Educational Inequality in Stillbirth: Temporal Trends in Québec From 1981 to 2009

Savard, Nathalie; Auger, Nathalie; Park, Alison L.; Lo, Ernest; Martinez, Jérôme

doi:10.1007/bf03405679

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…The decrease in absolute inequality for placental abruption was countered by an increase for unspecified causes. 31 These findings are also confirmed by global and semiglobal studies. 13 24 29 …”

Section: Discussionsupporting

confidence: 53%

Understanding determinants of unequal distribution of stillbirth in Tehran, Iran: a concentration index decomposition approach

et al. 2017

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ObjectiveThe present inquiry set to determine the economic inequality in history of stillbirth and understanding determinants of unequal distribution of stillbirth in Tehran, Iran.MethodsA population-based cross-sectional study was conducted on 5170 pregnancies in Tehran, Iran, since 2015. Principal component analysis (PCA) was applied to measure the asset-based economic status. Concentration index was used to measure socioeconomic inequality in stillbirth and then decomposed into its determinants.ResultsThe concentration index and its 95% CI for stillbirth was −0.121 (−0.235 to −0.002). Decomposition of the concentration index showed that mother’s education (50%), mother’s occupation (30%), economic status (26%) and father’s age (12%) had the highest positive contributions to measured inequality in stillbirth history in Tehran. Mother’s age (17%) had the highest negative contribution to inequality.ConclusionsStillbirth is unequally distributed among Iranian women and is mostly concentrated among low economic status people. Mother-related factors had the highest positive and negative contributions to inequality, highlighting specific interventions for mothers to redress inequality.

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Section: Discussionsupporting

confidence: 53%

Understanding determinants of unequal distribution of stillbirth in Tehran, Iran: a concentration index decomposition approach

et al. 2017

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“…Medical care has been mentioned as the route through which education leads to inequality in stillbirth from placental abruption and cord compression. 30 Suboptimal care including delayed recognition of medical problems or poor management has been noted to contribute to a significant proportion of stillbirths. 31 Delayed access of prenatal care services owing to ignorance is very common in developing countries.…”

Section: Discussionmentioning

confidence: 99%

Do biomass fuel use and consumption of unsafe water mediate educational inequalities in stillbirth risk? An analysis of the 2007 Ghana Maternal Health Survey

2017

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BackgroundNumerous studies have explored the association between educational inequalities and stillbirth but most have failed to elaborate how low educational attainment leads to an increased risk of stillbirth. We hypothesised that use of biomass fuels and consumption of unsafe water related to low educational attainment could explain the stillbirth burden in Ghana attributable to socioeconomic disadvantage.MethodsData from the 2007 Ghana Maternal Health Survey, a nationally representative population-based survey were analysed for this study. Of the10 370 women aged 15–49 years interviewed via structured questionnaires for the survey, 7183 primiparous and multiparous women qualified for inclusion in the present study.ResultsIn a logistic regression analysis that adjusted for age, area of residence, marital status and ethnicity of women, lower maternal primary education was associated with a 62% (OR=1.62; 95% CI 1.04 to 2.52) increased lifetime risk of stillbirth. Biomass fuel use and consumption of unsafe water mediated 18% and 8% of the observed effects, respectively. Jointly these two exposures explained 24% of the observed effects. The generalised additive modelling revealed a very flat inverted spoon-shaped smoothed curve which peaked at low levels of schooling (2–3 years) and confirms the findings from the logistic regression analysis.ConclusionsOur results show that biomass fuel use and unsafe water consumption could be important pathways through which low maternal educational attainment leads to stillbirths in Ghana and similar developing countries. Addressing educational inequalities in developing countries is thus essential for ensuring household choices that curtail environmental exposures and help improve pregnancy outcomes.

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“…Likewise, economic depressions at the national level could have widened the income-based gap in maternal health. Beyond the identification of health disparities, monitoring the temporal changes in disparities is also important for developing interventions to reduce it (Khang et al 2008 ; Savard et al 2013 ). However, limited evidence is available regarding disparities in maternal health along the socioeconomic gradient.…”

Section: Introductionmentioning

confidence: 99%

The income-based disparities in preeclampsia and postpartum hemorrhage: a study of the Korean National Health Insurance cohort data from 2002 to 2013

2016

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There is limited evidence on the effects of relatively low socioeconomic status on maternal health. Additionally, the global economic recession that began in 2008 could have worsened disparities in maternal complications. To explore disparities in maternal health, we analyzed the occurrence of preeclampsia and postpartum hemorrhage according to level of household income. A population-based cohort data set from the Korean National Health Insurance was used to calculate the age-adjusted incidence, slope index of inequality, and Kunst and Mackenbach relative index of inequality (RIIKM) for preeclampsia and postpartum hemorrhage from 2002 to 2013. In the aggregated data of 65,479 live births, women with lower household income showed a higher risk of developing preeclampsia and postpartum hemorrhage than those with higherhigher incomes after adjusting for conventional risk factors. The absolute and relative inequalities for both complications showed no significant change over the period from 2002 to 2013. Considering the difference in the trends and risks of major obstetric complications according to level of household income, policies to monitor and reduce disparities in maternal health across different economic levels need to be implemented.

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Educational Inequality in Stillbirth: Temporal Trends in Québec From 1981 to 2009

Cited by 5 publications

References 28 publications

Understanding determinants of unequal distribution of stillbirth in Tehran, Iran: a concentration index decomposition approach

Understanding determinants of unequal distribution of stillbirth in Tehran, Iran: a concentration index decomposition approach

Do biomass fuel use and consumption of unsafe water mediate educational inequalities in stillbirth risk? An analysis of the 2007 Ghana Maternal Health Survey

The income-based disparities in preeclampsia and postpartum hemorrhage: a study of the Korean National Health Insurance cohort data from 2002 to 2013

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