Growing up in Scotland: change in early childhood and the impact of significant events

CHAPTER 6: MATERNAL HEALTH PROBLEMS

In this chapter we focus on persistent maternal health problems. Previous analysis of GUS identified maternal health problems as a significant factor associated with child outcomes (Barnes et al., 2010). Recent analysis of MCS data focusing on parental health and child outcomes found that family socio-economic background variables explained the largest part of the association between parental health and children's lower cognitive ability. The largest part of the association between maternal health and behaviour difficulties was explained by maternal psychological well-being (Kelly and Bartley, 2010).

6.1 Key findings

• Most mothers in GUS experienced good health throughout the study period and the mother developing a persistent limiting health problem only occurred in two per cent of families.
• Mothers in workless households had a higher likelihood of developing a persistent limiting health problem, as were those mothers with poor mental health.
• Families in which the mother developed a persistent limiting health problem were more likely to subsequently have a high level of home chaos, live in income poverty, experience poor maternal mental health and high conflict in the parent-child relationship.

6.2 How many mothers experience long-standing health problems?

To look at the maternal health problems in this report, we look at long-standing health problems which limit daily activities. The majority of mothers (84%) reported no health problems at any of the five sweeps. This is to be expected considering the relatively young age of the mothers in GUS. While a very small percentage reported having health problems at every sweep (permanent health problem; 1%) or at two consecutive sweeps after sweep 1 (persistent health problem; 2%), temporary or recurrent health problems are more common (12%) (Table 6.1).

Table 6.1 Pattern of maternal health problems

Family status stability	%	Unweighted frequency
Stable good health	84	3039
Mother develops persistent health problem	2	82
Mother develops temporary or recurrent health problem	7	235
Mother has pre-existing 1 health problem, recurrent or recovery	5	156
Mother has pre-existing 1 permanent health problem	1	46
Bases
Weighted	3547
Unweighted	3558	3558

Base: All families taking part in all five years.

Note: ¹ Reported at the first interview.

As we are interested in events which are likely to have a large impact on family life, the remainder of this chapter will focus on those who develop a persistent limiting health problems ( i.e. 2%); that is, health problems which are reported in at least two consecutive years after the first interview.

Among those who report a health problem, 40% first report it at the initial interview. This category will include all those mothers with long-term pre-existing health problem prior to the birth of the child, as well as some who developed a long-standing illness following the birth of the GUS child. The proportion of mothers first reporting a health problem falls with each subsequent sweep. Mothers with a history of good health appear less likely to develop health problems (Table 6.2).

Table 6.2 First mention of mother's limiting long-standing health problem

Timing	% of mothers
Limiting long-standing illness recorded in 2005/06 1	40
Limiting long-standing illness first recorded in 2006/07	21
Limiting long-standing illness first recorded in 2007/08	15
Limiting long-standing illness first recorded in 2008/09	15
Limiting long-standing illness first recorded in 2009/10	10
Bases
Weighted	571
Unweighted	517

Base: All families taking part in all five years with mothers ever reporting limiting long-standing illness (lasting or expected to last more then 12 months).

Note: ¹The first GUS interview.

6.3 Which mothers are most likely to develop long-standing health problems?

The likelihood of the mother developing a persistent limiting health problem varies by a range of background characteristics recorded in 2005/06 (when the child was aged 0-1), as shown in Table 6.3. The likelihood was higher among:

• families where the mother was without educational qualifications;
• families where the mother had poor mental health;
• families living in rented accommodation; and
• workless families.

As noted in previous chapters, many of these characteristics are also highly correlated with each other and the characteristics which remained significant after controlling for other factors are highlighted in the table.

Table 6.3 Maternal health problems by child and parental background characteristics

Base: All families taking part in all five years, with mother originally in good health.

Note: Row per cent.

Note: Shaded rows show characteristics with statistically significant associations with maternal health status, after controlling for other factors in multivariate regression analysis.

Table 6.4 Maternal health problems by background characteristics of household

Base: All families taking part in all five years, with mother originally in good health.

Note: Row per cent.

Note: Shaded rows show characteristics with statistically significant associations with maternal health status, after controlling for other factors in multivariate regression analysis.

Multivariate analysis shows that the social class and mother's mental and physical health at the first interview were all significantly associated with persistent limiting health problems, all else being equal (see Table C.4 in the Technical Appendix).

• Mothers in households where no parent had ever worked were more likely to develop a persistent limiting health problem compared with mothers in families where at least one parent was in a managerial occupation.
• Mothers with poor mental health at the time of the first interview were more likely to develop a persistent limiting health problem compared with mothers with good or average mental health at that time.
• Mothers with higher scores on the SF-12 physical health scale ( i.e. mothers with better health) at the time of the first interview were less likely to develop a persistent limiting health problem.

6.4 What happens to children whose mothers develop persistent health problems?

The experience of maternal health problems is related to a number of drivers of child outcomes (measured in 2009/10) investigated in the report (Table 6.5). Families where the mother developed a persistent limiting health problem were more likely to:

• have a high level of household chaos;
• live in income poverty;
• have a mother with poor maternal mental health is higher; and
• have a high level of conflict in the mother-child relationship.

There does not seem to be a difference between the stable good health and health problem groups for the mother-child relationship on the warmth dimension.

Table 6.5 Drivers of child outcomes by maternal health

		%
Home chaos (% high level chaos)	Stable good health	32
	Persistent limiting health problem	61
	All	33
Income poverty (% poor)	Stable good health	27
	Persistent limiting health problem	55
	All	28
Maternal mental health (% poor mental health)	Stable good health	11
	Persistent limiting health problem	59
	All	12
Pianta warmth (% lower or least warmth)	Stable good health	22
	Persistent limiting health problem	23
	All	22
Pianta conflict (% higher or most conflict)	Stable good health	15
	Persistent limiting health problem	30
	All	15
Bases
Weighted		2895
Unweighted		2956

Base: All families taking part in all five years with mother originally in good health.

Next, we turn to multivariate analysis which allows us to investigate the relationship between maternal health and the drivers of child outcomes, while controlling for the drivers measured prior to the event and other factors. The table below (Table 6.6) summarises the results from the regression models (see Tables D.16 to D.20 in the technical appendix for full results).

When controlling for other variables, compared with those with stable good health, the onset of a persistent maternal health problem was associated with a higher likelihood of:

• high level home chaos;
• income poverty;
• poor maternal mental health; and
• parent-child conflict.

Table 6.6 Relationship between maternal health and drivers of child outcomes controlling for other variables

	Drivers of child outcomes
	High level home chaos	Income poverty	Poor maternal mental health	Parent-child - Low warmth	Parent-child - High conflict
Persistent limiting health problem	?	?	?		?
Driver present at year 1	n/a	?	?	? 1	?
Interaction: Driver present (year 1) and health problem	n/a

Note: All factors other than the Event are measured at the sweep 1 interview (2005/06).

Note: Arrows indicate whether an event or year 1 driver category is associated with significantly higher (?) odds of the driver of negative child outcomes occurring, compared with the reference category.

Note: All factors with arrows (?) are significant at 5% level, unless otherwise indicated. Blank cells indicate no significant relationship.

Note ¹: Significant at 10% level.

The timing of the onset of the persistent health problem was associated with home chaos, poverty, mental health and parent-child conflict (models not shown). There was a higher likelihood of:

• high level of home chaos for more recent onset of health problems;
• income poverty for those who developed their health problem between years 2 and 3 (when the GUS child was aged 2-3); and
• high conflict in the parent-child relationship for mothers who developed their health problem between years 1 and 2 or between years 3 and 4.

Again, caution is required when interpreting these results because of the small number of mothers developing persistent health problems in individual years.