Major questions around mortality among babies taken from their mothers in Northern Ireland remain unanswered, a reviewer said.
Retired senior police officer Judith Gillespie expressed concern about the unknown fate of some infants.
About a third were sent to baby homes following separation from their birth mothers.
An independent investigation will consider mother and baby homes with input from survivors.
Ms Gillespie said: “There are questions around consent regarding adoption, questions around cross-border adoptions and certainly big questions around mortality rates of infants taken to be adopted or taken away from the mother in these institutions, and we do not know what the outcomes were.”
Baby homes were not on the list of institutions assessed by the working group she chaired.
Researchers assessed the records of one home, St Joseph’s in Belfast.
The report said: “From information made available, it is evident that mortality rates were alarming in this home between the 1920s and 1950s.
“Death rates may have been as high as 50% of those admitted at some points during the 1920s.”
It added: “Further research is needed to draw full conclusions about the outcomes for children born in mother and baby homes who then moved to a number of other baby homes/units.”
Ms Gillespie also said some former residents had been left with “life-changing” trauma, as she called for proper services to be put in place.
She said researchers had spoken to many women and their grown-up, adopted children, as well as people who worked in the institutions.
“First and foremost, we want to offer our personal thanks to those women and their now adult children who came forward to contribute to the research. Your voices were silenced for so many years. That was a significant wrong.” pic.twitter.com/sRj0fYmpOB
— Arlene Foster #WeWillMeetAgain (@DUPleader) January 26, 2021
“It has uncovered a number of very serious concerns around how women were treated in these institutions, how they were robbed of their identity in many cases.
“They were subjected to judgmental behaviour, authoritarian regimes, no preparation for childbirth.”
She said it was important that that investigation or inquiry is co-designed with survivors, that they have agency in this process.
“This is a group of people that have had power and choices taken away from them for so long and now we are giving the choice back.”
She said there was also a lot more information available through the research.
“We know a lot more now as a result of this research than we did 12 months ago.”
She said the bespoke independent investigation should produce something really worthwhile and will deliver outcomes for those who need it most.
“We have listened to the story that these survivors have told and we have believed them because the impact is really far-reaching and long-lasting.”
She said it was not a legacy which could be addressed with a couple of counselling sessions and said proper services needed to be put in place.
“This has had life-changing impacts on these women and their children.”