Equity in maternal health outcomes in a middle-income urban setting: a cohort study
Abstract Background Low socioeconomic status (SES) is associated with more adverse perinatal health outcomes, risk factors and lower access to and use of maternal health care services. However, evidence for the association between SES and maternal health outcomes is limited, particularly for middle-...
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doaj-d66e525c72af4272b6155ee12db3c25f2020-11-25T02:47:09ZengBMCReproductive Health1742-47552019-06-011611910.1186/s12978-019-0736-3Equity in maternal health outcomes in a middle-income urban setting: a cohort studyAmanda De Groot0Lisanne Van de Munt1Daniel Boateng2Ary I. Savitri3Edward Antwi4Nienke Bolten5Kerstin Klipstein-Grobusch6Cuno S. P. M. Uiterwaal7Joyce L. Browne8Midwifery AcademyMidwifery AcademyJulius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityJulius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityJulius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityMidwifery AcademyJulius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityJulius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityJulius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityAbstract Background Low socioeconomic status (SES) is associated with more adverse perinatal health outcomes, risk factors and lower access to and use of maternal health care services. However, evidence for the association between SES and maternal health outcomes is limited, particularly for middle-income countries like sub-Saharan Ghana. We assessed the association between parental SES and adverse maternal and perinatal outcomes of Ghanaian women during pregnancy, delivery and the postpartum period. Methods A prospective cohort study of 1010 women of two public hospitals in Accra, Ghana (2012–2014). SES was proxied by maternal and paternal education, wealth and employment status. The association of SES with maternal and perinatal outcomes was analyzed with multivariable logistic and linear regression. Results The analysis included 790 women with information on pregnancy outcomes. Average age was 28.2 years (standard deviation, SD 5.0). Over a third (n = 292, 37.0%) had low SES, 176 (22.3%) were classified to have high SES using the assets index. Nearly half (n = 374, 47.3%) of women had lower secondary school or vocational training as highest education level. Compared to women with middle assets SES, women with low assets SES were at higher risk for miscarriage (odds ratio, OR 1.61, 95% CI 1.06 to 2.45) and instrumental delivery (OR 1.74, 95% CI 1.03 to 2.94), but this association was not observed for the other SES proxies. For any of the maternal or perinatal outcomes and SES proxies, no other statistically significant differences were found. Conclusion Women attending public maternal health care services in urban Ghana had overall equitable maternal and perinatal health outcomes, with the exception of a higher risk of miscarriage and instrumental delivery associated with low assets SES. This suggests known associations between SES, risk factors and outcomes could be mitigated with universal and accessible maternal health services.http://link.springer.com/article/10.1186/s12978-019-0736-3EquityMaternal healthLow- and middle income countriesSocio-economic status |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Amanda De Groot Lisanne Van de Munt Daniel Boateng Ary I. Savitri Edward Antwi Nienke Bolten Kerstin Klipstein-Grobusch Cuno S. P. M. Uiterwaal Joyce L. Browne |
spellingShingle |
Amanda De Groot Lisanne Van de Munt Daniel Boateng Ary I. Savitri Edward Antwi Nienke Bolten Kerstin Klipstein-Grobusch Cuno S. P. M. Uiterwaal Joyce L. Browne Equity in maternal health outcomes in a middle-income urban setting: a cohort study Reproductive Health Equity Maternal health Low- and middle income countries Socio-economic status |
author_facet |
Amanda De Groot Lisanne Van de Munt Daniel Boateng Ary I. Savitri Edward Antwi Nienke Bolten Kerstin Klipstein-Grobusch Cuno S. P. M. Uiterwaal Joyce L. Browne |
author_sort |
Amanda De Groot |
title |
Equity in maternal health outcomes in a middle-income urban setting: a cohort study |
title_short |
Equity in maternal health outcomes in a middle-income urban setting: a cohort study |
title_full |
Equity in maternal health outcomes in a middle-income urban setting: a cohort study |
title_fullStr |
Equity in maternal health outcomes in a middle-income urban setting: a cohort study |
title_full_unstemmed |
Equity in maternal health outcomes in a middle-income urban setting: a cohort study |
title_sort |
equity in maternal health outcomes in a middle-income urban setting: a cohort study |
publisher |
BMC |
series |
Reproductive Health |
issn |
1742-4755 |
publishDate |
2019-06-01 |
description |
Abstract Background Low socioeconomic status (SES) is associated with more adverse perinatal health outcomes, risk factors and lower access to and use of maternal health care services. However, evidence for the association between SES and maternal health outcomes is limited, particularly for middle-income countries like sub-Saharan Ghana. We assessed the association between parental SES and adverse maternal and perinatal outcomes of Ghanaian women during pregnancy, delivery and the postpartum period. Methods A prospective cohort study of 1010 women of two public hospitals in Accra, Ghana (2012–2014). SES was proxied by maternal and paternal education, wealth and employment status. The association of SES with maternal and perinatal outcomes was analyzed with multivariable logistic and linear regression. Results The analysis included 790 women with information on pregnancy outcomes. Average age was 28.2 years (standard deviation, SD 5.0). Over a third (n = 292, 37.0%) had low SES, 176 (22.3%) were classified to have high SES using the assets index. Nearly half (n = 374, 47.3%) of women had lower secondary school or vocational training as highest education level. Compared to women with middle assets SES, women with low assets SES were at higher risk for miscarriage (odds ratio, OR 1.61, 95% CI 1.06 to 2.45) and instrumental delivery (OR 1.74, 95% CI 1.03 to 2.94), but this association was not observed for the other SES proxies. For any of the maternal or perinatal outcomes and SES proxies, no other statistically significant differences were found. Conclusion Women attending public maternal health care services in urban Ghana had overall equitable maternal and perinatal health outcomes, with the exception of a higher risk of miscarriage and instrumental delivery associated with low assets SES. This suggests known associations between SES, risk factors and outcomes could be mitigated with universal and accessible maternal health services. |
topic |
Equity Maternal health Low- and middle income countries Socio-economic status |
url |
http://link.springer.com/article/10.1186/s12978-019-0736-3 |
work_keys_str_mv |
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