Women in England who face family court proceedings that could result in their children being removed are at dramatically higher risk of dying within 10 years of giving birth, according to a major study that is prompting calls for urgent reform of family justice and support services.

The research, published in the Journal of Epidemiology & Community Health, found that first-time mothers involved in care proceedings were 21 times more likely to die than mothers of the same age who had not experienced such proceedings.

Researchers analysed records from more than 2.7 million women, aged 15–39, who gave birth for the first time in NHS maternity units between 2007 and 2017. By linking maternity records with family courts, hospitals, and national mortality data, they tracked outcomes for mothers over the following decade.

Of the 2.7 million women studied, around 28,400 experienced care proceedings within 10 years of giving birth. These proceedings are launched when authorities believe a child is at risk of harm and may lead to foster care, adoption or placement with relatives.

The findings reveal a concerning trend. Just over 1% of mothers who experienced care proceedings died within 10 years, compared with 0.2% of those who did not. More strikingly, nearly three-quarters of those deaths were linked to causes considered potentially preventable, including suicide, homicide, drug or alcohol-related harm, and unintentional injuries.

The women involved were more likely to be younger, live in deprived areas, or have existing physical or mental health problems before giving birth. Researchers suggest that while these factors contribute to the elevated risk, they may not fully account for it.

“Mechanisms explaining a higher risk of death are complex, including pre-existing poorer mental and physical health, a theory supported by our data. It may also be that child removal increases maternal mortality risk,” the researchers wrote.

Previous studies in the UK, Australia and Canada have similarly linked child removals with profound psychological distress. Mental health experts have described the experience as one of the most severe forms of grief a parent can face. Feelings of shame, loss, stigma, and isolation can persist for years, often alongside poverty, addiction, domestic violence, or untreated mental illnesses.

“The profound impact of child removal has been described, including long-lasting grief, guilt and stigma; loss of identity as a parent; a sense of failure; and adverse health consequences—all without access to post-removal support,” the researchers added.

The authors cautioned that their study cannot prove that court decisions directly caused the deaths. However, they argue that healthcare services, social care agencies, and family courts must work together to identify vulnerable mothers early and provide support before, during, and after proceedings.

“Ultimately, a public health approach to family justice is needed that examines why families are courted in the first place, their journeys through the courts, and their long-term outcomes following proceedings,” they concluded.