Official Statistics

Child and maternal health profiles, December 2024 update: statistical commentary

Published 3 December 2024

Applies to England

What’s new

The latest update to the child and maternal health profiles includes more recent data for:

• maternal health in early pregnancy indicators on:
  • early access to maternity care
  • folic acid supplement use
  • obesity
  • smoking
  • alcohol
  • drug misuse
• babies whose first feed is breast milk
• birth outcomes indicators on multiple births and low and very low birth weight babies
• child education indicators on persistent absentees in primary and secondary schools, average attainment 8 score of children in care, and school-age pupils with special educational needs

The appendix lists all indicators which have been updated and gives further information about the geographical areas and time periods included.

Introduction

This commentary focuses on trends and inequalities in early pregnancy, babies whose first feed is breast milk, and birth outcomes indicators.

Separate commentaries for the indicators for child education which have been updated in the profiles in this release are available from the Department of Education. They should be consulted for further information about the interpretation of this data.

Main findings

The proportion of pregnant women taking folic acid supplements in preparation for pregnancy decreased between 2019 to 2020 and 2023 to 2024, while the proportion accessing maternity care within the recommended first 10 weeks of pregnancy has fluctuated. The proportion of pregnant women smoking in early pregnancy decreased in 2023 to 2024, while the proportion living with obesity has slightly increased.

There has been a slight increase in the proportion of babies born with low birth weight (less than 2,500g) between 2021 and 2022. The proportion of babies receiving breast milk as their first feed has remained relatively stable for the last 5 years.

All indicators presented in this commentary were generally worse in areas with higher deprivation. The completeness of the data available for the indicators on early pregnancy is improving as the data collection becomes more established. The variation in the data completeness across the years and between groups may affect the interpretation of the data, as detailed in the methodology.

Detailed findings

Preparing for pregnancy and having early access to maternity care improves the health of a pregnancy and birth outcomes for the mother and the baby. The NHS saving babies lives care bundle provides evidence-based best practice to improve these outcomes. It highlights the risk and preventative factors for maternal health in early pregnancy which are related to the indicators discussed in this commentary.

Folic acid supplement use

The proportion of women taking folic acid supplements before pregnancy has decreased to 19.7% in 2023 to 2024 compared with 25.7% in 2019 to 2020 (figure 1).

Figure 1: proportion of women taking folic acid supplements before pregnancy in England, financial year ending 2020 to 2024

Source: OHID analysis of Maternity Services Data Set version 2.0

For 2023 to 2024, the proportion of women taking folic acid supplements before pregnancy is lowest in the most deprived areas (10.1%) compared with the least deprived (27.9%). There is also regional variation from 6.8% in the North East to 32.0% in London. The proportion is lower for younger than older women (figure 2).

The proportion is lower for women of black (15.5%) and Asian (17.9%) ethnicity than for those of white ethnicity (20.4%). The proportion is also higher in first pregnancies (21.4%), compared with those having a subsequent pregnancy (18.1%).

Figure 2: proportion of women taking folic acid supplements before pregnancy in England by age, England 2023 to 2024

Source: OHID analysis of Maternity Services Data Set version 2.0

Early access to maternity care

The proportion of women attending their first antenatal appointment within 10 weeks of becoming pregnant was 63.5% in 2023 to 2024 but has fluctuated between 60.3% in 2019 to 2020 and 68.2% in 2020 to 2021. Notably, the proportions were highest during the years affected by the COVID-19 pandemic.

For 2023 to 2024, the proportion is lower in the most deprived areas at 56.9% compared with 69.6% in the least (figure 3). There is regional variation from 59.2% in London to 70.2% in the East Midlands.

Pregnant women aged between 30 to 34 are the most likely to attend early (65.9%), compared with those under 20 (53.3% to 59.3%) and those aged 35 and above (48.5% to 61.4%). Women having a first pregnancy were more likely to attend within the recommended 10 weeks (66.5%) than those with a subsequent pregnancy (62.5%).

Figure 3: proportion of women attending the first antenatal appointment within 10 weeks of pregnancy in England by level of deprivation, 2023 to 2024

Source: OHID analysis of Maternity Services Data Set version 2.0

Smoking

The proportion of women recorded as smoking in early pregnancy was 13.6% in 2023 to 2024, lower than the preceding year (17.2%). For 2023 to 2024, the proportion was higher at 20.8% in the most deprived areas compared with 7.2% in the least deprived.

The proportion is higher in younger than older pregnant women (figure 4). It is lower in first pregnancies (10.1%), compared with those having a subsequent pregnancy (15.4%). The proportion is also higher for white women (16.3%) compared with those of black (7.3%) or Asian ethnicity (4.8%).

Figure 4: proportion of women reported as smoking in early pregnancy in England by age, 2023 to 2024

Source: OHID analysis of Maternity Services Data Set version 2.0

Obesity

The proportion of women recorded as living with obesity in early pregnancy was 26.2% in 2023 to 2024, slightly higher than the preceding year (25.4%).

There is regional variation from 32.3% in the North East region to 20.9% in London. The proportion was highest in black women (36.3%) and lowest in those of Asian ethnicity (19.4%) (figure 5). It was higher in the most deprived areas (32.4%) compared with the least (19.8%). Maternal obesity is also lower in first pregnancies (22.0%) compared with those having a subsequent pregnancy (28.7%).

Figure 5: proportion of women reported as living with obesity in early pregnancy in England by ethnic group, 2023 to 2024

Source: OHID analysis of Maternity Services Data Set version 2.0

Breastfeeding

There is evidence for the benefits of breastfeeding and its effect on a wide range of health outcomes.

The proportion of babies whose first feed was breast milk has remained at around 72% each year between 2019 and 2024. For 2023 to 2024, the proportion was lower in the most deprived areas (59.1%) compared with the least deprived (81.3%). It also varied with maternal age and ethnicity, being lower in younger than older mothers (figure 6) and lower in those of white ethnicity (68.6%) compared with those of black (83.4%) or Asian ethnicity (78.7%).

Figure 6: proportion of babies whose first feed is breast milk in England by age of the mother, 2023 to 2024

Source: OHID analysis of Maternity Services Data Set version 2.0

Birth outcomes

Low birth weight has an enduring effect on child health, is a major factor in infant mortality and has serious consequences for health in later life.

The proportion of babies born with low birth weight (less than 2,500g) was 7.2% in 2022, an increase from 2021 (6.8%) However, it had remained largely unchanged at around 7.4% between 2011 and 2018, before declining until 2021 (figure 7).

The proportion of babies born with very low birth weight (less than 1,500g) was 1.0% in 2022 and has remained stable since 2020.

The proportions of low birth weight and very low birth weight babies are higher in more deprived areas, with 9.2% and 1.3% respectively in the most deprived areas compared with 5.6% and 0.8% in the least deprived.

Figure 7: proportion of low birth weight babies in England, 2010 to 2022

Source: OHID analysis of ONS birth registrations data

Methodology

The 7 indicators covering health in early pregnancy and breastfeeding are produced from the Maternity Services Data Set version 2.0 (MSDS version 2.0). This version was first introduced in 2019 and is still becoming established. Data produced from this version cannot be directly compared to statistics produced from earlier versions. Statistics published from MSDS version 2.0 are classified as indicators in development. These are new official statistics undergoing evaluation.

NHS England also publishes statistics covering smoking at booking, early access to maternity care, and folic acid supplement use in early pregnancy. These NHS England analyses look retrospectively at mothers who have had a birth in the reporting period, based on approximately 525,000 records each year. The indicators produced here cover all women who have had their first antenatal (booking) appointment in the reporting period (approximately 650,000 records each year), irrespective of the outcome of the pregnancy.

Detailed methodology for all indicators is described in the definitions tab in Fingertips.

Data quality for indicators based on MSDS version 2.0

For the latest year ending March 2024, the completeness of data recording for the proportion of babies whose first feed is breast milk was 91.9%, early access to maternity services was 98.6% and for folic acid supplement use was 83.8%. Smoking status was recorded in 70.2% of records and body mass index (used for obesity) in 60.5%. Data was only reported for 2 years for these 2 indicators because data before year ending March 2022 was of insufficient quality.

Data completeness for substance misuse status and for drinking alcohol were lower at 25.1% and 17.3% respectively. For this reason, data for these indicators has not been included in this commentary and has only been presented in the profile at national and regional level for the latest 3 years.

Within these early pregnancy indicators, data completeness also varies by demographic and socio-economic characteristics, region and local area which may influence the results presented in this commentary. A 70% data completeness threshold has been applied to suppress data for upper-tier local authorities where their data quality does not meet this target. National and regional indicators include data from all records regardless of their levels of completeness. All proportions were calculated using records which contained valid data and therefore do not cover the complete cohort of maternity booking records.

Revisions

An earlier version of the maternal health in early pregnancy indicators was initially produced for the financial year ending 2019 using MSDS version 1.5. This has now been revised using MSDS version 2.0. The change of data source has meant that definitions and methodologies have been revised.

The previously published data on percentage of babies whose first feed is breast milk has been replaced with new data from the latest version of the MSDS version 2.0 dataset.

Appendix

In this update, the following indicators have been updated at national and regional levels, for financial years ending 2022 to 2024:

• drinking in early pregnancy
• drug misuse in early pregnancy

The following indicators have been updated at national and upper-tier local authority levels for financial years ending 2023 to 2024:

• smoking in early pregnancy
• obesity in early pregnancy

The following indicators have been updated at national and upper-tier local authority levels for financial years ending 2020 to 2024:

• early access to maternity care
• folic acid supplements before pregnancy
• baby’s first feed breast milk

The following indicators have been updated at national and upper-tier local authority levels for the calendar year 2022:

• multiple births
• low birth weight of all babies
• very low birth weight of all babies

The following indicators have been updated at national and upper-tier local authority levels for the reporting year 2023:

• persistent absentees in primary schools
• persistent absentees in secondary schools
• average attainment 8 score of children in care

The following indicators have been updated at national and upper-tier local authority levels for the reporting year 2024:

• school-age pupils with special educational needs

For further information or queries about this update, please contact pha-ohid@dhsc.gov.uk.