Community Remoteness, Perinatal Outcomes and Infant Mortality among First Nations in Quebec~!2009-12-02~!2010-04-12~!2010-07-06~!

Abstract

ObjectiveLittle is known about community remoteness in relation to birth outcomes among Indigenous populations. We assessed whether community remoteness matters for perinatal outcomes and infant mortality in Quebec First Nations communities.Study DesignA retrospective cohort study of all births (n=11,033) to residents of First Nations communities in Quebec 1991–2000, using linked vital statistics data. First Nations communities were grouped by community remoteness into four zones from the least to most remote.ResultsPreterm birth rates declined progressively from the least remote (8.0%) to the most remote (5.7%) zones (p=0.002). In contrast, total fetal and infant mortality rose progressively from the least remote (10.4 per 1000) to the most remote (22.7 per 1000) zones (p<0.001). The excess infant mortality in the more remote zones was mainly due to higher rates of postneonatal mortality. Similar patterns were observed after adjusting for maternal age, education, parity and marital status. Substantially elevated risks in most remote communities remained for perinatal death (adjusted OR=2.1), postneonatal death (adjusted OR=2.7), and total fetal and infant death (adjusted OR=2.3).ConclusionLiving in more remote First Nations communities was associated with a substantially higher risk of fetal and infant death, especially postneonatal death, despite a lower risk of preterm delivery. There is a need for more effective perinatal and infant care programs in more remote First Nations communities to reduce perinatal and infant mortality.

Indigenous women’s reproductive health in the Arctic zone of Western Siberia: challenges and solutions

“…Recent research has shown that the main factors affecting the health of the Indigenous population in the North are: low level of medical care, lack of medicines, and poor quality of food [ 47 , 48 ]. We identified huge maternal-newborn health disparities between Indigenous and non-Indigenous populations: high rates of spontaneous miscarriage (three times higher among the Indigenous tundra residents compared with the immigrated population and twice as high as among the Indigenous settlement residents) and infant mortality rates (3.5 times more frequent in the Indigenous tundra residents of the settlement and 8 times more than in the immigrated female population).…”

“…The nomadic lifestyle of Indigenous peoples in the YNAO is associated with low living standards, insufficient sanitary conditions and limited access to medical facilities [ 47 ]. In the Arctic zone of Western Siberia, Indigenous women living in remote communities or in the tundra have limited access to perinatal maternity care.…”

Childbirth-Related Hospital Burden by Socioeconomic Status in a Universal Health Care Setting

“…Socioeconomic patterning was still observed in maternal hospital burden for these data, which could be augmented by neonatal health records in the future. Finally, the study is sensitive to all limitations associated with the use of administrative data for health research (33) including uncertain data quality, missing data, reliability, a lack of control over the information collected and documentation. These factors likely led us to underestimate the extent of health care burden.…”

“Lost births,” service delivery, and human resources to health

“…Nations communities and a significantly higher risk of fetal and infant death, particularly postnatal death (Wassimi et al, 2010). Despite these data coming out of Quebec, birth outcomes are inconsistently tracked and reported Canada-wide (Smylie, 2011).…”