Children’s Health in Northern Ireland

1. Children’s Health in Northern Ireland Summary

2. Mothers – Summary 3% of births to teenage mums, 2017/18 Highest live birth rate (12.3) in United Kingdom, 2017 4% of births to older mums (40+), 2017/18 2010/11: 15.5% 2017/18: 8.4% Highest fertility rate across UK (1.87, 2017) Women with diabetes Women who smoke 2017/18: 13.8% Over 1 in 5 women obese at booking, 2017/18 2010/11: 1.8% Graphics downloaded from: thenounproject.com

3. Children – Summary 31% of infants born by Caesarean Section 6.4% of singleton infants born pre-term (<37 weeks gestation), 2017/18 3% of infants born as a multiple, 2017/18 48.1% of infants breastfed (partial/total), 2017/18 6.1% low birth weight (<2,500g, live infants), 2017/18 13.7% high birth weight (>4,000g, live infants), 2017/18 Overweight & obese (IOTF), 2017/18: 24% of P1 girls 17% of P1 boys Graphics downloaded from: thenounproject.com

4. Trends in births 2017: • 23,177 registered births to NI residents. • Birth rate of 12.3 per 1,000 population (total births). • Livebirth rate (12.3) is the highest across the four UK countries, but lower than Republic of Ireland (12.9). • 102 registered stillbirths. • 17.5% of live births to mothers whose country of birth was not NI. Report – Tables 1.1 and 1.2 Source: ONS (UK) and CSO (RoI) https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/vitalstatisticspopulationandhealthreferencetables http://www.cso.ie/en/statistics/birthsdeathsandmarriages/

5. Trends in births – Health Trusts 2017: • Largest number of registered births recorded to NHSCT residents (5,565), with the lowest number in the WHSCT (3,858). • Percentage share of births: • BHSCT = 18.7% • NHSCT = 24.0% • SEHSCT = 17.4% • SHSCT = 23.2% • WHSCT = 16.6% • % change in total births in the last ten years: 4.3% decrease in Southern Trust, 14.1% decrease in South Eastern Trust (NI = -10.0%). Report – Table 1.2 Source: NISRA https://www.nisra.gov.uk/statistics/births-deaths-and-marriages/births

6. Trends - Projected Births • In the next 20 years (2017-2037), the number of births is projected to increase in Southern (5%) and Belfast (2%) Trusts, but decrease in all other Trusts • Report – Table 1.3 Source: NISRA https://www.nisra.gov.uk/statistics/births-deaths-and-marriages/births

7. Trends - Infant Mortality • Infant mortality is considered a key indicator of the health of a population. In the last ten years, although fluctuating, mortality rates for children less than one year old in NI, have seen small overall decreases, and in the last two years in particular, decreases were noted in infant and neonatal mortality rates. Risk factors for infant mortality include younger mothers, smoking during pregnancy and not breastfeeding. (Report Sections 3, 6 and 10) • Perinatal deaths continue to have the highest rate of death in children aged less than one year, however the number of children dying in this age group has fallen in the last ten years (157 deaths in 2017). Source: NISRA Perinatal mortality rate: Number of stillbirths and deaths in the first week of life per 1,000 live and stillbirths per annum. Neonatal mortality rate: Number of deaths in the first four weeks of life per 1,000 live births per annum. Post neonatal mortality rate: Number of deaths after the first four weeks but before the end of the first year per 1,000 live births per annum. Infant mortality rate: Number of deaths in the first year of life per 1,000 live births per annum. Rates include non Northern Ireland residents.

8. Fertility • NISRA state that the number of births across Northern Ireland is projected to decrease by 6.0% over the next twenty-five years (2016 – 2041). This is due to migration - a net outflow of women who are of child bearing age (15 - 44 years) which they project will occur between mid 2017 and mid 2041. • Source: • NISRA, “2016-based Population Projections for Northern Ireland”, Statistical Bulletin • https://www.nisra.gov.uk/sites/nisra.gov.uk/files/publications/2016-based%20Population%20Projections%20-%20statistical%20bulletin.pdf

9. Age of mother 2017/18 Teenage mothers: • Following small increases during 2015/16 and 2016/17, the number fell to 680 births to teenage mothers in 2017/18. • 3.0% of all births were to teenage mothers. • 5.4% in the most deprived areas, 1.5% in the least deprived (NIMDM 2017). Older mothers (aged 40+): • % births increased year on year between 2010/11 and 2015/16. Decreasing since 2016/17 (3.7% of all births in 2017/18). • 2.4% in the most deprived areas, 5.4% in the least deprived areas (NIMDM 2017). Report – Table 3.1 Source: Child Health System Source: NISRA, NI Multiple Deprivation Measure 2017 https://www.nisra.gov.uk/statistics/deprivation/northern-ireland-multiple-deprivation-measure-2017-nimdm2017

10. Multiple Births 2017/18: • In general, the proportion of infants born as part of a multiple birth pregnancy increased with mother’s age (1.8% of those aged under 20 years who gave birth in 2017/18, compared to 4.3% of those aged 35-39 years) • In 2017/18, there was little difference in the proportion of infants born as a multiple when considering ethnic group of mother, Trust of residence of mother or deprivation status (NIMDM 2017). Report – Table 4.2 Source: Child Health System • Source: NISRA, NI Multiple Deprivation Measure 2017 https://www.nisra.gov.uk/statistics/deprivation/northern-ireland-multiple-deprivation-measure-2017-nimdm2017

11. Infant Gestation 2017/18: • The proportion of infants born to mothers booking at 15 or more weeks varies by age of mother. • There are substantial differences in the timescales of when mothers book by ethnic group. • Report – Table 5.2 • Source: NIMATS • Source: NISRA, NI Multiple Deprivation Measure 2017 https://www.nisra.gov.uk/statistics/deprivation/northern-ireland-multiple-deprivation-measure-2017-nimdm2017

12. Maternal risk factors 2017/18 : • 13.8% of mothers smoked (2010/11 = 15.5%) • 8.4% of mothers had diabetes (2010/11 = 1.8%) Note: increase may be due in part to improved recording of diabetes on NIMATS/CHS • 4.9% had pregnancy induced hypertension (2010/11 = 4.5%) Report – Table 6.1 Source: Child Health System (2010/11 - 2016/17), NIMATS (2017/18)

13. Maternal risk factors - Smoking 2017/18: • % mothers who smoked at booking decreased with age – 30.0% of those aged <20 years, 8.2% of those aged 40+. • A smaller proportion of first time mothers smoked (11.5%), compared to those who have been pregnant previously (15.2%). • Over 17% of mothers in BHSCT area smoked, compared to 11.6% in SHSCT (NI=13.8%). • In the most deprived areas (NIMDM 2017), 25.7% of mothers smoked, compared to 5.2% in the least deprived areas. Report – Table 6.2 Source: NIMATS Source: NISRA, NI Multiple Deprivation Measure 2017 https://www.nisra.gov.uk/statistics/deprivation/northern-ireland-multiple-deprivation-measure-2017-nimdm2017

14. Maternal risk factors - Diabetes 2017/18 : • % mothers with diabetes increased with age - 3.3% of those aged less than 20 years, compared to 13.9% of those aged 40+. All mothers = 8.4%. • Higher proportion of mothers from “non-white” ethnic groups had diabetes (16.7%), compared to those from a “white” ethnic group (8.1%). All mothers = 8.4%. • There was little variation by deprivation quintile (NIMDM 2017). Report – Table 6.2 Source: NIMATS Source: NISRA, NI Multiple Deprivation Measure 2017 https://www.nisra.gov.uk/statistics/deprivation/northern-ireland-multiple-deprivation-measure-2017-nimdm2017

15. Maternal Body Mass Index (BMI) 2017/18: • 22.2% of mothers measured as obese at time of booking appointment. Proportion has increased year on year since 2011/12. • 52.5% of all mothers considered pre-obese or obese.   • 26.0% of mothers from most deprived areas (NIMDM 2017) were classified as obese, compared to 15.9% from the least deprived areas. Report – Table 7.2 Source: NIMATS Source: NISRA, NI Multiple Deprivation Measure 2017 https://www.nisra.gov.uk/statistics/deprivation/northern-ireland-multiple-deprivation-measure-2017-nimdm2017

16. Method of Delivery 2017/18: • 31.0% of infants born by Caesarean Section (CS), 57% had a normal delivery, 12% had another type of delivery e.g. breech, forceps. • Proportion of infants born by CS increased with age of mother. • Daisy Hill Hospital had the highest % CS (34.1%). Report – Table 8.2 Source: NIMATS Source: NISRA, NI Multiple Deprivation Measure 2017 https://www.nisra.gov.uk/statistics/deprivation/northern-ireland-multiple-deprivation-measure-2017-nimdm2017

17. Infant Birth Weight 2017/18: • 6.4% of all births were of a low birth weight (6.1% live, 69.3% still). • % low birth weight slightly higher in those mothers aged over 40 (8.1%). (Note that this age group has a higher proportion of multiple births) • 13.7% of live infants were born with a higher birth weight (4,000g+) and of these, 1.8% with a birth weight of 4,500g+. • Mothers from a ‘white’ ethnic group were more likely to have a baby born with a high birth weight (4,000g+)(13.9%). ‘Non-white’ = 6.3%. Report – Table 9.2 Source: Child Health System and NIMATS

18. Breastfeeding (total/partial) – at discharge 2017/18: • 48.1% of live infants breastfed at discharge.   • Increases with age of mother: aged <20 = 24.9%, 40+ = 57.6%. • Much higher rates in infants born to mothers whose ethnic origin was not ‘white’.   • By Council area, % breastfed ranges from 36.5% in Derry and Strabane to 58.1% in Lisburn and Castlereagh. • Markedly lower in more deprived areas (33.0%). Least deprived = 64.8%. Report – Table 10.2 Source: Child Health System and NIMATS Source: NISRA, NI Multiple Deprivation Measure 2017 https://www.nisra.gov.uk/statistics/deprivation/northern-ireland-multiple-deprivation-measure-2017-nimdm2017

19. Body Mass Index – Primary 1 2017/18: • Higher proportion of girls were overweight/obese (24.3%) compared to boys (16.9%).   All genders = 20.5%. • Antrim and Newtownabbey LGD had the highest proportion of children overweight/obese = 24.9%. • 23.4% of children living in the most deprived areas were overweight/obese, compared to 17.9% of children from the least deprived areas. Report – Table 11.2 Source: Child Health System Source: NISRA, NI Multiple Deprivation Measure 2017 https://www.nisra.gov.uk/statistics/deprivation/northern-ireland-multiple-deprivation-measure-2017-nimdm2017

20. Body Mass Index – Year 8 2017/18: • 27.9% of children measured as overweight/obese. • Little difference in the proportion overweight/obese between the two genders (27.4% male, 28.3% female). • Larger proportion of children from more deprived areas were measured as overweight/obese (33.7%), compared to those living in the least deprived areas (21.8%). Report – Table 11.5 Source: Child Health System Source: NISRA, NI Multiple Deprivation Measure 2017 https://www.nisra.gov.uk/statistics/deprivation/northern-ireland-multiple-deprivation-measure-2017-nimdm2017