Associations Between Neighborhood Violence During Pregnancy and Birth Outcomes: Evidence From São Paulo’s Western Region Birth Cohort

Abstract

Background: Low birth weight and prematurity remain leading causes of infant mortality and morbidity globally. Although an extensive literature has highlighted the importance of socioenvironmental characteristics for birth outcomes, the role of indirect violence on health remains fairly understudied.Methods: Using geocoded birth records from the ongoing Western Region Birth Cohort (Região Oeste Coorte – ROC-Cohort) of infants born between 2012-2014 and geocoded crime reports, we assessed the associations between exposure to violent crimes during pregnancy within a 1-km radius of mother’s residence and low birth weight, preterm delivery, and being born small-for-gestational-age. Violent crime exposure was categorized into quintiles. Multivariate logistic regressions were used to examine the associations between violence exposure and birth outcomes. Models were adjusted for sex, maternal age and education, socioeconomic status, and risk factors such as hypertension, diabetes, smoking, and drinking during pregnancy.Results: Among the 5,268 infants included, the average crime exposure during the first two trimesters of pregnancy ranged from 0.44 violent crimes in the least exposed quintile to 12.74 crimes in the most exposed. Compared to children with the lowest violence exposure, children in the highest exposure quintile were at higher odds of being born small-for-gestational-age (1.41[1.06-1.89]), preterm (1.35[1.01-1.80]), and low birth weight (1.42[1.03-1.98]). While socioeconomic status and maternal education were positively associated with lower violence exposure, no associations were found between these characteristics and the birth outcomes.Conclusions: Higher exposure to external violent crimes in the close vicinity are associated with substantial increases in the odds of adverse birth outcomes. Policies to improve neighborhood safety can contribute not only to the short-term well-being of populations but may also have large social, economic, and health benefits in the long run.

Factors associated with home birth in Peru: An analysis of the Demographic and Health Survey, 2019

“…On the other hand, the present study showed that women living in rural areas are more likely to have home births, which is consistent with a recent systematic review (24). One possible explanation lies in the fact that pregnant women in rural areas feel fear that their privacy and traditions are not going to be respected in health facilities, and some indicated that they were afraid of being victims of abuse by health professionals (25)(26)(27), which highlights the marked gap between the rural population and health care.…”