Policies to discourage disadvantaged families from having too many children could help address the rapidly rising number of children in out-of-home care in Australia, an academic paediatrician has suggested.

The rate at which non-Indigenous children have been placed in short or long-term care has more than doubled over the past 18 years, and more than tripled for Indigenous children, Australian Institute of Health and Welfare (AIHW) data shows.

The “absolutely astronomical increase” was symptomatic of the need for a “politically charged” discussion of the issue, said Prof Peter Jones, the dean of medicine at Bond University on the Gold Coast.

In a perspective published in the Medical Journal of Australia on Monday, Jones wrote that a range of interventions needed to be trialled and implemented to reduce out-of-home care numbers, which he saw as indicative of a failing of society, rather than “an expected consequence”.

“We need to ask politically charged questions, such as should we be developing policies that encourage disadvantaged families to have fewer children?” he wrote.



Jones told Guardian Australia that capping child support benefits for up to two children could be among strategies geared at reducing the number of those in out-of-home care.

“It’s a tough call, it’s out of kilter with how our system currently works ... [but] there are other countries that make these decisions in the best interest of the community,” he said.

He denied suggesting that particular groups be disincentivised from having children but said limiting financial support would send the message that “if you have more children ... it’s your responsibility to provide for them”.

Jones imagined that as one response among a range intended to solve a “multifaceted, complicated problem”, and compared it to long-term, multi-pronged initiatives to reduce tobacco-related and road fatalities.

Another strategy would be to redirect resources to support vulnerable children towards “strengthening the family into which they are born” by supporting disadvantaged first-time mothers to pursue work or educational opportunities, he said.

As of 30 June 2015, the AIHW reported there were nearly 43,400 children in out-of-home care, defined as those up to 18 years who are unable to live with their families and placed with alternate caregivers on a short- or long-term basis.

Nicole Rich, the executive director of Family, Youth and Children’s Law at Victoria Legal Aid, said the system was overwhelmed, meaning there were no available resources to dedicate to preventative measures. “Only the crisis point cases are getting the attention that they need.”

Rich said there was significant “intergenerational involvement” of children in the system going on to become vulnerable young parents. Many were not offered support at the pregnancy stage, even if a risk had been identified.

“In lots of cases no one’s put any parenting programs in place for these young vulnerable mums and dads before the birth, so there’s a real gap that we see and that needs to be addressed.”

Supporting at-risk families as soon as they were identified – whether it be through parenting programs, disability and/or housing support, respite care, drug and alcohol counselling, or family violence services – produced the best outcomes for children, she said.

A study published in the Journal of Paediatrics and Child Health found children in care have significantly poorer mental health outcomes than those who have never been in care. In his perspective, Jones found nothing to suggest that out-of-home care reduced the prevalence of mental health problems.

He pointed to a 2015 report by the New South Wales ombudsman as evidence they were at increased risk of harm compared to those who had never been in care. Of 41 reviewable child deaths between 2012 and 2013, 14 had died while in out-of-home care – a statistic that Jones said was of “major concern”.

The assumption that out-of-home care was in many cases the safest option for vulnerable children needed to be challenged, he said, and that the bar for removing them from their parents was sometimes too low.

“You do have to ask the question, ‘How do we encourage behaviours that lead to less child maltreatment and neglect?’ ... I think setting low expectations and expecting a social disaster from certain parts of society becomes a self-fulfilling prophecy.”

The president of the Australian Medical Association, Dr Michael Gannon, said it was a “difficult balancing act” between ensuring children’s best interests and “the extremely fraught decision” to remove them from their family.

“Every week doctors see children in desperate social circumstances that they know is just not good for their health, yet balancing that against the known health risks of removing children from their families, the disastrous effect that can have on individuals and at a societal level – we don’t claim to have the answers, and we acknowledge how complex the issues are.”

The priority should be on supporting vulnerable people to attain safe and secure living circumstances, employment and community, he said: “Then they’re less likely to have health problems.”