Mapping UK policies and strategies relevant to child and maternal health to identify opportunities for upstream evaluations: Initial findings from the maternal and child health network (MatCHNet)

Stewart, E. , Pearce, A. , Given, J., Gilbert, R., Broph, S., Cookson, R., Hardelid, P., Harron, K., Leyland, A. and Wood, R. (2021) Mapping UK policies and strategies relevant to child and maternal health to identify opportunities for upstream evaluations: Initial findings from the maternal and child health network (MatCHNet). SSM Annual Scientific Meeting 2021, Online, 15-18 Sep 2021. (doi: 10.1136/jech-2021-SSMabstracts.75)

Abstract

Background Interventions to tackle the social determinants of health can improve outcomes during pregnancy and early childhood, leading to better health across the life-course. Variation in content, timing, and implementation of policies across the 4 UK nations holds great potential for quasi-experimental evaluations. We aimed to adapt systematic review methods to identify UK policies that potentially affect maternal and child health across the social determinants of health framework; and determine suitable candidates for quasi-experimental evaluation using administrative data. Methods A systematic search strategy comprised open keyword (i.e. ‘child’, ‘child health’, ‘child and maternal health’) and category searches of UK Government websites (e.g. Children and Families, Education, Health and Social Care, Welfare) and extensive hand searching of existing policy reviews until saturation was reached. We extracted information on geographical coverage and time periods. Quality assessment was carried out to rate and filter policies according to five criteria: 1. Potential for policy to affect maternal and child health outcomes; 2. Implementation variation across the UK; 3. Population reach and expected effect size; 4. Ability to identify exposed group in administrative data; 5. Potential to affect health inequalities. Finally, a consensus workshop was undertaken with experts to prioritise the included policies based upon existing knowledge. Results The systematic search found 335 policies and 306 strategy documents. After filtering, 88 policies were found to vary across the 4 UK nations. Domains include: 32 welfare, 23 education, 20 health, 7 environment, 4 housing and 2 employment policies. Policies were mainly excluded due to criteria 2, 3 & 4. The consensus workshop identified three policies as suitable candidates for quasi-experimental evaluation using administrative data: Pregnancy grants (welfare), Early Years Childcare (education) and Universal Credit (welfare). These policies are broadly similar across countries but differ in timing of implementation and details of target populations, offering opportunities for evaluation of effectiveness. For example, pregnancy grants are given to first born children in all UK countries, but only to second and subsequent children in Scotland. Conclusion Through applying systematic review methods to a policy search, we identified some valuable opportunities to evaluate upstream impacts on mother and child outcomes. However, many potentially impactful policies did not meet the criteria for quasi-experimental evaluation, which could lead to the inverse evidence law. This could be ameliorated by better access to administrative data (e.g. on eligibility criteria), staged implementation of future policies (affording greater cross-country variation) or alternative evaluation methods (e.g. simulations).

• Item Type: Conference or Workshop Item
• Additional Information: Abstract - Available from Journal of Epidemiology & Community Health 75: A35-A36
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Pearce, Dr Anna and Stewart, Dr Emma and Leyland, Professor Alastair
• Authors: Stewart, E., Pearce, A., Given, J., Gilbert, R., Broph, S., Cookson, R., Hardelid, P., Harron, K., Leyland, A., and Wood, R.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: Journal of Epidemiology and Community Health