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CHAPTER THREE HEALTH AND WELL-BEING OF RURAL BABIES AND CHILDS

Introduction

3.1 In terms of planning services to meet the health needs of children and families in Scotland, it is important to understand whether these needs vary between urban and rural areas. The first sweep of GUS included a range of questions about the child's health, including 'objective' indicators (such as birth weight), more subjective measures, such as parental concerns about their child's development, and questions about parental behaviours during pregnancy and the early years (such as breastfeeding and smoking) that may later affect children and babies. In general, there is little significant variation across the urban-rural classification in most of these measures of child health and development. Although indicators associated with parental health-influencing behaviours suggest that the chances of a healthy start are slightly lower in urban areas and slightly higher in rural areas, these differences are primarily explained by the characteristics of mothers in rural areas, who tend to be better educated, older and wealthier than their urban counterparts.

Birth weight

3.2 Low birth (defined as less than 2.5 kilos) is one of the first indicators of general health. While there are no significant differences in the proportion of babies with low birth weights between urban and rural areas generally, the proportion of GUS babies with low birth weights is slightly higher in small remote towns than in rural areas (11%, compared with 4% in remote rural areas, Table 11).

Table 11 Percentage of babies with low birth weights by urban-rural

Reported health problems or disabilities

3.3 There was no significant variation in the reported level of child health problems or disabilities between areas - babies and toddlers in remote rural areas are just as likely as children in large urban areas to be reported as suffering from long- term ill health or disability expected to last more than a year (15% in remote rural areas, compared with 14% in large urban areas).

Contact with NHS for health problems

3.4 Again, there does not appear to be any clear variation between urban and rural areas in terms of contact with the NHS in general. Children in remote rural Scotland are no more or less likely to have NHS contact than children in large urban areas (82% of babies in both kinds of area have had at least one problem for which they have sought NHS attention). Similarly, young children in remote and rural areas are no more or less likely than children in urban areas to have had accidents for which their parents sought medical attention (Table 12).

3.5 Children in small remote towns, however, clearly emerge as being the least likely to have had contact with the NHS about general health problems - for example, just 70% of babies in remote small towns have had at least one health problem which their parents contacted the NHS about, compared with 82% in both large urban and remote rural areas. In contrast, toddlers in small remote towns are most likely to have had an accident involving medical attention - 33%, compared with 18% in remote rural and 23% in large urban areas. The reasons for this are unclear - whether it is associated with availability of particular services, differences in need, or some other factor. However, these findings highlight the health services use of children in remote small towns as an area for further investigation in future years of GUS.

Table 12 Percentage who had one or more accidents involving medical attention by urban-rural

Parental concerns about child's development

3.6 Just as toddlers are more likely than babies to have accidents, so also parental concerns about children's development and behaviour are more common in relation to toddlers. There is relatively little variation in parental concerns about babies by area, but concerns about toddlers' development are lowest in remote rural areas - 90% have no concerns, compared with between 78% in small accessible towns and 84% in small remote towns (Table 13).

Table 13 Percentage of children for whom no concerns are reported concerning their development or behaviour by urban-rural

Health-influencing behaviour

3.7 In comparison with our other child-health measures, the health influencing parental behaviours of breast feeding and smoking do vary somewhat across the urban-rural classification. Mothers in remote and rural areas are more likely than those in urban areas to have planned to breastfeed (Table 14) and to have actually breastfed (Table 15), and are less likely to smoke (Table 16). However, regression analysis shows that these differences are due to the higher proportions of rural mothers with high levels of education, older ages at birth, the higher proportion of rural babies who are second children and the lower proportions in low income households. These factors, and not the urban-rural division in itself, largely explain these differences.

Table 14 Percentage of respondents saying they planned to breast feed before the baby was born by urban-rural

Table 15 Percentage of respondents saying they ever breastfed by urban-rural

Table 16 Percentage of respondents/main carers who smoke by urban-rural

3.8 Respondents were also asked about various activities that parents and children do together which are likely to aid children's development. These included questions about how often they do things like painting, drawing and playing various sorts of games. There were no significant differences in the frequency with which rural and urban mothers undertake such activities with their children. We also asked about how many children's books were in the house. Almost all households had at least some books aimed at their child's age group and most households had more than ten of such books. However, children in remote small towns and rural areas were the least likely and those in large urban areas the most likely to have few books at home. But again these differences disappear once the fact that parents in rural areas tend to be educated to a higher level and are less likely to be in the lowest income group is taken into account.

Table 17 Percentage of babies and toddlers with few books (0-10 books) for them at home by urban-rural

3.9 There is some debate about the benefits and disadvantages in terms of child development of very young children watching television. The majority of toddlers from all areas watch TV for at least ten minutes several times a week, with very little difference by area. However, babies in remote towns and rural areas were less likely than their urban counterparts to watch any television - for example, 60% of babies in remote rural areas had not watched any TV in the last week, compared with just 45% in large urban areas (Table 18).

Table 18 Percentage of babies and toddlers who did not watch any TV in the past week by urban-rural

Conclusion

3.10 Overall, then, there is little evidence that babies and toddlers from rural areas have better health and well-being, or that such differences as exist are influenced by urban rural differences beyond the characteristics of their parents and immediate households. However, because rural mothers are less likely to be in low income households or have low levels of education, rural babies are likely to be exposed to rather different patterns of parental behaviour and advantage. Lower rates of smoking and higher rates of breastfeeding and of having many books for babies at home are some examples of this.

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