Practice
Research
Universal child and family health services: A critical lever for equitable early development
FDC-Friendly
Fiona Alston
Oct 23, 2025
Save
A recent Medical Journal of Australia perspective argues that universal child and family health (CFH) services must be strengthened and better integrated with early childhood systems to improve health and development outcomes for all Australian children—particularly those experiencing disadvantage.
In Australia, increasing attention is being paid to the first 2000 days of life, from conception to five years as a critical period shaping long-term health, development, and participation. Federal and state-level initiatives, such as the Early Years Strategy, Measuring What Matters framework, and NSW First 2000 Days Framework, highlight a coordinated focus on prevention and early intervention.But according to authors Dr Anna Price, Dr Elodie O’Connor and Professor Sharon Goldfeld, more needs to be done to ensure that universal child and family health services (CFH) are positioned as essential infrastructure within this early years system.
CFH services, also known across states as CaFHS, CHaPS or Maternal and Child Health, provide free, non-stigmatising, well-child care from birth to school entry. They are the health sector’s primary vehicle for prevention, health promotion, early identification and family support.
These services work in parallel with early childhood education and care (ECEC) and are staffed by nurses, midwives, Aboriginal and Torres Strait Islander health workers, social workers and allied professionals.
CFH services play a broad and proactive role in supporting families. Their offerings typically include:
- Growth and developmental surveillance
- Immunisations and general health education
- Mental health screening and support for caregivers
- Early identification of family violence and social risks
- Referral to intervention, parenting support and community resources
Through these services, families gain early access to tailored advice, connections to broader systems, and help addressing the social determinants that shape health equity. Importantly, they offer a way to build parenting confidence and strengthen child development outcomes.
Despite their universal design, CFH services in Australia are not consistently or equitably implemented.
“Australia’s early childhood system has invested more heavily in ECEC, particularly preschool, than in health-based supports for families with children aged 0–2,” the authors note.
The result is significant variation in service reach, delivery and impact across states and territories. For example:
- In NSW, a study of over 18,000 children found that 17 per cent had no contact with CFH services in their first 2000 days, despite guidelines recommending eight visits.
- Aboriginal and Torres Strait Islander families have lower engagement rates with CFH services.
- In Victoria, lower-income families were less likely to be screened for family violence—despite higher known rates.
- During COVID-19, service reach was further limited, particularly for children over eight weeks old and families without acute vulnerabilities.
These findings reflect the inverse care law: those most in need of services are often the least likely to receive them.
To address these gaps, the authors propose that CFH services adopt a public health approach known as proportionate universalism. Adapted from the work of Sir Michael Marmot, this model supports the idea that services should be available to all, but delivered in proportion to need.
Queensland is among states expanding sustained home visiting via the Maternal Early Childhood Sustained Nurse Home Visiting (MECSH) program, supported by evidence for long-term developmental and economic benefits.
To make this model effective and equitable, the authors call for:
- Workforce planning to deliver flexible, scalable care
- Sustained investment in universal and targeted supports
- Standardised guidelines and training across jurisdictions
- Integrated data collection to track outcomes and service reach
For ECEC providers and educators, the findings reinforce the importance of partnerships with health professionals in supporting the wellbeing of children and families. Embedding coordinated, wraparound support across health and education systems is essential, particularly in the first two years of life when children are most vulnerable.
Australia’s CFH services have a strong foundation and broad public support. But to fulfil their potential as the backbone of a universal early childhood development system, they must be resourced, coordinated and delivered in ways that reflect both the shared needs and differentiated challenges facing Australian families.
As early childhood professionals, there is a growing role to advocate for integrated systems that meet families where they are, whether in a health clinic, a community centre or an early learning service.
“When proportionate universalism is embedded in policy and practice, we move closer to a system where every child has the opportunity to thrive, no matter their postcode or background,” the authors conclude.
Reference:Price AMH, O’Connor E, Goldfeld SR. The importance of universal child and family health services for equitable early development in Australia. Med J Aust. 2025;223(8):387–390.
Don’t miss a thing
Related Articles
