnected mothers, including the implementation of service delivery models that work with pregnant women in dire situations, such as living on the streets or in shelters.

“Previous research has identified a fear of detection or involvement with CPS as an important barrier for at-risk pregnant women, potentially leading to disengagement from, avoidance of, or delayed presentation to prenatal care,” the researchers noted. “To reduce barriers such as lack of transportation and distrust of formal settings in health care may help to improve engagement.”

In their conclusion, researchers added that pregnancy “represents an important opportunity to increase positive outcomes for vulnerable women and to enable children to have the best possible start in life,” and that “this represents an obligation within the child rights principles and a crucial strategy for reducing population-level disparities.”

Source: CMAJ