Parents’ experiences of perinatal child protection processes: A systematic review and thematic synthesis informed by a socio-ecological approach

Abstract

Background

Nationally and internationally, researchers and practitioners are increasingly expressing concerns regarding the number of babies removed by child protection systems soon after birth and how child protection processes in the perinatal period (conception to one year following birth) impact families.

Aim

This systematic review synthesises qualitative studies to gain an understanding of the experiences and needs of pregnant women, mothers, and fathers involved in perinatal child protection processes that occur in health, welfare, and legal systems.

Methods

Multi-disciplinary electronic databases (13) were searched for relevant peer-reviewed journal articles written in English and published since 2000. Twenty-four articles met the inclusion criteria. Analysis adopted a socio-ecological approach and thematic synthesis. An expert advisory group comprised of lived experience advisors, service providers, and academics contributed to development of the thematic framework.

Results

Although the reviewed studies were conducted between 2005 and 2023 with diverse participants from six countries, they highlight parents’ similar experiences of perinatal child protection processes. Parents’ experiences were synthesised according to spheres of the socio-ecological model:

(i) At the individual level, parents described their love, hope, confusion, fear, agency, and anguish.

(ii) Within relationships parents recounted broken parent-baby bonds, limited personal and professional support, and the implications of trauma and trust for parent-professional relationships.

(iii) When engaging with organisations parents reported pervasive surveillance and harmful processes, inadequate communication and support, and power imbalances.

(iv) At policy and societal levels parents’ experiences pointed to dominant Western norms and values, increased poverty and homelessness, compromised rights, and prejudicial perinatal policies.

Also synthesised are parents’, professionals’, and researchers’ recommendations for improving perinatal child protection processes and supporting families.

Conclusions

Over the last 20 years, qualitative studies from around the globe have consistently reported the adverse biopsychosocial impacts of removing babies from their families. Addressing poverty and trauma, redressing power imbalances, and mitigating the enduring impact of perinatal child protection processes is critical for parents’ to be able to keep or be reunified with their babies. Shifts at institutional, policy, and societal levels are needed to: prioritise prevention and early intervention; enable relational practice and cross-sector collaboration; and move beyond traditional Western notions of family. Centring parents’ voices in efforts to improve child protection processes before and after birth will help inform the delivery of early and appropriate support to meet parents’ identified needs and promote family wellbeing.