Cohort characteristics
Of the 1 339 494 eligible children, 1 283 165 (95.8%) were included in the main analysis and 747 967 (55.8%) in sensitivity analysis. Maternal ethnicity was largely representative of the general population of women of child-bearing age (15–49 years) and infants at the time of the 2011 Census (Table 1),30 as were most other sociodemographic, maternal, and birth factors (Supplementary Table S1). There was a slightly lower proportion of children born preterm in the current study cohort. North East, East Midlands, and Yorkshire and the Humber were excluded from analyses involving regional stratification because of small group sizes. There were no notable differences in patterns of missing data between ethnic groups or between those who did and did not receive baby checks.
Table 1. Distribution of ethnicity in the study cohort compared with the general population of Englanda
Six-to-eight-week baby checks by maternal ethnicity, year, and region
The effect of ethnicity varied over time and by region. Coverage increased between 2006–2007 and 2015–2016, then stabilised between approximately 80% and 90% across the rest of the study period for most ethnic groups (Supplementary Figure S1 and Supplementary Table S2).
However, between 2006–2007 and 2010–2011, a much lower proportion of children born to mothers of Bangladeshi (for example, 52.7% compared with 68.7% in the White British group in 2006–2007) and Pakistani (for example, 57.0% in 2006–2007) ethnicity received the baby check. This gap between Pakistani and Bangladeshi groups and other ethnic groups was even greater in the sensitivity analysis (Supplementary Figure S2 and Supplementary Table S3).
By region, lower coverage and greater disparities between ethnic groups were observed in the West Midlands and the North West (Supplementary Figure S3 and Supplementary Table S4). In the West Midlands, baby check coverage was the lowest for four ethnic groups where only 59.3–60.2% of babies received the check: Bangladeshi, Caribbean, African, and Any other Black, African or Caribbean background (RR 0.74, 95% confidence intervals [CIs] ranging from 0.7 to 0.8 compared with White British; Figure 3, Supplementary Figure S3, and Supplementary Tables S4 and S5). In contrast, coverage was 80.5% in the White British group.
Figure 3. Average (total) effect of maternal ethnicity on 6–8 week baby checks, accounting for effect modification by region (comparing each ethnic group with the White British reference group in the same region). CI = confidence interval. RR = risk ratio.
In the North West, baby check coverage was lowest for the Bangladeshi (65.3%, RR 0.83, 95% CI = 0.8 to 0.86 compared with White British) and Pakistani ethnic groups (69.2%, RR 0.88, 95% CI = 0.85 to 0.9). Coverage was 79.0% in the White British group. These patterns were similar in sensitivity analysis (Supplementary Figures S2, S4, and S5 and Supplementary Tables S3, S6, and S7) and remained consistent after adjusting for sociodemographic, maternal, and birth factors (Supplementary Figures S6 and S7 and Supplementary Tables S8 and S9).
In the West Midlands and North West, ethnic inequities persisted over time (Figure 4, Supplementary Table S10). For example, the Bangladeshi and Caribbean groups still had lower coverage than White British in the West Midlands in 2020–2021 (71.2% coverage, 95% CI = 62.4 to 79.9% for Bangladeshi and 70.8%, 95% CI = 58 to 83.7% for Caribbean groups compared with 89.3%, 95% CI = 88.4 to 90.1% for the White British group). In the North West, coverage in the Bangladeshi group improved in the mid-2010s then declined again in recent years (for example, 68.4% coverage, 95% CI = 60.5 to 76.3% in 2020–2021 compared with 87.8%, 95% CI = 87 to 88.6% in the White British group).
Figure 4. Six-to-eight-week baby check by maternal ethnic group, region, and year. Data points for ethnic groups within each region and year with less than five children who had not received a baby check have been removed. a) London; b) East of England; c) North West; d) South East; e) South West; f) West Midlands.
Six-to-eight-week baby checks, maternal checks, and infant vaccination
Six-to-eight-week maternal check coverage was lower than baby checks, between 58.0% and 68.0% across ethnic groups. Pakistani (58.0%) and Any other Black, African or Caribbean background (60.4%) had the lowest maternal check coverage (Supplementary Tables S11 and S12).
Baby check coverage was lower for those whose mothers did not receive a maternal check, particularly for the Caribbean group. Baby check coverage was also lower in those who did not receive at least one dose of an infant vaccination, particularly for the Pakistani group (Figure 5, Supplementary Figure S8). Across all ethnic groups, the gap in baby check coverage was wider between children who did and did not receive infant vaccination than between children whose mothers did and did not receive maternal checks.
Figure 5. Six-to-eight-week baby check coverage by ethnic group, stratified by receipt of maternal checks and infant vaccination.
Of babies receiving a 6–8 week check, approximately three-quarters received at least one other service on the same day (Supplementary Figures S9 and S10). This was consistent across ethnic groups, with slight differences in the proportion of each ethnic group receiving different combinations of services on the same day. For example, the Pakistani group had the lowest proportion of babies and mothers receiving their 6–8 week checks on the same day (23.6% compared with 35.1% in the White British group). Bangladeshi and Any other White background had the lowest proportion of babies receiving their baby check on the same day as infant vaccination (24.8%), although this was similar to that of the White British group (26.2%)
