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CHAPTER FIVE SERVICE USE

Introduction

5.1 Analysis of service use among families with young children presented in the overview report on sweep 1 (Anderson, Bradshaw et al, 2007) showed some stark socio-demographic differences which may have implications for children's health and wellbeing. For example, there were differences in take-up of ante-natal services by family type, household income and maternal age ( Ibid., pp37-39). The report also showed differences in the sources that different parents use for information or advice about pregnancy, child health and child behaviour. For example, use of the internet for information during the pregnancy was much more common among older mothers than younger mothers ( Ibid., p41). Many of these differences persist within urban and rural areas. However, in order to more fully inform the planning, targeting and marketing of services for mothers and young families, it seems important to establish whether, after controlling for differences in family circumstances by area, there are any genuine urban/rural differences in up-take of services and use of advice. Much of the more detailed analysis of service use that follows focuses on the birth cohort because of its bigger sample size.

Ante-natal classes

5.2 Ante-natal classes are an opportunity for first time mothers to get access to expert information and advice about pregnancy and birth. The percentage of first-time mothers who do not attend any ante-natal classes is highest, at 39%, in remote small towns and lowest in accessible rural areas (17% - Table 25).

Table 25 Percentage of first-time mothers in the birth cohort who did not attend any ante-natal classes by urban-rural

5.3 Mothers who did not attend ante-natal classes were asked about their reasons for not attending. A higher proportion of mothers in rural areas and remote small towns said 'there were no classes available' (13% in rural areas - accessible and remote combined - compared with 3% in large urban). In addition, travel problems were more often cited in rural areas and particularly remote rural areas, despite the high levels of car ownership seen in the first section of this paper. Fourteen per cent of first-time mothers in rural areas cited travel problems as a reason for not attending, in comparison to 4% of their equivalents in large urban areas. This may suggest that household cars were not necessarily available to mothers in rural areas at the time of ante-natal classes.

Table 26 Reasons for non-attendance given by first-time mothers in the birth cohort who did not attend any ante-natal classes by urban-rural

5.4 The final row of Table 26 shows first-time mothers who cited at least one access problem - lack of knowledge/awareness of classes, no classes available, or travel problems - as their reason for non-attendance at ante-natal classes. Thirty-two per cent of rural mothers who did not attend ante-natal classes cited at least one of these three reasons, compared with 18% in large urban areas. Thus although rural first-time mothers were no less likely than mothers in urban areas to attend ante-natal classes overall, it is clear that access is a distinct problem for the minority of rural mothers who are not able to attend. Access problems were not significantly higher among mothers in small remote towns compared with urban areas, suggesting that the higher level of non-attendance in small remote towns is not explained by such issues.

Information and advice during pregnancy

5.5 In addition to being asked about ante-natal classes, mothers were asked whether they had used any other source of help, information or advice during their pregnancy. Not surprisingly, there are some significant differences between first-time mothers and mothers who have already had a child. The latter have lower rates of consulting a wide range of sources of help and advice including friends and family. Therefore, in comparing patterns across urban-rural areas it is important to distinguish first-time and other mothers. There is very little urban-rural variation in the pattern of usage of the most common sources of help, information and advice among mothers who already have at least one child. Across all areas, over 90% had used at least one type of health professional, such as a GP, midwife or health visitor and over 50% had used family or friends for help, information or advice (Table 27).

Table 27 Percentage of mothers (birth cohort, excluding first time mothers) using different sources of help, information or advice during pregnancy by SE urban rural classification

5.6 There are, however, some differences with respect to usage of other sources of advice and these are often more marked among mothers having a second or subsequent child than among first time mothers. For example, mothers in remote rural areas were the most likely to use books, magazines or newspapers, with urban-rural differences more marked among mothers who already had children than among first-time mothers. The pattern is similar with respect to use of the booklet Ready Steady Baby. In remote rural areas usage of this booklet drops from 60% among first time mothers to 50% of other mothers but in large urban areas it drops from 51% to 33%. This may suggest that urban mothers are less likely than rural mothers to continue consulting such sources after their first child.

Childcare

5.7 In terms of drawing on help with childcare, families in remote rural areas and small remote towns are less likely than families in urban areas to make regular use of any help looking after their babies - for example, just 48% of families with babies in remote rural areas compared with 61% in large urban get any help with childcare on a regular basis (Table 28). However, this difference was not apparent for toddlers. As the first section has shown, rural mothers were no less likely to be in paid employment - indeed they are just as likely to be working full-time and slightly more likely to be working part-time. Thus lower levels of use of childcare in rural areas do not appear to reflect differences in working patterns among urban and rural mothers. However, it was also shown that a much smaller proportion of rural mothers are lone parents. The option of sharing child care between two partners may therefore be more feasible for rural families if it is possible to stagger working hours.

Table 28 Percentage of respondents/main carers who get help with childcare on a regular basis from any of a list of the main formal and informal sources of help

5.8 Among those families who do not use childcare for their baby on a regular basis, lack of access to services is not the main issue for many families in Scotland - rather, preferring to look after their baby themselves or not needing to be away from them are the main reasons cited. The pattern of answers is broadly similar across urban-rural areas (Table 29). However, in remote small towns a higher proportion of mothers say 'I'd rather look after him/her myself' (84%, compared with 66% in large urban areas and 67% in remote rural areas).

Table 29 Percentage of mothers/main carers, birth cohort, who do not get help with childcare on a regular basis giving various reasons for not using childcare

5.9 When parents do use childcare - and the majority of parents of toddlers do across all areas - the pattern of use of formal services (but not informal care) was rather different in rural and urban areas. In the birth cohort, parents in rural areas and remote small towns were more likely than parents in large urban areas to use childminders (16% in remote rural areas, compared with 7% in large urban areas), while those in large urban areas were the most likely to use nursery or crèche provision (35%, compared with 20% in remote rural areas and just 10% in small remote towns - Table 30).

Table 30 Percentage of families in the birth cohort who are using childcare, who currently use various types of childcare

5.10 Among the child cohort, those in remote rural areas and remote small towns were significantly more like to use playgroups - 39% of parents from remote rural areas and 34% from remote small towns make use of this provision, compared with 12% in large urban areas (Table 31). Those in remote areas were also more likely to use childminders but again were less likely to use nurseries or crèches. These differences reflect established variations in provision by area - rural areas tend to have more playgroups and childminders and fewer nurseries because of financial difficulties in sustaining nurseries in sparsely populated areas.

Table 31 Percentage of families in the child cohort who are using childcare who currently use various types of childcare

5.11 Across urban and rural areas, the most commonly cited reason for using child-care is to enable the child's mother to work in paid employment. However, respondents could choose up to three reasons for using their main provider, and child-centred reasons for using childcare were also commonly cited, particularly by respondents in the child cohort. Respondents in rural areas and remote small towns were particularly likely to cite a child's educational development as a reason for using childcare - 50% of respondents in remote rural areas compared with 35% in large urban areas mentioned this as a motive (Table 32). Mothers in remote rural areas are also particularly likely to say they use childcare so the child can take part in a leisure activity, which may support the suggestion that mothers in remote locations are more likely to make particular efforts to ensure that their children have particular sorts of experiences.

Table 32 Percentage of mothers/carers citing child-centred reasons for use of childcare (mothers who use childcare)

Awareness of government initiatives

5.12 The overview report (Anderson, Bradshaw, et al, 2007) found some evidence that parents in rural areas had higher awareness of key government supported initiatives aimed at children and families. For example, mothers in remote rural areas were almost twice as likely as mothers in large urban areas to have heard of Sure Start (48% compared with 28%). This may reflect differences in levels of education between mothers in urban and rural areas, but may also indicate the higher visibility of funding streams for services in rural areas.

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