Towards reducing variations in infant mortality and morbidity : a population-based approach

Background: Our aims were (1) to improve understanding of regional variation in early-life mortality rates and the UK’s poor performance in international comparisons; and (2) to identify the extent to which late and moderately preterm (LMPT) birth contributes to early childhood mortality and morbidity. Objective: To undertake a programme of linked population-based research studies to work towards reducing variations in infant mortality and morbidity rates. Design: Two interlinked streams: (1) a detailed analysis of national and regional data sets and (2) establishment of cohorts of LMPT babies and term-born control babies. Setting: Cohorts were drawn from the geographically defined areas of Leicestershire and Nottinghamshire, and analyses were carried out at the University of Leicester. Data sources: For stream 1, national data were obtained from four sources: the Office for National Statistics, NHS Numbers for Babies, Centre for Maternal and Child Enquiries and East Midlands and South Yorkshire Congenital Anomalies Register. For stream 2, prospective data were collected for 1130 LMPT babies and 1255 term-born control babies. Main outcome measures: Detailed analysis of stillbirth and early childhood mortality rates with a particular focus on factors leading to biased or unfair comparison; review of clinical, health economic and developmental outcomes over the first 2 years of life for LMPT and term-born babies. Results: The deprivation gap in neonatal mortality has widened over time, despite government efforts to reduce it. Stillbirth rates are twice as high in the most deprived as in the least deprived decile. Approximately 70% of all infant deaths are the result of either preterm birth or a major congenital abnormality, and these are heavily influenced by mothers’ exposure to deprivation. Births at < 24 weeks’ gestation constitute only 1% of all births, but account for 20% of infant mortality. Classification of birth status for these babies varies widely across England. Risk of LMPT birth is greatest in the most deprived groups within society. Compared with term-born peers, LMPT babies are at an increased risk of neonatal morbidity, neonatal unit admission and poorer long-term health and developmental outcomes. Cognitive and socioemotional development problems confer the greatest long-term burden, with the risk being amplified by socioeconomic factors. During the first 24 months of life each child born LMPT generates approximately £3500 of additional health and societal costs. Conclusions: Health professionals should be cautious in reviewing unadjusted early-life mortality rates, particularly when these relate to individual trusts. When more sophisticated analysis is not possible, babies of < 24 weeks’ gestation should be excluded. Neonatal services should review the care they offer to babies born LMPT to ensure that it is appropriate to their needs. The risk of adverse outcome is low in LMPT children. However, the risk appears higher for some types of antenatal problems and when the mother is from a deprived background

Childhood, responsibility and the liberal loophole: Replaying the sex-wars in debates on sexualisation?

Feminist media discourses on 'sexualisation' have set out a critique of sexist cultural forms in contemporary society, using the figure of the 'girl' to show how women are socialised in harmful ways. This is an ingenious move - discussing the interplay between sexism and commercialism through discourse on minors can circumvent retorts to feminist claims about the harms of sexist culture that 'well, that's her choice'. Yet such discourses also necessarily render morally problematic any expression of sexuality or desire for the female subject under discussion, since the 'girl' is understood as prior to sexual consent. Debating sexism over the bodies of 'girls' therefore has had the unintended consequence of generating a replay of the 'sex wars', a debate between different feminist camps over whether consent can be meaningful. The terrain of debates on sexualisation has also facilitated coalitions between feminist discourses and a conservative policy agenda. © Sociological Research Online