Background Hugely concerning changes to health outcomes have been observed in the UK since the early 2010s, including reductions in life expectancy and a marked widening of inequalities. These have been largely attributed to UK Government ‘austerity’ policies which have profoundly affected poorer populations. Studies in mainland Europe have shown associations between austerity and increases in adverse birth outcomes such as low birthweight. The aim here was to establish whether the period of UK austerity was also associated with higher risks of such outcomes.

Methods We analysed all live births in Scotland between 1980 and 2019 (n = c.2.4 million), examining outcomes of preterm birth (PB), low birthweight (LBW) and small-for-gestational-age (SGA). Descriptive trend analyses, segmented regression (to identify changes (‘breakpoints’) in trends) and logistic regression modelling (to compare risk of outcomes between time periods) were undertaken, stratified by infant sex and quintiles of socioeconomic deprivation. For additional context, trends in child poverty rates over the period were analysed.

Results There were marked increases in rates of LBW and PB in the austerity period (2010 onwards), particularly in more deprived areas. Following long-term decreases from the early 2000s, between 2009/11 and 2017/19 PB rates increased by 19% overall, and by 26% in the most deprived quintile; the equivalent figures for LBW were 8% and 15% respectively. However, rates of SGA decreased (likely explained by greater increases in PB than LBW). The regression analyses confirmed these results: trends in PB and LBW changed within 3 years of austerity (e.g. for most deprived quintile, breakpoints of 2011.0 (male) and 2012.8 (female) were identified; equivalent breakpoints for LBW were 2010.0 and 2012.9), and that period was associated with higher risk of such outcomes in adjusted models. For example, for male babies in the most deprived quintile, the odds ratio for a change in the slope following austerity was 1.07 (95% CI 1.05 to 1.09). The changes in rates of PB and LBW coincided with marked increases in levels of child poverty over the same period.

Conclusion The results add to the growing European evidence base of worsening birth outcomes associated with austerity-related policies. Given that further austerity is still debated by both the current, and potential future, UK Government, it is vital that policymakers of all UK political parties fully understand the evidence of worsening birth trends, their likely causes, and their future implications for child and adult health.