Social deprivation and adverse perinatal outcomes among Western and non-Western pregnant women in a Dutch urban population
Highlights
► We use a composite multidimensional variable indicating neighbourhood social quality (Social Index). ► We take into account clustering of individuals within neighbourhoods by using a multilevel approach. ► Our results demonstrate a more profound effect of social deprivation on adverse perinatal outcomes in Western women. ► Implications concern general policies, and targeted policies which differ for Western and non-Western women.
Introduction
In The Netherlands perinatal mortality exceeds the European average, despite a high standard of mother and child healthcare with free access (Mohangoo et al., 2008). Perinatal health in the larger cities is even worse, with the highest rates of perinatal mortality and morbidity being observed in deprived neighbourhoods (de Graaf et al., 2008). The high prevalence of ethnic minority groups and disseminated social deprivation in urban areas are generally put forward as key aetiologic factors (Agyemang et al., 2009; Goedhart, van Eijsden, van der Wal, & Bonsel, 2008a, 2008b; de Graaf et al., 2008; Poeran, Denktas, Birnie, Bonsel, & Steegers, 2011). Social deprivation is a very broad term and can be defined as ‘reduction or prevention of culturally normal interaction with the rest of society’. Indeed, aspects of social deprivation such as material poverty and lack of social cohesion are both related to ill health, and also strongly connected; the combined reinforcing presence of these factors might be particularly important for perinatal ill health (Fang, Madhavan, Bosworth, & Alderman, 1998; Halpern & Nazroo, 2000; Jonkers, Richters, Zwart, Ory, & van Roosmalen, 2011). Numerous studies have shown ethnicity and social deprivation to be strongly related to adverse perinatal outcomes such as preterm birth and small for gestational age (Agyemang et al., 2009; Auger, Giraud, & Daniel, 2009; Elo et al., 2009; Farley et al., 2006; Goedhart et al., 2008a; O'Campo et al., 2008; Timmermans et al., 2011). However, many recent studies have been conducted in the United States and Canada where ethnic minorities differ considerably from those in Europe and, more specifically, The Netherlands (Agyemang et al., 2009; Elo et al., 2009; Genereux, Auger, Goneau, & Daniel, 2008; Goedhart et al., 2008a, 2008b; de Graaf et al., 2008; Janevic et al., 2010; O'Campo et al., 2008; Poeran et al., 2011). In the United States, the majority of ethnic minorities either comprise African Americans or Hispanics; in Europe, they mainly originate from former colonies (for example in the United Kingdom or The Netherlands) or they result from the 1960s labour migration from countries such as Turkey or Morocco (for example in Germany and France, respectively). Findings from these studies do not necessarily apply to European countries.
Another motivation for our study pertains to findings from a recent Dutch study, which showed Western (European/North-American/Australian) women in deprived neighbourhoods to have an increased risk of adverse perinatal outcomes as opposed to non-Western women (de Graaf et al., 2008).
Rotterdam, the second largest city of The Netherlands, has the highest proportion of non-Western inhabitants as well as the highest number of deprived neighbourhoods, and the highest rate of adverse perinatal outcomes, creating a suitable population in which to study the effect of social deprivation on perinatal outcomes (de Graaf et al., 2008). In continuation of previous work, we investigated the background and the association of social deprivation with adverse perinatal outcomes, for Western and non-Western women separately, as we hypothesise differential effects. We use a composite variable, the so-called ‘Social Index’ (SI) as deprivation indicator at the neighbourhood level in the city of Rotterdam. As social deprivation is considered an important metric of neighbourhood quality, policy makers have created the SI and its underlying domains to measure this. It is used to measure the effectiveness of efforts to reduce area-based social deprivation. The SI conceptually resembles the less detailed Scottish Carstairs index (Carstairs & Morris, 1990). We use the unaltered SI values to facilitate communication of study results to policy makers.
Section snippets
Outcome data
Data from all single pregnancies in Rotterdam over the period 2000–2007 were derived from The Netherlands Perinatal Registry. This registry contains population-based information of 97% of all pregnancies in The Netherlands (The Netherlands Perinatal Registry, 2009). Source data are collected by 94% of midwives, 99% of gynaecologists and 68% of paediatricians, including 100% of Neonatal Intensive Care Unit paediatricians (The Netherlands Perinatal Registry, 2009). The mission of The Netherlands
Results
A total of 56,443 singleton pregnancies were analysed. Characteristics of the study population are shown in Table 1.
Discussion
This study is one of the few European studies to address the effect of a combined social deprivation measure on adverse perinatal outcomes and applying multilevel modelling (Gray et al., 2008). In the large, multi-ethnic city of Rotterdam the impact of social deprivation on adverse perinatal outcomes plays a key role with a striking ethnicity-related effect. In the most deprived neighbourhoods, perinatal outcomes were universally poor with a tendency for even worse figures for Western women
Acknowledgement
We would like to thank the Rotterdam Centre for Research and Statistics (COS, 31 www.cos.rotterdam.nl) for their cooperation.
References (38)
- et al.
Perinatal complications associated with maternal tobacco use
Seminars in Neonatology
(2000) - et al.
The risk of preterm delivery in women from different ethnic groups
BJOG
(2002) - et al.
Social inequality and ethnic differences in smoking in New Zealand
Social Science & Medicine
(2004) - et al.
Residential segregation and mortality in New York City
Social Science & Medicine
(1998) Racial disparities in low birthweight and the contribution of residential segregation: a multilevel analysis
Social Science & Medicine
(2006)- et al.
Neighborhood deprivation and adverse birth outcomes among diverse ethnic groups
Annals of Epidemiology
(2010) - et al.
Severe maternal morbidity among immigrant women in the Netherlands: patients' perspectives
Reproductive Health Matters
(2011) Classification and heterogeneity of preterm birth
BJOG
(2003)- et al.
Maternal and child health and neighborhood context: the selection and construction of area-level variables
Health & Place
(2006) - et al.
The effect of neighbourhood income and deprivation on pregnancy outcomes in Amsterdam, the Netherlands
Journal of Epidemiology and Community Health
(2009)
The prevention paradox or the inequality paradox?
European Journal of Public Health
The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: a population-based study
BMC Public Health
Race and preterm birth – the case for epigenetic inquiry
Ethnicity & Disease
Deprivation and health in Scotland
Health Bulletin (Edinburgh)
Transgenerational effect of neighborhood poverty on low birth weight among African Americans in Cook County, Illinois
American Journal of Epidemiology
Spatial dynamics of white flight: the effects of local and extralocal racial conditions on neighborhood out-migration
American Sociological Review
An urban perinatal health programme of strategies to improve perinatal health
Maternal and Child Health Journal
Neighbourhood deprivation and small-for-gestational-age term births in the United States
Paediatric and Perinatal Epidemiology
Low birth weight: race and maternal nativity – impact of community income
Pediatrics
Cited by (50)
Patients’ experiences with an obstetric telephone triage system: A qualitative study
2023, Patient Education and CounselingCitation Excerpt :It therefore remains unclear what experiences pregnant women have with triage systems if there is a language barrier. This is particularly important as there is evidence that non-western women experience challenges in accessing care and that this negatively affects birth outcomes [43]. The exclusion of women in a life-threatening situation and underage pregnant women also limits the generalizability of these results for the total pregnant population.
Addressing diversity in prenatal genetic counseling
2022, Prenatal Genetic Counseling: Practical Support for Prenatal Diagnostics, Decision-Making, and Dealing with UncertaintyPoint
2019, American Journal of Obstetrics and GynecologyPerceptions of pregnancy preparation in women with a low to intermediate educational attainment: A qualitative study
2018, MidwiferyCitation Excerpt :Despite high quality perinatal care in the Netherlands for example, perinatal mortality remains high compared to other European countries (Mohangoo et al., 2014; EURO-PERISTAT project with SCPE EUROCAT and EURONEONET, 2008; EURO-PERISTAT project with SCPE and EUROCAT, 2013). Moreover, similar to other health outcomes there is a social gradient observable in pregnancy outcomes (Marmot et al., 2012; de Graaf et al., 2013; Poeran et al., 2013). People in the lowest part of the social gradient, typically people who live in a deprived neighbourhood, face substantially higher risks to have poor pregnancy outcomes (Vos et al., 2014; Scholmerich et al., 2014; Weightman et al., 2012).
China's social deprivation: Measurement, spatiotemporal pattern and urban applications
2017, Habitat International