Residential mobility in the UK during pregnancy and infancy: Are pregnant women, new mothers and infants ‘unhealthy migrants’?
Introduction
Pregnant women and families with infants have high rates of residential mobility in developed countries. Studies in the UK, USA and Canada have found rates of change of address during pregnancy to range approximately from 12 to 31% (Canfield et al., 2006, Fell et al., 2004, Khoury et al., 1988, Miller et al., 2009, Pearce et al., 2008, Shaw and Malcoe, 1991, Zender et al., 2001). Rates of mobility among adult women in the UK are highest during their child bearing years, peaking in their late teens and early twenties when, in 2001, over 30% had changed residential address within the country in the last year compared to 11% of the population as a whole (Champion, 2005). In the UK, in 2001, infants were the age group that, following teenagers and young adults, were most likely to have moved within the country in the previous year, with approximately 20% having changed address (Champion, 2005).
Family formation is itself a significant cause of residential mobility among young adults. In the 1971 Census, 84% of women in the UK moved home in the year of their marriage (Grundy & Fox, 1985). More recent European data demonstrate that pregnancy and childbirth are important triggers for mobility of households, with the birth of a first child most likely to result in relocation (Clark and Huang, 2003, Grundy, 1986, Kulu, 2005, Rabe and Taylor, 2009).
Despite the frequency of residential mobility among pregnant women and families with infants, relatively few studies have focused on the relationship between mobility and health among these groups. This paper begins by reviewing existing literature regarding mobility and health in developed countries pertaining to these groups. Residential mobility has been defined in most studies by the number of moves within a time period or the length of time since last change of address. In this paper the terms residential ‘mobility’, ‘migration’ and ‘relocation’ are used interchangeably to describe a change of place of residential home, either permanent or temporary.
Analyses of mobility within developed countries suggest that overall those that move demonstrate a ‘healthy migrant effect’ with better health outcomes than non-movers (Boyle et al., 2002, Champion, 2005, Verheij et al., 1998). In the UK, in 2001, 12.5% of people who described their health as ‘good’ in the previous year had moved within the country in the previous year, compared to 8.6% of those who described their health as ‘not good’ (Champion, 2005). This healthy migrant effect reflects the high frequency of residential mobility among young, high socio-economic status adults pursuing higher education and professional employment (Bailey and Livingston, 2005, Champion, 2005). However, the relationship between health and migration varies significantly across the life course. Among young adults, those that move home within countries in Europe and USA have been found to have lower risk of morbidity and mortality than non-migrants, but in midlife this pattern reverses and migrants are more likely to have poor health (Bentham, 1988, Findley, 1988, Verheij et al., 1998). The limited research available relevant to mobility among pregnant women and families with infants suggests migrants in these groups may be of relatively low socio-economic status and at risk of poor health, and so another ‘exception’ to the healthy migrant effect.
Studies in North America have found mobility during pregnancy to be associated with low household income, low level of maternal education and mothers being unemployed (Canfield et al., 2006, Fell et al., 2004, Miller et al., 2009, Shaw and Malcoe, 1991). One exception to this pattern of indicators of low socio-economic status among families mobile during pregnancy is from a US study which found greater rates of mobility among women in higher socio-economic status neighbourhoods (Miller et al., 2009). Mobility during pregnancy has also been found to be associated with young maternal age, mother being unmarried, unplanned pregnancy, low maternal parity and tobacco use during pregnancy (Canfield et al., 2006, Fell et al., 2004, Khoury et al., 1988, Miller et al., 2009, Shaw and Malcoe, 1991). Measures of low socio-economic status and smoking during pregnancy have in turn been found to be associated with poor birth outcomes, such as low birth weight (de Bernabé et al., 2004).
Analysis of mobile families with infants, completed while monitoring the sample for the UK Millennium Cohort Study (MCS), found mobile families were more likely to have mothers who were young and unmarried, and to live in socioeconomically disadvantaged wards (Plewis, 2007). High rates of residential mobility among families with children in the USA have been found to be associated with single parenthood, unemployment and low education of household head (Astone and McLanahan, 1994, Long, 1992, Tucker et al., 1998). Children in the UK, aged 0–14 years, are also more likely to have moved home if they live in a deprived neighbourhood (Smith et al., 2006).
A number of studies, mostly completed in the USA, have considered behavioural and psychological outcomes for mobile children. A recent systematic review of residential mobility in childhood and health outcomes concluded that high rates of residential change were associated with increased behavioural problems during childhood, and risk taking behaviours in adolescence, after adjustment for anticipated confounders (Jelleyman & Spencer, 2008).
The association between low socio-economic status, mobility and poor heath among children has led to the suggestion that mobility may be a cause of poor health among disadvantaged families. However, it is difficult to separate the effects of residential instability upon health from those of instability in family relationships, employment and economic fortunes. For example, children’s residential moves in the USA have been found to follow relationship breakdown and result in relocation to poorer neighbourhoods, and these factors account in part for the poor educational and behavioural outcomes among more mobile children (Astone and McLanahan, 1994, Tucker et al., 1998, South et al., 1998).
The most residentially unstable families experience marked and interlinked health and social disadvantage. ‘Frequent movers’ have increasingly been noted as a group at risk of social exclusion in the UK (Cole et al., 2006). Frequent moving is common among women and children fleeing domestic violence, teenage care leavers and the most vulnerable homeless groups with drug and mental health problems (Cole et al., 2006). Pregnancy and child birth may themselves be linked to an increased risk of homelessness among women (Weitzman, 1989). Homelessness and living in temporary accommodation during pregnancy have been found to be associated with preterm births and low birth weight of infants, poorer mental health among mothers and children, and higher rates of accidents, developmental delay and behavioural problems among children (Amery et al., 1995, Cumella et al., 1998, Little et al., 2005, Stein et al., 2000, Victor, 1993, Vostanis et al., 1998).
The possibility that residential mobility may impact upon health has been assessed in studies focussed on a variety of causal pathways including environmental and infectious exposures, psychological pressures, social support and health care utilisation. Studies of mobility and environmental and infectious exposures have considered the incidence of Sudden Infant Death Syndrome (SIDS), asthma and leukaemia. A study of SIDS found infants’ change of address was associated with risk of death, but only in univariate analysis (Schluter, Ford, Mitchell, & Taylor, 1998). A small number of studies have supported the possibility of an association between early house moves and later diagnosis with asthma among children (Austin and Russell, 1997, Jones et al., 1999, Hughes and Baumer, 1995, Strachan et al., 1996).
Stress resulting from the upheaval of moving home may cause psychological and behavioural difficulties. Research on families in the UK with children under 12 years found worse mental health among parents who had recently moved (Hooper & Ineichen, 1979). The negative psychological effects of moving may be greater for women than men (Magdol, 2002) so could be particularly pertinent to maternal health. Stress related to moving home has been hypothesised as a precipitating factor in burn accidents among children aged 0–5 years in a study which found a higher frequency of such incidents in recently mobile households (Knudson-Cooper & Leuchtag, 1982).
It has also been suggested that moving home may damage inter-personal relationships and reduce access to social support. Residential mobility has been widely used as a proxy for social deficits, however, there is relatively little empirical research evidence to indicate that mobility harms social ties among adults (Magdol, 2000). Analysis in the USA, in the 1960s, found that women that moved had more regular contact with friends and neighbours both before and after moving than non-movers (McAllister, Butler, & Kaiser, 1973). A recent American study of mothers found no significant effects of moving on social networks (Magdol, 2000). For children, residential moves that result in changes in child care and education will inevitably disrupt friendships and contact with carers and teachers. Some research in the USA has concluded that worse school performance among more mobile children is partially the result of declines in social relationships (Pribesh & Downey, 1999).
The potential of residential mobility to disrupt pregnant women and children’s health care has also been studied. Pregnant women in mobile households in the USA have been found to access prenatal care later than other pregnant women (Fell et al., 2004). A UK study found ‘frequently moving or homelessness’ to be the most common reasons given by parents for children not having up-to-date immunisations (Riley, Mughal, & Roland, 1991). Analysis of the MCS found that children in families that had moved during pregnancy or more frequently in early childhood were more likely to be partially immunised with the primary immunisations and unimmunised against measles, mumps and rubella but not more likely to be unimmunised with primary vaccines (Pearce et al., 2008). Analysis of the relationship between immunisation and mobility in the USA has also produced mixed findings, with some studies concluding that there is an association (Anderson, Wood, & Sherbourne, 1997) and others that there is not (Findley et al., 1999, Miller et al., 1994). American studies have found that children in more mobile families have poorer continuity of medical care (Mustard, Mayer, Black, & Postl, 1996) and are more likely to lack a regular site for preventative or ‘sick care’ (Fowler, Simpson, & Schoendorf, 1993). However, a Finnish study found no significant association between child mobility and number of medical services visits per year (Vuorinen, 1990).
Most research into residential mobility and health has focused upon the potentially harmful consequences of mobility. However, residential moves may benefit health if they provide the opportunity to improve the quality of housing and environment. Moves among pregnant women and new parents are often motivated by a desire for greater space and a more pleasant environment for children (Kulu, 2005). Research in Europe, including analysis of the UK MCS, suggests that moves by families with children are disproportionately towards more affluent and rural areas (Bailey and Livingstone, 2007, Dobsen and Stillwell, 2000, Kulu, 2005, Smith et al., 2006, Joshi et al., 2008, Rabe and Taylor, 2009).
A study of adults in Switzerland that had moved in the previous year found that the majority stated that their self-rated health has improved compared with their former residence (Kahlmeier, Schindler, Grize, & Braun-Fahrländer, 2001). Analysis of rehousing policies also suggests that relocation can benefit the mental and physical health of adults with serious housing problems (Blackman et al., 2003, Kearns et al., 1992, Smith et al., 1997). A recent survey of statutorily homeless families in England revealed that the majority of households moving into either temporary or settled accommodation reported experiencing an improvement in their overall quality of life (Pleace, Fitzpatrick, Johnsen, Quilgars, & Sanderson, 2008).
In summary, while there is evidence that pregnant women, mothers and infants may be an exception to the broad ‘healthy migrant’ pattern, the nature of the association between mobility and health among these groups is not well understood. A diverse literature has considered a range of different aspects of the relationship between families’ mobility and health but significant gaps in knowledge remain. There have been fewer studies focussed on mobility and health among pregnant women and infants than mothers and older children. A lack of research into the influence of the drivers for moving home upon the association between mobility and health of families is also a significant gap in the literature (Jelleyman & Spencer, 2008). The relationship between mobility and health is likely to be complicated by the diverse causes of mobility and experiences of moving home, as well as the possibility that moves may have both positive and negative impacts on health that operate along a range of different pathways.
Section snippets
Aims
The aim of this study is to provide a more comprehensive picture of the relationship between mobility and health among pregnant women, infants and mothers in the UK. The paper will firstly assess whether pregnant women, new mothers and infants in the UK are ‘unhealthy migrants’ by comparing a broad range of mental and physical health outcomes among movers and non-movers. Secondly, the paper will consider the nature of the association between mobility and health in several ways. It will compare
Data
This analysis uses data from the first wave of the MCS, the Centre for Longitudinal Studies’ (CLS) survey of the social, economic and health characteristics of children and their families in the UK. The population of this cohort study was 18,819 infants – henceforth referred to as ‘cohort children’ – born in the UK during 2000–2002 and aged 8–12 months at wave one (Plewis, 2007). The sample was stratified by electoral ward type to over represent ‘ethnic wards’ (wards with more than 30% of the
Results
Of the 18,197 families, 12.7% had last moved since the cohort child’s birth, 16.3% in the nine months before birth, and 71.0% were residentially stable during pregnancy and since birth. Among families that had moved since the birth of the cohort child, 76.1% described their move as a motivated by positive factors and 20.0% by negative factors. Homelessness had been experienced by 7.2% of families moving during the cohort child’s infancy (Table A and Table B, in the electronic appendix, LINK
Discussion
These findings support, in the UK, research that has suggested families moving during pregnancy and infancy are an exception to the ‘healthy migrant’ pattern – exhibiting poorer health compared to non-movers. The analysis confirms that families that move during pregnancy and infancy have distinctive socio-demographic characteristics, with younger mothers and lower socio-economic status on average. This analysis also suggests that the poorer health outcomes among mobile families are, to a large
Conclusion
This analysis indicates that pregnant women, new mothers and infants who move home in the UK are an exception to the ‘healthy migrant’ pattern, and might be regarded as ‘unhealthy migrants’. Mobility during pregnancy and infancy is most common in socio-demographically disadvantaged families with young mothers. The poorest health among mobile families is found in families that move under negative circumstances and/or experience homelessness. Overall, the poor health outcomes of mobile families
Acknowledgement
The authors would like to thank the families who have taken part in the MCS, the MCS study team at the Centre for Longitudinal Studies, Institute of Education, University of London and the UK Data Archive, administered by the Economic and Social Data Service, at the University of Essex which provided the data. The MCS is supported by grants to Heather Joshi, director of the study, from the ESRC and other government sources. The authors are also grateful to Richard Shaw, Hilary Graham, Joy
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