Tag Archives: Poverty

Sad child at window

Pregnant and poor? Children likely to face many more challenges  

Over the past two decades, an increasing amount of research on Adverse Childhood Experience (ACEs)* has helped to highlight the importance of the early life social environment as a predictor of what a person’s health will be like as they get older. The research has shown that children who experience one trauma such as parental divorce, alcohol misuse or child maltreatment, are much more likely to report another, with each bad experience increasing the chances of others and making poor health outcomes more likely. Now new research from Rebecca Lacey and colleagues at the ESRC International Centre for Lifecourse Studies at UCL has highlighted a strong link between children born to pregnant mothers living in poverty and the likelihood of them experiencing multiple ACEs. Here the researchers explain their findings and share their concerns about how COVID-19 might exacerbate and increase the bad experiences faced by children from poorer backgrounds.

The Institute for Fiscal Studies recently reported that relative child poverty increased by three percentage points up to 2018-19 – the most sustained rise since the early 1990s, whilst in March this year, the Trussell Trust, which supports a UK-wide network of food banks, also reported a 122 percent increase in food parcels given to children.

With four million UK children already living in poverty and many families experiencing uncertain employment prospects as a result of COVID-19, there has never been a more important time to consider not just how we prevent bad things happening to children, but what we can do to make sure that all children, not just well-off ones, get a good start in life.  

Our research analysed two decades of information from the Avon Longitudinal Study of Parents and Children (ALSPAC) which has collected data from 14,000 women, their children and partners. We were looking to get a better grasp of the connections between being poor during pregnancy and the number of ACEs experienced by children across their childhood up to the age of 19. 

The children of mums who reported facing poverty in pregnancy were more likely to report being sexually abused, parental separation, or their parents experiencing issues with mental health, drug or alcohol abuse. This group of children were nine times more likely to face additional traumatic experiences compared to their wealthier peers.

The meaning of poverty

It’s worth noting that our definition of poverty focused on material conditions rather than income measures as family income was not available in the data until the children were 21 months old. Poverty was indicated by whether a child’s parents reported difficulties in affording food, heating or accommodation, or had recently been homeless at any point whilst pregnant. Any parent reporting any of these four difficulties was ascertained to be ‘in poverty’ during pregnancy.

It goes without saying that these sorts of difficulties are likely to put major pressure on families. 

Our study shows that poverty is not only an adversity in its own right but that it acts to increase and compound the risk of children facing further traumatic experiences, such as maltreatment and mental health problems.

There has been a lot of talk in policy circles and public discourse about so-called “troubled families”, but there hasn’t been enough discussion about poverty. If people can’t afford heating, food or accommodation or have faced homelessness, there’s a direct link with mental health problems and domestic and substance abuse. It’s a really strong predictor of those problems, but is often overlooked. 

Children need a better start

Now more than ever, this research is hugely relevant. The COVID-19 pandemic has shone a light on schisms in society and this research is showing just how important tackling poverty is if we want to ensure children from poorer backgrounds get a comprehensively better start in life than many currently do. 

Successive policies have done little to close the gaps and with the number of people being thrown into poverty – people on furlough and with millions of job losses close down the line – we’re not seeing child poverty decreasing. 

Domestic violence is increasing, and post COVID there is talk of a tsunami of mental health problems. Policymakers and those in a position to act must grasp the nettle and acknowledge and act on the understanding that  poverty is a really strong indicator of lots of these ACEs coming together. 

We just can’t underestimate this – if you don’t pay attention to that then it’s just sticking a plaster on the symptoms without dealing with the actual cause.

Further information

The Clustering of Adverse Childhood Experiences in the Avon Longitudinal Study of Parents and Children: Are Gender and Poverty Important? is research by Rebecca E. Lacey, Laura D. Howe, Michelle Kelly-Irving, Mel Bartley, Yvonne Kelly and is published in the Journal  of Interpersonal Violence.

The research was conducted by UCL, the University of Bristol and INSERM, Toulouse. It used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), also known as Children of the 90s, a world-leading birth cohort study based at the University of Bristol.

*Adverse childhood experiences (ACEs) could include: parental separation/divorce, death of a close family member (parent or sibling), parental convictions, parental drug use, parental alcohol misuse, parental mental health problems, inter-parental violence, physical abuse (parent-child), emotional abuse (parent-child), or sexual abuse (older child/adult-child).

Why poorer children are at greater risk of obesity

Obesity may be the biggest public health crisis facing the UK today. Levels have risen more than three fold since 1980. Being obese makes you vulnerable to a range of health risks. Being an overweight child makes it more likely you will become an obese adult. And you are much more likely to be an overweight child, if you come from a poor family. If current trends continue, half the population of Britain could be obese by 2050. Early intervention is the most effective way to break this cycle. And that requires a better understanding of why children become overweight. A new study by a team at the ESRC funded International Centre for Lifecourse Studies in Society and Health at UCL and LSE makes clear the scale of the problem and points to some crucial factors likely to lead less-well-off children to gain excess weight, as co-author Professor Yvonne Kelly explains.

A link between poverty and childhood obesity has been found in many developed countries. Intuitively, it seems likely this link is the result of poorer parents not being able to afford healthier food, like fruit, or outings involving exercise for their children. It could also be that those parents know less about healthy lifestyles and that they themselves eat less healthily and exercise less. But intuition is an insufficient basis for the scale of intervention required. This study is the first attempt to examine and compare in detail why children in poorer families are more likely to be overweight.

Our data comes from the Millennium Cohort Study (MCS). This tracks nearly 20,000 families from across the UK. We used measurements made when the children were aged 5 (when just entering primary school) and 11 (the point at which they leave primary school and are on the cusp of adolescence). We used standard definitions for ‘obese’ and ‘overweight’.

‘Stark’ link between poverty and obesity

The first thing we found was that the link between relative poverty and childhood obesity is stark. At age 5, poor children were almost twice as likely to be obese compared with their better off peers (6.6% of children from families in the poorest fifth of the sample were obese while the figure for the richest fifth is just 3.5%). By the age of 11, the gap has widened- nearly tripling (7.9% of the poorest fifth are obese; for the best-off, the figure is 2.9%).

Given that obesity is linked to the development of numerous chronic diseases and that there is evidence overweight and obese children are less likely to grow into economically and socially successful adults, this is a significant burden to be borne by the children of the less-well-off. And unless we can weaken the link our chances of reversing the overall obesity trend are much reduced.

Potential causes of that link

The MCS collects a broad range of data, allowing us to dig beneath these headline numbers to identify some of the specific ways in which relative poverty in childhood leads to an increased risk of obesity.

To measure the degree to which the mother followed a healthy life-style we looked at factors previously shown to be linked to the increased risk of obesity, such as whether the mother smoked during pregnancy, how long she breastfed for and whether the child was introduced to solid food before the age of four months.

We could also factor in the degree to which the mother was herself overweight or obese. To assess the impact of physical behaviour, we compared the frequency of sport or exercise, active play with a parent, hours spent watching TV or playing on a computer, journeys by bike and the time that children went to bed. We compared dietary habits via data on whether the child skipped breakfast and on fruit and sweet drink consumption.

Multiple factors

What we found was that a lot of these factors were relevant. Maternal behaviour in early childhood was certainly important. Markers of ‘unhealthy’ lifestyle here could mean as much as a 20% additional risk of obesity for a child. Measures of physical activity and diet were also relevant at both 5 and 11 years of age, as were early bedtimes and fewer hours in front of the TV or games console. Skipping breakfast and eating more fruit were factors at 5 but less significant at 11. Doing sport more frequently played a more important and protective role at age 11 than at age 5.

Further examination of the differences between the children aged 5 and aged 11 revealed that poorer children aged 5 were much more likely to gain excess weight up to age 11 than richer children. The earlier certain lifestyle factors can be challenged, therefore, the greater the chance of positive impact.

Multiple responses

Assuming that income inequality is not going to disappear, we can only tackle ‘inherited’ obesity via the lifestyle choices that tend to go with lower incomes. Early intervention with mothers clearly has huge potential. And evidence from our work suggests that this should start before birth or even conception. It is clear, too, that campaigns to encourage family physical activity and healthier diets would help.

The Government is already trying to persuade families to eat more healthily and take more exercise. But these efforts are widely targeted and their effectiveness only broadly assessed. Our analysis has already suggested better targeting. More research should be undertaken to narrow the aim and increase effectiveness still further.

Why are poorer children at higher risk of obesity and overweight? A UK cohort study is research by Alice Goisis, Amanda Sacker and Yvonne Kelly and is published in the European Journal of Public Health.

Photo credit: Playing on the computer,  John Watson