Social determinants of vulnerability in the population of reproductive age: a systematic review

Abstract

Background The health of an (unborn) child is largely determined by the health and social determinants of its parents. The extent to which social determinants of parents or prospective parents affect their own health depends partly on their coping or resilience abilities. Inadequate abilities allow negative effects of unfavourable social determinants to prevail, rendering them vulnerable to adverse health outcomes. Addressing these determinants in the reproductive-aged population is therefore a key approach in improving the health of the future generation. This systematic review aims to synthesise evidence on social determinants of vulnerability, i.e., inadequate coping or low resilience, in the general population of reproductive age. Methods The databases EMBASE, Medline, PsycINFO, CINAHL, Google Scholar, Web of Science, and Cochrane Library, were systematically searched from database inception to December 2th 2021. Observational studies examining social determinants and demographics in relation to vulnerability among the general population of reproductive age (men and women aged 18-40 years), conducted in a high-income country in Europe or North America, Australia or New Zealand were eligible for inclusion. Relevant data was extracted from each included article and findings were presented in a narrative and tabulated manner. Results We identified 40,028 unique articles, of which 78 were full text reviewed. Twenty-five studies were included, of which 21 had a cross-sectional study design (84%). Coping was the most frequently assessed outcome measure (n = 17, 68%). Thirty social determinants were identified. Overall, a younger age, lower socioeconomic attainment, lack of connection with the social environment, and adverse life events were associated with inadequate coping or low resilience. Conclusions This review shows that certain social determinants are associated with vulnerability in reproductive-aged individuals. Knowing which factors make people more or less vulnerable carries health-related implications. More high-quality research is needed to obtain substantial evidence on the strength of the effect of these social conditions in this stage of life.

Creating a sense of urgency and provoking action – An example on the use of heat maps to address perinatal health inequalities

“…The risk of vulnerability is determined by a developed model that predicts the degree of vulnerability in the population of reproductive age, based on the occurrence of (social) factors that are identified in scientific literature as vulnerability increasing factors ( van der Meer, 2022 ). The data used for model development was obtained through Statistics Netherlands (CBS) and can be updated every-four years ( Erasmus Medical Center, 2020 ).…”

Editorial: Inequities and disparities in reproductive health: reproductive epidemiology

“…While some progress has been made, life expectancy for women remains lower in LMIC, and maternal mortality remains high ( 14 ). In contrast, factors impacting women's health in more economically developed countries (MEDC) include younger age, lower socioeconomic attainment, lack of connection with the social environment, and adverse life events ( 15 ).…”

Stimulating the Uptake of Preconception Care by Women With a Vulnerable Health Status Through mHealth App–Based Nudging (Pregnant Faster): Cocreation Design and Protocol for a Cohort Study

“…Although decreasing, perinatal morbidity and mortality rates are still relatively high in the Netherlands, especially among women who live in deprived neighborhoods and have a low socioeconomic status (SES) [1][2][3]. These women, who represent up to 45% of the total population in the 4 largest cities in the Netherlands [4], are more likely to have adverse pregnancy outcomes based on the accumulation of health-deteriorating risk factors such as poor lifestyle behaviors (eg, smoking, alcohol consumption, and sedentary lifestyle), inadequate nutrition (consumption of unhealthy food or insufficient intake of healthy food), mental stressors, and impaired health literacy and agency [5][6][7]. These risk factors, some of which are modifiable, can detrimentally influence the pregnancy course and outcome in the periconceptional phase comprising the preconceptional period of gametogenesis and the first 3 months of embryogenesis and placentation [8].…”