Social Determinants and Inequitable Maternal and Perinatal Outcomes in Aotearoa New Zealand

Overview

Journal Womens Health (Lond)

Specialty Gynecology & Obstetrics

Date 2022 Feb 3

PMID 35109729

Authors

Pauline Dawson

Benoit Auvray

Crystal Jaye

Robin Gauld

Jean Hay-Smith

Affiliations

Soon will be listed here.

Abstract

Objectives: Aotearoa New Zealand has demonstrable maternal and perinatal health inequity. We examined the relationships between adverse outcomes in a total population sample of births and a range of social determinant variables representing barriers to equity.

Methods: Using the Statistics New Zealand Integrated Data Infrastructure suite of linked administrative data sets, adverse maternal and perinatal outcomes (mortality and severe morbidity) were linked to socio-economic and health variables for 97% of births in New Zealand between 2003 and 2018 (~970,000 births). Variables included housing, economic, health, crime and family circumstances. Logistic regression examined the relationships between adverse outcomes and social determinants, adjusting for demographics (socio-economic deprivation, education, parity, age, rural/urban residence and ethnicity).

Results: Māori (adjusted odds ratio = 1.21, 95% confidence interval = 1.18-1.23) and Asian women (adjusted odds ratio 1.39, 95% confidence interval = 1.36-1.43) had poorer maternal or perinatal outcomes compared to New Zealand European/European women. High use of emergency department (adjusted odds ratio = 2.68, 95% confidence interval = 2.53-2.84), disability (adjusted odds ratio = 1.98, 95% confidence interval = 1.83-2.14) and lack of engagement with maternity care (adjusted odds ratio = 1.89, 95% confidence interval = 1.84-1.95) had the strongest relationship with poor outcomes.

Conclusion: Maternal health inequity was strongly associated with a range of socio-economic and health determinants. While some of these factors can be targeted for interventions, the study highlights larger structural and systemic issues that affect maternal and perinatal health.

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References

McRae D, Muhajarine N, Stoll K, Mayhew M, Vedam S, Mpofu D . Is model of care associated with infant birth outcomes among vulnerable women? A scoping review of midwifery-led versus physician-led care. SSM Popul Health. 2018; 2:182-193. PMC: 5757823. DOI: 10.1016/j.ssmph.2016.01.007. View

Marmot M . The health gap: the challenge of an unequal world. Lancet. 2015; 386(10011):2442-4. DOI: 10.1016/S0140-6736(15)00150-6. View

Downe S, Finlayson K, Walsh D, Lavender T . 'Weighing up and balancing out': a meta-synthesis of barriers to antenatal care for marginalised women in high-income countries. BJOG. 2009; 116(4):518-29. DOI: 10.1111/j.1471-0528.2008.02067.x. View

Waljee A, Mukherjee A, Singal A, Zhang Y, Warren J, Balis U . Comparison of imputation methods for missing laboratory data in medicine. BMJ Open. 2013; 3(8). PMC: 3733317. DOI: 10.1136/bmjopen-2013-002847. View

Chin M, King P, Jones R, Jones B, Ameratunga S, Muramatsu N . Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States. Health Policy. 2018; 122(8):837-853. PMC: 6561487. DOI: 10.1016/j.healthpol.2018.05.001. View

Ballantyne A, Style R . Health data research in New Zealand: updating the ethical governance framework. N Z Med J. 2017; 130(1464):64-71. View

Sandall J, Soltani H, Gates S, Shennan A, Devane D . Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2016; 4:CD004667. PMC: 8663203. DOI: 10.1002/14651858.CD004667.pub5. View

Filoche S, Lawton B, Stanley J . Access to Secondary Mental Health Services in a Cohort of New Zealand Mothers. Community Ment Health J. 2016; 52(8):964-971. DOI: 10.1007/s10597-016-0042-2. View

Fitzhugh C, Pearsall M, Tully K, Stuebe A . Social Determinants of Health in Maternity Care: A Quality Improvement Project for Food Insecurity Screening and Health Care Provider Referral. Health Equity. 2021; 5(1):606-611. PMC: 8665789. DOI: 10.1089/heq.2020.0120. View

10.

Dawson P, Jaye C, Gauld R, Hay-Smith J . Barriers to equitable maternal health in Aotearoa New Zealand: an integrative review. Int J Equity Health. 2019; 18(1):168. PMC: 6822457. DOI: 10.1186/s12939-019-1070-7. View

11.

Whitehead M . The concepts and principles of equity and health. Int J Health Serv. 1992; 22(3):429-45. DOI: 10.2190/986L-LHQ6-2VTE-YRRN. View

12.

Blumenshine P, Egerter S, Barclay C, Cubbin C, Braveman P . Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med. 2010; 39(3):263-72. DOI: 10.1016/j.amepre.2010.05.012. View

13.

Farquhar C, Sadler L, Masson V, Bohm G, Haslam A . Beyond the numbers: classifying contributory factors and potentially avoidable maternal deaths in New Zealand, 2006-2009. Am J Obstet Gynecol. 2011; 205(4):331.e1-8. DOI: 10.1016/j.ajog.2011.07.044. View

14.

Shakespeare T . Still a health issue. Disabil Health J. 2012; 5(3):129-31. DOI: 10.1016/j.dhjo.2012.04.002. View

15.

Lawton B, Wilson L, Dinsdale R, Rose S, Brown S, Tait J . Audit of severe acute maternal morbidity describing reasons for transfer and potential preventability of admissions to ICU. Aust N Z J Obstet Gynaecol. 2010; 50(4):346-51. DOI: 10.1111/j.1479-828X.2010.01200.x. View

16.

Hickey S, Roe Y, Ireland S, Kildea S, Haora P, Gao Y . A call for action that cannot go to voicemail: Research activism to urgently improve Indigenous perinatal health and wellbeing. Women Birth. 2021; 34(4):303-305. DOI: 10.1016/j.wombi.2021.03.011. View

17.

Lawton B, MacDonald E, Brown S, Wilson L, Stanley J, Tait J . Preventability of severe acute maternal morbidity. Am J Obstet Gynecol. 2014; 210(6):557.e1-6. DOI: 10.1016/j.ajog.2013.12.032. View

18.

Anand P, Dolan P . Equity, capabilities and health. Soc Sci Med. 2004; 60(2):219-22. DOI: 10.1016/j.socscimed.2004.04.031. View

19.

Stekhoven D, Buhlmann P . MissForest--non-parametric missing value imputation for mixed-type data. Bioinformatics. 2011; 28(1):112-8. DOI: 10.1093/bioinformatics/btr597. View

20.

Cutts D, Coleman S, Black M, Chilton M, Cook J, Ettinger de Cuba S . Homelessness during pregnancy: a unique, time-dependent risk factor of birth outcomes. Matern Child Health J. 2014; 19(6):1276-83. DOI: 10.1007/s10995-014-1633-6. View