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Home , Blaenau Gwent, Gwent (county)

Population Population and births and births 1

1.1 Population structure

1.2 Child population

1.3 Population change

1.4 Fertility

1.5 Preterm births

1.6 Low birth weight

1.7 Breastfeeding at birth

Public Health Observatory 15 Key messages • In 2011, there were just under a million children and young people (aged 0-24 years) living in Wales, representing 30% of the total population. • and Vale is the health board with the highest percentage of children and young adults (34%). This is mainly attributable to the large number of university students (18-24 year olds) living in and around the Cardiff area. The size of the 0-24 year old population in the Cardiff and Vale area has been increasing since 2002 and from 2002 it is projected to increase by 33% to around 200,000 in the year 2033. • The total fertility rate in Wales is 1.9 children per woman. The highest fertility rates in 2011 were seen in , Isle of , Conwy, , and Bridgend. • 1 in 18 babies are of low birth weight, this rises to 1 in 15 in Cwm Taf Health Board. is the only local authority area where the percentage of low birth weight babies is statistically signifi cantly higher than the Wales average. • Overall 56% of babies were breastfed at birth. This is as high as 4 in 5 in and , but less than a third in Blaenau , Neath and .

1616 PublicPublic HealthHealth WaWalesles ObObservatoryservatory of different servicesneededineachofthehealthboard areas. higher percentages inthisagegroup. Variations suchasthesewillhaveabearingonthevolume percentages of18-24yearoldsthanWales whileCardiff andVale hasmuch these agegroups. BetsiCadwaladr, PowysandAneurinBevan havesmaller seen tohavesimilarpopulationstructures totheall-Wales averagefor Hywel Dda,AbertaweBro MorgannwgandCwmTaf healthboards are 5-11, 12-17and18-24years). 0-24 yearoldsgrouped into approximate educationalagecategories(0-4, use 5or10yearagebands,thesepopulationpyramidsonlypresent datafor health board areas. However, unlikethetraditionalpopulationpyramidsthat Figure 1.1showspopulationpyramidsforWales andeachoftheseven 0-24 yearoldpopulationofWales hasanon-whiteEthnicbackground. 199,400 inBetsiCadwaladr. Basedonthe2011Census,around 7%ofthe (928,400), rangingatthehealthboard levelfrom 35,600inPowysto young peopleaged0-24yearsandlivinginWales isjustunderamillion The latestpopulationestimates(2011)report thenumberofchildren and time. population ofanarea. Studentsare includedinthesefi Mid-year populationestimates(asat30Juneeachyear)provide anestimateoftheresident preterm, lowbirthweightbabiesandbreastfeeding.for achildsuchasbabiesborn This chapteralsolooksatsomeofthebirthmeasures whichcanberelated tohealthoutcomes Fertility ratesare alsoincludedastheyaffect thegrowth ofthepopulation. last 10yearsalongwithpredicted changesinnumbersforthisagegroup overthenext20years. area ofresidence. Italsoshowshowthechildandyoungadultpopulationhaschangedover and indicatorsonthenumberofchildren andyoungpeoplelivinginWales byagegroup and understanding ofthesizeanddistributionpopulation.Thischapterprovides information In order toundertakeanyinvestigationofpopulationhealthitisimportantstartwithan 1.1 1 Populationstructure gures usingarea ofresidence interm Public Health Wales Observatory Article 24.2(d) Rights oftheChild, Convention onthe The UnitedNations for mothers’. natal healthcare pre-natal andpost- ensure appropriate measures to appropriate ‘… shalltake Governments 17

Population and births Figure 1.1 % of population by age group, 2011

Health board males Health board females Wales males Wales females

Betsi Cadwaladr Powys

18-24 12-17 5-11 0-4

Hywel Dda ABM 18-24 12-17 5-11 0-4 Age group

Cardiff & Vale Cwm Taf 18-24 12-17 5-11 0-4

Aneurin Bevan Wales 18-24 12-17 5-11 0-4

864202468 864202468

Data source: MYE (ONS)

1.2 Child population Figures 1.2a and 1.2b illustrate the distribution of school age children within each geographical area, allowing for comparisons across the UK nations and at the health board and local authority level. Across the UK nations, Wales (30%) has similar percentages to and Scotland. Northern Ireland has the greatest percentage of 0-24 year olds (34%) and also the highest percentage within each of the school age groups. At the heath board level, the percentage of persons aged 0-24 also varies, ranging from just over 1 in 4 in Powys to about 1 in 3 in Cardiff and Vale. Cardiff and Vale also has the largest percentage of 18-24 year olds among the health boards. At the local authority level (Figure 1.2b) there is also considerable variation across areas. Ceredigion has the lowest percentage of 0-4 year olds (4.6%) and the highest percentage of 18-24 year olds (16.1%). Ceredigion, Cardiff and have over a third of their 0-24 year old population in the 18-24 age group which is largely due to their university student populations.

18 Public Health Wales Observatory Figure 1.2a % of population aged 0-24 by school age group, 2011

0-4 years 5-11 years 12-17 years 18-24 years Total United Kingdom 6.2 7.8 7.3 9.4 30.7 Population and births

Scotland 5.7 7.3 6.8 9.6 29.3 Northern Ireland 6.9 8.7 8.3 9.7 33.5 England 6.3 7.9 7.3 9.4 30.8 Wales 5.8 7.5 7.3 9.7 30.3

Betsi Cadwaladr 5.8 7.4 7.1 8.6 29.0 Powys 4.9 7.2 7.6 7.0 26.7 Hywel Dda 5.4 7.3 7.1 9.6 29.4 ABM 5.5 7.5 7.1 9.8 29.9 Cardiff & Vale 6.3 7.5 7.0 13.1 33.9 Cwm Taf 6.2 7.8 7.4 9.5 30.8 6.0 7.9 7.8 8.7 30.5

Data source: MYE (ONS)

Figure 1.2b % of population aged 0-24 by school age group, 2011

0-4 years 5-11 years 12-17 years 18-24 years Total Isle of Anglesey 5.6 7.0 6.7 7.6 26.9 5.6 7.3 6.7 11.3 30.8 Conwy 5.1 6.9 7.1 7.2 26.2 Denbighshire 5.7 7.4 7.6 8.1 28.9 6.1 7.8 7.5 8.2 29.6 Wrexham 6.6 8.0 7.0 8.6 30.1 Powys 4.9 7.2 7.6 7.0 26.7 Ceredigion 4.6 6.3 6.1 16.1 33.0 Pembrokeshire 5.5 7.5 7.5 7.8 28.3 5.6 7.5 7.3 8.2 28.6 Swansea 5.5 7.4 6.8 11.8 31.4 5.5 7.4 7.3 8.1 28.2 Bridgend 5.6 7.7 7.4 8.2 28.9 Vale of Glamorgan 5.8 7.8 7.8 7.9 29.4 Cardiff 6.5 7.3 6.7 15.0 35.5 Rhondda Cynon Taf 6.2 7.8 7.3 9.5 30.9 6.2 7.6 7.6 9.3 30.6 Caerphilly 6.3 8.2 7.7 8.5 30.7 5.7 7.3 7.5 9.4 29.9 5.9 7.8 8.1 8.7 30.4 5.1 7.5 8.0 6.9 27.5 Newport 6.6 8.3 7.9 9.7 32.5

Data source: MYE (ONS)

Variation across areas is also evident at the lower super output area (LSOA) level with percentages ranging from 12% to 86% (Figure 1.3).

Public Health Wales Observatory 19 Figure 1.3 % of population aged 0-24, 2011

2011 LSOA, percentage 71.3 to 86.2 (7)

56.5 to 71.3 (20)

41.7 to 56.5 (52)

26.9 to 41.7 (1200)

12.1 to 26.9 (630)

Local authority boundary

Produced by Public Health Wales Observatory, using MYE (ONS) © Crown Copyright and database right 2013. Ordnance Survey 100044810

20 Public Health Wales Observatory age group haveremained fairlyconstant andare projected toremain thesame until2033. to seesmall decreases intheir0-24populations. InPowysandHywel Dda,populationsinthis but toalesserextent.The areas ofBetsiCadwaladr, CwmTaf andAneurinBevanare projected of thepopulationinAbertawe Bro Morgannwgarea is alsoprojected toincrease by2033 and from 2002 it isprojected toincrease by33%toaround 200,000intheyear2033. Thesize Cardiff andVale area thesizeof 0-24yearoldpopulationhasbeenincreasing since2002 Figure 1.4showspopulationchangeinpersonsaged0-24between2002and2033.Inthe birth ratescanbediffi calculated usingassumptionsaboutfuture trends infertility, deathsandmigration.Trends in sustainable policies.Populationprojections represent future populationestimatesandare as understandingthecurrent populationstructure whendeliveringservicesandproducing Understanding howthepopulationstructure willchangeinthefuture isjustasimportant delivering servicesandtargetinginterventions. 71% oftheirpopulationaged0-24.Variations suchastheseare importantconsiderationsfor Seven ofthe1,909LSOAsinWales (6beinginCardiff andtheotherinBangor)haveover but withinthisarea there are LSOAswithover40%oftheirpopulationinthisagegroup. this agegroup. Forexample,26%ofthepopulationinConwylocalauthorityare aged0-24 0-24 yearolds,there are LSOAswhichhaveamuchhigherpercentage oftheirpopulationin Figure 1.3highlightsthatevenwithinlocalauthorityareas whichhavealowpercentage of Figure 1.4 1.3 Data source: 2002-11MYEs(ONS)&2008-basedpopulationprojections for2012-33(StatsWales)

Population (thousands) Populationchange 100 150 200 250 100 150 200 250 100 150 200 250 100 150 200 250 50 50 50 50 0 0 0 0

Health boardprojections Health boardpasttrend Population change,pasttrends andprojections, personsaged0-24,2002-2033 2002 2004 2006 2008 culttopredict sotheseprojections canonlybebestestimates. 2010 2012 2014 2016 2018 2020 es awld Powys Betsi Cadwaladr

2022 Aneurin Bevan adf aeCwmTaf Cardiff &Vale 2024 2026 Hywel Dda 2028 2030 2032 1000 1200 200 400 600 800 0 2002 *The y-axisscaleisdifferent forWales 2004 2006 2008 Wales projections Wales pasttrend 2010 Public Health Wales Observatory 2012 2014 2016 2018 2020 2022 2024 2026 2028

2030 Wales*

2032 ABM 21

Population and births 1.4 Fertility The total fertility rate (TFR) is the average number of live children a group of women would have if they experienced the age-specifi c fertility rates for the calendar year in question throughout their childbearing lifespan. The replacement rate which describes the TFR required to replace the current population (excluding migration) is 2.075 for the UK.2 In 2011, the TFR for Wales was 1.9 children per woman which was equivalent to the TFR in England (Figure 1.5). TFR is higher in the Betsi Cadwaladr, Powys and Cwm Taf areas (2.0 children per woman) and with Cardiff and Vale having the lowest TFR (1.8 children per woman). Among local authorites in Wales the TFR ranged from 1.7 in Ceredigion and Cardiff to 2.2 in Denbighshire. Fertility levels vary by local area for several reasons including differences in the timing of childbearing and differing ideals on family size. These can be infl uenced by the population characteristics of the area such as levels of educational attainment, ethnicity/country of birth, and deprivation levels.3 In areas such as Cardiff and Ceredigion, the TFR is skewed downwards due to the large female student population who experience very low birth rates.

Figure 1.5 Total fertility rate, 2011 Wales = 1.9 England 1.9 North East 1.9 North West 1.9 Yorkshire and The Humber 1.9 East midlands 2.0 West midlands 2.0 East of England 2.0 London 1.8 South East 2.0 South West 2.0

Betsi Cadwaladr 2.0 Powys 2.0 Hywel Dda 1.9 ABM 1.9 Cardiff & Vale 1.8 Cwm Taf 2.0 Aneurin Bevan 1.9

Isle of Anglesey 2.1 Gwynedd 2.0 Conwy 2.1 Denbighshire 2.2 Flintshire 2.0 Wrexham 2.1 Powys 2.0 Ceredigion 1.7 Pembrokeshire 2.1 Carmarthenshire 1.9 Swansea 1.8 Neath Port Talbot 1.9 Bridgend 2.1 Vale of Glamorgan 2.1 Cardiff 1.7 Rhondda Cynon Taf 2.0 Merthyr Tydfil 1.9 Caerphilly 1.9 Blaenau Gwent 1.8 Torfaen 2.0 Monmouthshire 1.8 Newport 2.0 Data source: VS1 (ONS)

22 Public Health Wales Observatory weight. smokingand nutritionareof children. importantriskfactorsassociated withlowbirth Maternal Birth weightisanimportant considerationwhendeterminingthefuture health andwell-being Bridgend andMonmouthshire). Three localauthoritieswere statisticallysignifi preterm occurringin Ceredigion (5.2%)andthehighestoccurringinBridgend(9.3%). There isconsiderablevariationatthelocalauthoritylevel,lowestpercentage ofbabiesborn board levelthisrangedfrom 6.5%inCardiff andVale to7.9%inAbertaweBro Morgannwg. pretermIn 2011,7.1%oflivebirthswere (<37weeksgestation)inWales born andatthehealth Figure preterm babieswhoare 1.6showsthepercentage byarea born oflive born ofresidence. age,nutritionandhealth. associated withpreterm birthswhichincludematernal gestation) are more prone topoorer healthoutcomesandthere are anumberofriskfactors Gestational agehasanimpactonthehealthofababy. preterm (before Babiesborn 37weeks in adulthood. after birthbutthere isalsoanassociationwithpoor healthandincreased riskofchronic diseases associated withit. preterm babiesare atriskofhavinglowbirthweighttheyare alsoatriskoftheproblems 1.6 Figure 1.6 1.5 Data source: NCCHD(NWIS) Lowbirthweight Preterm births 7 Lowbirthweightbabies are notonlyatagreater riskofproblems occurringduringand

% of babies born preterm (<37weeksgestationatbirth),2011 % ofbabiesborn 4,7,8 Rhondda CynonTaf

Vale ofGlamorgan Neath PortTalbot Carmarthenshire Betsi Cadwaladr Monmouthshire Isle ofAnglesey Blaenau Gwent Pembrokeshire Aneurin Bevan Merthyr Tydfil Cardiff &Vale Denbighshire Ceredigion Hywel Dda Caerphilly Wrexham Gwynedd Flintshire Bridgend Newport Cwm Taf Swansea Torfaen Cardiff Conwy Powys Powys ABM 7.2 9.1 7.1 7.6 6.6 7.2 7.9 6.7 5.8 9.3 7.2 7.5 6.3 8.8 5.2 7.2 6.8 7.4 8.2 6.3 5.3 7.6 7.2 7.7 6.5 7.9 6.9 7.2 6.9 cantlyhigherthanWales (Pembrokeshire, Wales =7.1% Public Health Wales Observatory 4,5,6 Since 23

Population and births Figure 1.7 % of low birth weight babies (under 2500g), singleton live births, 2011

Wales = 5.4% Betsi Cadwaladr 5.3 Powys 5.2 Hywel Dda 5.3 ABM 5.3 Cardiff & Vale 5.1 Cwm Taf 6.4 Aneurin Bevan 5.5

Isle of Anglesey 5.7 Gwynedd 4.7 Conwy 4.7 Denbighshire 5.5 Flintshire 5.6 Wrexham 5.5 Powys 5.2 Ceredigion 4.8 Pembrokeshire 5.3 Carmarthenshire 5.5 Swansea 5.5 Neath Port Talbot 4.9 Bridgend 5.2 Vale of Glamorgan 4.6 Cardiff 5.3 Rhondda Cynon Taf 6.3 Merthyr Tydfil 6.8 Caerphilly 5.6 Blaenau Gwent 6.6 Torfaen 5.4 Monmouthshire 4.7 Newport 5.4

Data source: NCCHD (NWIS)

It can be seen that at the health board level the percentage of low birth weight babies are similar to Wales (5.4%) for all health boards apart from Cwm Taf where 6.4% of singleton births in 2011 were born with a low birth weight (Figure 1.7). At the local authority level, the percentage ranges from 4.6% in the Vale of Glamorgan to 6.8% in Merthyr Tydfi l. The percentage of low birth weight babies is statistically signifi cantly higher in Rhondda Cynon Taf than Wales.

1.7 Breastfeeding at birth Breast feeding has health benefi ts for both mother and baby and continues to be promoted as the most benefi cial diet for babies.9 The presence of antibodies in breast milk give babies the best start in life by protecting them from common childhood illnesses.9 Breastfed babies are less likely to have to go to hospital with infections, and are more likely to grow up with a healthy weight and without allergies.10 Breastfeeding is free so saves money for both families and the health service.10

24 Public Health Wales Observatory overcome theproblems withtheavailabilityandqualityofbreast feedingdata. group andEarlyyears programme isbeingcarriedouttosupportbreastfeeding inWales and strategyimplementation Considerable workandeffort Maternity bytheWelsh Government (approximately 1in5)continuedtobebreastfed at8weeks. 2011 fi breastfeeding status recorded inPowyscompared to91%inCwmTaf. InCwmTaf the considerable variationincodingacross Wales withlessthan1%of8weekoldbabieshaving as breastfeeding statusisnotalwaysrecorded forbabiesatthatage.In2011there was greater benefi Breastfeeding at6to8weeksisagoodmeasure ofsustainedbreastfeeding andtherefore (Blaenau Gwent28%)breastfeeding ratesatbirth. percentage pointsbetweenthelocalauthoritieswithhighest(Ceredigion 80%)andlowest There isevengreater variabilityatthelocalauthoritylevelwithadifference ofover50 percentage rangedfrom 38%inAneurinBevanto78%Powys. across bothhealthboards andlocalauthorityareas inWales. Atthehealthboard levelthe In 2011,56%ofbabieswere breastfed atbirthinWales (Figure 1.8).Thispercentage varied Figure 1.8 Data source: NCCHD(NWIS) gures showthatalthough51%ofbabiesare breastfed atbirth, only22%ofbabies

% ofbabiesbreastfed atbirth,2011 ttotheinfant.However, dataisnotcurrently availableforthismeasure Rhondda CynonTaf Vale ofGlamorgan Neath PortTalbot Carmarthenshire Betsi Cadwaladr Monmouthshire Isle ofAnglesey Blaenau Gwent Pembrokeshire Aneurin Bevan Merthyr Tydfil Cardiff &Vale Denbighshire Ceredigion Hywel Dda Caerphilly Wrexham Gwynedd Flintshire Bridgend Newport Cwm Taf Swansea Torfaen Cardiff Conwy Powys Powys ABM 41.9 57.6 35.6 28.2 33.0 40.2 53.6 72.2 69.7 59.3 30.7 45.6 62.7 62.5 79.6 77.6 59.1 52.6 57.6 62.6 62.4 59.0 38.0 51.0 71.6 45.6 65.3 77.6 58.7 Wales =55.5% Public Health Wales Observatory 25

Population and births References 1. Offi ce for National Statistics. Population estimates methodology. [Online]. Available at: http://www.ons.gov.uk/ons/guide-method/method-quality/specifi c/population-and-migration/pop-ests/index.html 2. Offi ce for National Statistics. Replacement Fertility: What has it been and what does it mean?. [Online]. Available at: http://www.ons.gov.uk/ons/rel/population-trends-rd/population-trends/no--119--spring-2005/replacement- fertility--what-has-it-been-and-what-does-it-mean-.pdf 3. Tromans N et al. Have national trends in fertility between 1986 and 2006 occurred in England and Wales? Population Trends 2008;133:7-19. Available at: http://www.ons.gov.uk/ons/rel/population-trends-rd/population-trends/no--133--autumn-2008/have-national- trends-in-fertility-between-1986-and-2006-occurred-evenly-across-england-and-wales-.pdf 4. Kurinczuk JJ et al. Infant mortality: overview and context. Inequalities in infant mortality project briefi ng paper 1. Oxford: National Perinatal Epidemiology Unit; 2009. Available at: https://www.npeu.ox.ac.uk/fi les/downloads/infant-mortality/Infant-Mortality-Briefi ng-Paper-1.pdf 5. Goldenberg RL et al. Epidemiology and causes of preterm birth. Lancet 2008;371 (9606): 75–84 6. Hendler I et al. The preterm prediction study: association between maternal body mass index (BMI) and spontaneous preterm birth. Am J Obstet Gynecol 2005;192(3): 882–886. Available at: http://www.sciencedirect.com/science/article/pii/S0002937804010397 7. Bull J, Mulvihill C, Quigley R. Prevention of low birth weight: assessing the effectiveness of smoking cessation and nutritional interventions. London: Health Development Agency; 2003. Available at: http://www.nice.org.uk/niceMedia/documents/low_birth_weight_evidence_briefi ng.pdf 8. Barker DJ et al. Fetal origins of adult disease: strength of effects and biological basis. Int J Epidemiol 2002 Dec;31(6):1235-9. 9. Start 4 Life. The nationwide campaign to help adults and families to eat well and move more. [Online] Available at: http://www.nhs.uk/start4life/Pages/healthy-pregnancy-baby-advice.aspx 10. Betsi Cadwaladr University Health Board. Executive director of public health annual report, 2011. The early years – building blocks for future life. [Online]. 2011. Available at: http://www.wales.nhs.uk/sitesplus/documents/861/ Annual%20Report%20-%20Executive%20Director%20of%20Public%20Health%202011.pdf

26 Public Health Wales Observatory