Children and Families Bill

Memorandum submitted by Twins and Multiple Births Association (Tamba) (CF 65)

Briefing on the need for additional maternity and paternity leave and pay for families with twins, triplets or more.

Summary

1. Our families tend to have much more to contend with during pregnancy, birth and the first eighteen months of life then families only having one baby at a time. They are also more likely to experience real financial hardship during this time than other families.

2. The current level of maternity and paternity leave, and financial support provided by the state, which is the same as for other families only having one baby at a time, does not meet their needs. We welcome the proposals in the Bill for greater flexibility in leave, shared between partners, but it will not meet the fundamental needs of our families. Nor will the proposal to allow partners to attend up to two antenatal appointments.

3. As a result of the current provision, many multiple birth parents, may find the first eighteen months of their new babies lives unnecessarily difficult contributing to paternal ill health, financial hardship, relationship stress and mothers in particular appear to have less opportunity to return to work and consequently this reduces their ability to help their family work themselves out of poverty.

4. The Children and Families Bill should be amended to double the length of paid maternity and paternity leave for all multiple birth families. Or at the very least, maternity and paternity leave legislation for multiples should take prematurity into account, by using babies’ expected (not actual) due date when calculating maternity and paternity leave. It should also allow partners to attend six scans during pregnancy (according to NICE guidance, this is the minimum number of scans they will receive).

About Tamba

5. Tamba is a registered charity that works throughout the UK. We have over 12,000 family members and 180 local clubs. Our aim is to improve the lives of multiple birth families and we achieve this by providing a number of support services including; professional help in the home to families in crisis; a telephone helpline; specialist support groups, free publications and resources; and undertake research and campaigning.

About multiple birth families

6. In the UK, about 1 in 65 pregnancies is a multiple pregnancy and 1 in 32 children is a multiple, which equates to just over 11,000 births a year (11,053 in 2010).

Challenges of multiple pregnancies, births and the first eighteen months

Pregnancy

7. Multiple births are relatively high risk pregnancies and this is usually due to multiples being born prematurely or under weight. [1]

8. Expectant multiple birth mothers are nearly six times more likely to be hospitalized during pregnancy and more than twice as likely to be admitted to the intensive care compared to expectant mothers of singletons. Maternal length of stay during the birth admission is 60-70% higher for multiple versus singleton births. [2] Mothers expecting twins have on average 8 scans and triplets 9 compared to an average of 3 scans for mothers with a singleton pregnancy [3] .

9. Whilst we welcome the proposal in the Bill to allow partners to attend up to two scans, the reality is many partners will have to take unpaid leave to find out how their partners high risk pregnancy is progressing. Some employers may be unwilling to allow partners time off for these appointments and for many, this leave needs to be saved for the postnatal period should their babies be born prematurely or underweight and require time in neonatal care. Furthermore, many partners may have to use their leave (paid or unpaid) to care for their other children should the mother be hospitalised during pregnancy.

10. Our online survey of over 1,000 multiple birth families in March 2013 looked at their experience of maternity and paternity leave and pay and found that this legal anomaly can be devastating. The report, "Multiple Births Parents’ Experience of Maternity and Paternity Leave", discovered that:

· Due to the increased likelihood of complications during pregnancy, 29% took more than a month off sick and nearly 25% of mothers were hospitalised.

· Ill health necessitated many mothers to take early maternity leave. 29% of twin mothers took leave at 28-31 gestation (the average gestation for single birth is 40 weeks and for twins 37 weeks), 50% of triplet mothers started their leave at this time.

· Over 10% of partners took holiday or unpaid leave to look after their other children, whilst their mother was poorly.

· Several respondents said they needed weekly or fortnightly scans. Over half (58.8%) of partners took additional time off during pregnancy to attend antenatal appointments or scans. Of these, a third of partners (31.3%) took more than five days of unpaid leave.

Births

11. The average length of singleton pregnancies is 40 weeks and the average birth weight is 3.5kg. This compares to twin pregnancies which average 37 weeks and triplets which average 34 weeks and their average birth weights are 2.5kg and 1.8kg respectively. [4] As a result, twins are also four times more likely to die during pregnancy when compared to singletons, seven times more likely to die shortly after pregnancy, ten times more likely to be admitted to a neonatal special care unit and have six times the risk of cerebral palsy.

First eighteen months of life

12. Around 44% of twins and 91% of triplets are born prematurely and spend time in neonatal care. 42% of all multiple-birth families had at least one baby requiring neonatal care for more than a week. One in five families (20%) had at least one baby needing special care for over a month [5] .

13. As a result, many mothers and partners spend a considerable proportion of their maternity or paternity leave on a neonatal unit wondering if their babies will survive or will be left with long term disability. This often leaves very little time to settle in when they return home, which is made especially acute when trying to bond with, develop a routine and care for more than one baby.

Postnatal depression

14. Our research found that a considerable proportion of mothers prove to be very isolated on return from hospital. A combination of the above factors coupled with the increased demands of caring for more than one baby appears to result in almost 20% of multiple birth mothers suffering from Postnatal Depression (compared to 10% of singletons). Independent research on mothers of twins over a 12 year period have found them to be more anxious and more depressed than women with singletons. Mothers of twins tend to suffer more with fatigue, anxiety and emotional distress [6] . Twin parents can show significantly higher parenting anxiety and this can have an impact on their overall well-being and mental function [7] .

15. 60% of our mothers reported in the first six months they struggled to leave the house and often only had 1-2 hours contact a day with another adult. This would obviously be eased if partners were given more paid paternity leave to help share the burdens of caring for babies during the early weeks of their lives.

Challenges for mothers of returning to work

16. The Millennium research data also shows that multiple birth mothers find it significantly more difficult to return to the work place then other mothers and often delay returning until their children start at primary school [8] . This may have a detrimental effect on their career prospects but more fundamental on the financial wellbeing of the household.

17. The reasons for delaying returning to work include: disproportionate cost of childcare, availability of childcare, developmental delays (speech and language delays are more common in multiple birth children, lack of mobility (unable to take them places), requirement to attend hospital appointments, continuation of breastfeeding (unable to afford formula milk for more than one baby), physical exhaustion (unable to balance work with caring for more than one baby).

18. The intensity of caring for more than one baby also restricts mother’s abilities to return to the workplace. Caring for twins and multiples can create additional stress and mood/emotional disturbance for some parents, especially in the first years of life. Taking care of multiples is more difficult and complicated than caring for a singleton due to the ‘interaction factor’ in addition to other factors (such as sleep deprivation, marital disharmony and the increased domestic workload for twins) [9] .

19. It is possible that a twin parent is more likely to experience mental health difficulties, mood disturbance and this can result in cognitive compromises. Therefore for those that do go back to work, mental health difficulties or mood disturbance may have an impact on working life function as executive functions can be essential to being an effective employee. The most notable areas of executive functions which could have an impact on working efficacy could be the ability to plan, use your working memory, problem solve, verbally reason, multi-task, initiate tasks and monitor your own actions. Deficits in any of these skills could lead to poorer performance on work-based activities.

Financial pressures of multiple births

20. An analysis by NPI of Family Resources Surveys found that around 20% of our families live in poverty. According to the American Society for Reproductive Medicine, "The total cost of raising multiples is likely higher than the cost of raising the same number of singletons." [10] Half of all multiple birth families do not already have children and therefore cannot benefit from reusing existing resources. The costs of having a child/children and then multiples is also greater – very few families will have multiple cots, pushchairs, highchairs, bottles, baby clothes. Our own membership surveys and independent research suggests balancing household finances is one of the biggest problems faced by multiple birth families.

21. The greatest period of financial strain occurs between the ages of 0-12 months. [11] This is also confirmed by Professor Mckay’s examination of the millennium cohort data, which found multiple birth families reported higher levels of material deprivation, and lower well-being for their children. Nearly half (48%) of those raising twins or triplets had used up some or all of their savings, compared with 37% of all families. They were also more likely to be unable to afford key items for their children, and to have more arrears on their bills. Nine months after giving birth, mothers of multiple births were nearly 20% less likely to have returned to work than mothers of singletons. There was a greater expectation that paid work would have to wait until their children were aged five, i.e. at full-time primary school, due to the expense of childcare.

22. The report also revealed that parents of a multiple birth are more likely to separate or divorce – 28% of the ever-married had divorced or separated among multiple birth families, compared with 24% for other families with children

23. Although the Sure Start Maternity Grant and the Healthy Start scheme partially recognize the additional costs of raising a multiple birth family (they pay multiples of the grant depending on the number of children born), Child Benefit and Child Tax Credits do not. As a result, multiple birth families receive an estimated £55 million less per annum (based on the figures from 2007-8) from the Government towards the cost of living than other families and we are concerned that without amendment the Children and Families Bill 2013 will exacerbate this existing inequality. [12] This is contrary to the rulings of the European Court of Justice [13] which recommended that Governments ensure their system of leave, support and benefits are structured to support the needs of multiple birth families.

Amendments to the Bill

24. The problems outlined above would be addressed by amending the bill to double paid ‘maternity’ leave for all multiple birth ‘mothers’.

25. The cost extending paid leave from 39 weeks to 78 weeks would be around £58.1 million. (£135.45 per week maternity allowance x additional 39 weeks x 11,000 multiple birth mothers) Although based on existing data around 40% of multiple birth mothers return within a year and therefore the true cost is likely to be nearer to £35 million. At this rate, it would generate 6,600 cases to deal with each year or around 127 per week.

26. Furthermore, these problems would also be best addressed by amending the bill to double the amount of paid paternity leave for all multiple birth ‘partners’.

27. The cost of extending this paid leave from 2 to 4 weeks would be around £2.97 million (£135.45 paternity pay x additional 2 weeks x 11,000 partners). Again, due to financial pressures not all partners would take this amount of leave and the eventual cost is likely to be considerably less.

28. Recognising the financial restraints of the time, at the very least, maternity and paternity leave legislation for multiples should take prematurity into account, by using babies’ expected (not actual) due date when calculating maternity and paternity leave. Although this would be a disappointing outcome for the majority of our families, the cost of implementing this would be considerably less and support would be targeted at those families who miss out on time at home with their babies after birth and are arguably in greatest need.

29. The Bill should also be amended to allow partners to attend six scans during pregnancy (according to NICE guidance, this is the minimum number of scans they will receive).

March 2013


[1] HFEA Press release “ HFEA calls for national strategy to reduce the biggest risk of fertility treatment - Multiple births” 4 December 2007.

[2] Professor Barbara Luke, ScD, MPH, RD, Nutrition in Multiple Gestations, Clinics in Perinatology, page 403, June 2005.

[3] Maternity care for women having a multiple birth, NPEU, 2011

[4] ONS, 2005

[5] Tamba, Multiple Failing Report, 2009

[6] Pearlman, E. M & Gannon, J. A. (2000). ‘ Raising Twins from Birth to adolescence’. HarperCollins. USA .

[7] Nishihara R ,  Hattori R ,  Kobayashi Y ,  Hayakawa K .,(2006), ‘ Parenting anxiety and childhood development of twins as compared to singletons’, Nihon Koshu Eisei Zassh i.  2006 Nov;53(11):831-41.[Article in Japanese]

[8] Professor Steven McKay , “ The Effects of Twins and Multiple Births Families and Their Living Standards' 2010

[9] Collier, H (2003). ‘The Psychology of Twins: The essential handbook for parents of mulitples’, Business World. USA .

[10] American Society for Reproductive Medicine, Challenges of Parenting Multiples (Patients' Fact Sheet), Released January 2003, Available online: www.asrm.org/Patients/FactSheets/fact.html.

[11] Tamba Members survey 2004

[12] The cost of extending the Child Tax Credit so that parents receive a higher family element to reflect each child in a multiple birth would be approximately £5 million per year (HC Deb 13 June 2003 c 1089w). The annual extra cost in 2007-08 of paying the eldest child rate of child benefit in respect of multiple birth children is estimated to be approximately £50 million (HC Parliamentary Question [173124] 13 Dec 2007 c 810w).

[13] Zoi Chatzi v Ipourgos Ikonomikon C-149/10, [2010] All ER (D) 84 (Sep)

Prepared 19th April 2013