The Social Determinants of Infant Mortality and Birth Outcomes in Western Developed Nations: A Cross-Country Systematic Review

Abstract

Infant mortality (IM) and birth outcomes, key population health indicators, have lifelong implications for individuals, and are unequally distributed globally. Even among western industrialized nations, striking cross-country and within-country patterns are evident. We sought to better understand these variations across and within the United States of America (USA) and Western Europe (WE), by conceptualizing a social determinants of IM/birth outcomes framework, and systematically reviewing the empirical literature on hypothesized social determinants (e.g., social policies, neighbourhood deprivation, individual socioeconomic status (SES)) and intermediary determinants (e.g., health behaviours). To date, the evidence suggests that income inequality and social policies (e.g., maternal leave policies) may help to explain cross-country variations in IM/birth outcomes. Within countries, the evidence also supports neighbourhood SES (USA, WE) and income inequality (USA) as social determinants. By contrast, within-country social cohesion/social capital has been underexplored. At the individual level, mixed associations have been found between individual SES, race/ethnicity, and selected intermediary factors (e.g., psychosocial factors) with IM/birth outcomes. Meanwhile, this review identifies several methodological gaps, including the underuse of prospective designs and the presence of residual confounding in a number of studies. Ultimately, addressing such gaps including through novel approaches to strengthen causal inference and implementing both health and non-health policies may reduce inequities in IM/birth outcomes across the western developed world.

Recent Declines in Infant and Neonatal Mortality in Turkey from 2007 to 2012: Impact of Improvements in Health Policies

“…Wide within-country variations in birth outcomes have been reported even in WE nations (13,14). In Turkey, previous reports revealed that IMR and NMR in rural areas were approximately 1.5 times higher than those in urban areas; the East region had the highest mortality rates (7).…”

Óbitos infantis evitáveis nas coortes de nascimentos de Pelotas, Rio Grandedo Sul, Brasil, de 1993 e 2004

“…Entre os aspectos positivos incluem-se a coleta primária dos dados de mortalidade no primeiro ano de vida em duas coortes de nascimento, da mesma cidade, com 11 anos de inter- 3 refletem o efeito de inúme-ras intervenções bem-sucedidas, tanto sociais quanto na organização do sistema de saúde, implementadas no país a partir da década de 80 18 . Contudo, inequidades sociais decorrentes, principalmente, do nível econômico (renda e escolaridade materna), cor da pele e grupo étnico, com reflexos negativos sobre os indicadores de mortalidade infantil, ainda persistem e se repetem nos dias atuais, até mesmo em países desenvolvidos da Europa e nos Estados Unidos 3,19,20 .…”

Mortality among children under the age of one: analysis of cases after discharge from maternity *

“…Notwithstanding, in Brazil, diarrhea and pneumonia are outstanding diseases with unfavorable outcomes in this age group, despite the expansion of the vaccine schedule and exhaustive scientific knowledge about proper management of gastrointestinal diseases (30) . These diseases that lead to unfavorable outcomes are directly related to the inefficacious and inefficient care provided to the population or absence of this care, notably in regions where access to health services is difficult (15,26) . However, the subject municipality is the second largest one in the state, and counts on a health system that provides mostly public services at different levels of care.…”

“…A study in the United States and Western Europe showed that social inequalities explain the variations of infant mortality rates, which is an indication of a higher risk of death in social strata with worse socio-economic conditions (15) . In Italy, income inequality and unemployment have significantly increased the risk of infant mortality in that country (16) .…”