Healthy start

In 2024, there were around 7,200 live births in Norfolk.^[1] While motherhood is usually a positive and fulfilling experience, it can be associated with poor physical and mental health.

Promoting healthy behaviours can give children the best start in life. Stopping smoking in pregnancy reduces risks of pregnancy and birth complications, such as still birth, premature birth, low birth weight and sudden infant death syndrome.^[2] In their first-year, infants are vulnerable to ill health and accidents leading to interactions with health services and admissions to hospital. The World Health Organisation recommends that babies are exclusively breastfed for the first six months of life due to significant health benefits for both mother and baby.^[3]

1. www.nomisweb.co.uk/datasets/lebirthrates
2. www.nhs.uk/pregnancy/keeping-well/stop-smoking/
3. www.who.int/health-topics/breastfeeding

Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period (the period after childbirth). In 2023, there were around 7,200 live births in Norfolk.^[4] While motherhood is usually a positive and fulfilling experience, it can be associated with ill-health with around 1-in-4 women experiencing mental health problems during pregnancy and within a year of birth.^[5]

Whilst women dying in childbirth is low in the UK, the leading direct cause of death is blood clots with the next most common direct causes being sepsis, suicide and obesetric haemorrhage; and indirect causes of death (related to pre-existing conditions) include heart disease, neurologial disease and cancer.^[6] Other pregnancy related conditions include gestational diabetes, depression and anxiety, high blood pressure and sickness.^[7]

Perinatal mental illness encompasses a range of mental health illnesses that mothers may experience during pregnancy or in the first year after the birth of their child. These include antenatal and postnatal depression, maternal obsessive-compulsive disorder, anxiety, PTSD and in rare cases, psychosis.^[8] These conditions may be experienced for the first time in the perinatal period, or childbirth can lead to a recurrence of existing conditions. Experiencing mental health problems can make adjustment to motherhood and caring for new and existing children more difficult potentially negatively impacting a mother’s self esteem and their children. Stigma around mental health may mean it is under reported which means people may not always be accessing appropriate support.^[9]

Research suggests there are variations in mental health across different groups of mothers. Certain studies have shown that younger mothers are far more vulnerable to mental health issues associated with childbirth.^[10] Research also suggests perinatal mental health issues are higher in areas of higher deprivation and that it may be underestimated in areas with a higher proportion of ethnic minorty females.^[11]

An infant is a child aged between birth and one year. Infants are vulnerable to ill health and accidents. Infant mortality represents a particularly distressing category of premature death and is an indicator of the general health of an entire population. For the period 2021-23, the infant mortality rate in Norfolk was 4.0 deaths per 1,000 live births (92 deaths in total, implying an average of around 31 infant deaths per year). This is almost identical to England as a whole which had a rate of 4.1 deaths per 1,000 live births over the same time period.^[12] In 2023, infant deaths account for 60% of the deaths of people aged 0-19 in Norfolk.^[13]

Breastfeeding is associated with positive health outcomes for both mother and baby, in early years and later life. The World Health Organisation recommends that mothers exclusively breastfeed their baby for the first 6 months of life followed by a combination of breast milk and adequate complementary foods.^[14] Across the first two quarters of 2024/25 around 52% of babies in Norfolk were recorded as being fully or partially breastfed at the time of their 6-8-week check-up, this compares with a figure of around 54% for England over the same time period.^[15]

Smoking in pregnancy can cause serious pregnancy-related health problems, including complications during labour and an increased risk of miscarriage, premature birth, stillbirth, low birthweight and sudden unexpected death in infancy.^[16] Potential harms to the child include the increased chance of attention difficulties, breathing problems and learning difficulties.^[17] Smoking in pregnancy is more likely in deprived areas and so disproportionately impacts these communities.^[18] In 2023/24 in Norfolk, women smoking at time of delivery was 11.2%, higher than for England as a whole (7.4%).^[19]

Teenage Pregnancy (usually defined as pregnancy in young people aged under 18) is an important health issue because most teenage pregnancies are mostly unplanned and around half end in an abortion.^[20] While many teenagers do make excellent parents, bringing up a child as a teenager can be extremely difficult and result in poorer outcomes for both the teenage parent and the child.^[21]

n 2021 the number of conceptions of women aged under 18 in Norfolk was 12.8 per 1,000 females aged 15-17,^[22] with 50.6% leading to abortion^[23] (across England 13.1 per 1000 with 53.4% leading to abortion). In Norfolk the rate of women under the age of 18 giving birth has dropped from 8.1 per 1,000 females aged 15-17 in 2013 (119 live births) to 3.5 per 1,000 in 2022 (48 live births). This drop follows a similar trend for England as a whole.^[24]

Poverty causes deep material and psychological harm to those who experience it. Evidence suggests that childhood poverty leads to premature mortality and poor health outcomes in adults. Other evidence shows that young people from the poorest families are over four times more likely than rich ones to experience several mental health problems while growing up.^[25]

In 2023/24, 22.3% of children (under 16) in Norfolk were living in low income households, similar to the 22.1% across England as a whole.^[26] Households are classified as having a low income if their disposable income, after adjusting for the size of the household, is below 60% of the median household income.^[27]

Vaccinations (vaccines) help protect children and communities from many serious and potentially deadly diseases; specific vaccines are recommended for pregant women and throughout childhood.^[28] There is a target that 95% of children receive the routine childhood vaccinations by the time they are 5 years old. For 2023/24, nationally, none of the childhood vaccines met this target.^[29] However, in Norfolk in 2023/24, the PCV vaccine (offering protection againt pnemococcal infections), the combined 6-in-1 vaccine, and the MMR (Measles, Mumps and Rubella) vaccine all exceeded the 95% coverage target and the other vaccines to be delivered by age 5 had coverage between 90% and 95%.^[30]