Perinatal outcomes of socially disadvantaged women in Australia: A population‐based retrospective cohort study

Abstract

ObjectiveTo examine the perinatal outcomes of women who experience social disadvantage using population‐based perinatal data collected between 1999 and 2016.DesignPopulation‐based, retrospective cohort study.SettingVictoria, Australia.Population or SampleA total of 1 188 872 singleton births were included.MethodsCohort study using routinely collected perinatal data. Multiple logistic regression was performed to determine associations between social disadvantage and adverse maternal and neonatal outcomes with confidence limits set at 99%. Time‐trend analysis for perinatal outcomes was performed in relation to area‐level disadvantage measures.Main Outcome MeasuresIncidence of maternal admission to intensive care unit (ICU), postpartum haemorrhage (PPH) and caesarean section, perinatal mortality, preterm birth, low birthweight (LBW), and admission to special care nursery/neonatal intensive care unit (SCN/NICU).ResultsSocial disadvantage was associated with higher odds of adverse perinatal outcomes. Disadvantaged women were more likely to be admitted to ICU, have a PPH or experience perinatal mortality (stillbirth or neonatal death) and their neonates were more likely to be admitted to SCN/NICU, be born preterm and be LBW. A persistent social gradient existed across time for the most disadvantaged women for all outcomes except caesarean section.ConclusionsSocial disadvantage has a marked negative impact on perinatal outcomes. This aligns with national and international evidence regarding the impact of disadvantage. Strategies that improve access to, and reduce fragmentation in, maternity care in addition to initiatives that address the social determinants of health may contribute to improving perinatal outcomes for socially disadvantaged women.

Perceptions and Experiences of Inequity for Women of Refugee Background Having a Baby during the COVID-19 Pandemic in Melbourne, Australia

“…Women of refugee background are more likely to experience difficulty understanding health information [4], receive fewer than recommended antenatal appointments [1], give birth to a low birth weight or stillborn baby [2,5,6], and experience mental or social health concerns [2]. It is important to note that these comparisons do not include First Nations [7], LGBTQIA+ [8], and other [9] women, individuals, families, and communities that are more likely to experience impacts to their physical, mental, and/or social health, due to the intersection of systemic factors such as discrimination and marginalisation. Equity-oriented change has been identified as a global health priority, to meet the needs of women of refugee background having a baby-including improving the understanding of and access to culturally safe maternity (pregnancy, labour, birth, and/or postnatal) care [3,10,11].…”