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Public health
Original research
Inequalities and stillbirth in the UK: a meta-narrative review
  1. Carol Kingdon1,
  2. Devender Roberts2,
  3. Mark A Turner3,
  4. Claire Storey4,
  5. Nicola Crossland5,
  6. Kenneth William Finlayson5,
  7. Soo Downe6
  1. 1 Research in childbirth and health, University of Central Lancashire, Preston, UK
  2. 2 Department of Obstetrics, Liverpool Womens NHS Foundation Trust, Liverpool, UK
  3. 3 Department of Women's and Childrens Health, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
  4. 4 International Stillbirth Alliance, Bristol, UK
  5. 5 Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
  6. 6 Research in childbirth and health, University of Central Lancashire, Preston, UK
  1. Correspondence to Dr Carol Kingdon; ckingdon{at}uclan.ac.uk

Abstract

Objective To review what is known about the relationship between stillbirth and inequalities from different disciplinary perspectives to inform stillbirth prevention strategies.

Design Systematic review using the meta-narrative method.

Setting Studies undertaken in the UK.

Data sources Scoping phase: experts in field, exploratory electronic searches and handsearching. Systematic searches phase: Nine databases with no geographical or date restrictions. Non-English language studies were excluded.

Study selection Any investigation of stillbirth and inequalities with a UK component.

Data extraction and synthesis Three authors extracted data and assessed study quality. Data were summarised, tabulated and presented graphically before synthesis of the unfolding storyline by research tradition; and then of the commonalities, differences and interplays between narratives into resultant summary meta-themes.

Results Fifty-four sources from nine distinctive research traditions were included. The evidence of associations between social inequalities and stillbirth spanned 70 years. Across research traditions, there was recurrent evidence of the social gradient remaining constant or increasing, fuelling repeated calls for action (meta-theme 1: something must be done). There was less evidence of an effective response to these calls. Data pertaining to socioeconomic, area and ethnic disparities were routinely collected, but not consistently recorded, monitored or reported in relation to stillbirth (meta-theme 2: problems of precision). Many studies stressed the interplay of socioeconomic status, deprivation or ethnicity with aggregated factors including heritable, structural, environmental and lifestyle factors (meta-theme 3: moving from associations towards intersectionality and intervention(s)). No intervention studies were identified.

Conclusion Research investigating inequalities and stillbirth in the UK is underdeveloped. This is despite repeated evidence of an association between stillbirth risk and poverty, and stillbirth risk, poverty and ethnicity. A specific research forum is required to lead the development of research and policy in this area, which can harness the multiple relevant research perspectives and address the intersections between different policy areas.

PROSPERO registration number CRD42017079228.

  • stillbirth
  • inequalities
  • deprivation
  • social class
  • poverty
  • ethnicity
  • meta-narrative

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-029672

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    Footnotes

    • Contributors CK, DR, MAT and CS designed the review with input from SD. NC and KWF conducted the searches, identification and screening with agreement by consensus of all authors on final inclusions. NC, KWF and CK extracted data, and agreed initial storylines and final meta-themes with review by SD, DR, MAT and CS. CK wrote the first draft of the paper. All authors read, commented and approved the final manuscript.

    • Funding This study was supported by Stillborn and Neonatal Death Charity (RF510).

    • Competing interests CK, SD, NC, KWF and CS report a grant from SANDS, the Stillbirth and Neonatal Death Charity, during the conduct of the study. CS also reports her position as vicechair of the International Stillbirth Alliance (ISA). DR and MAT have nothing to disclose.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.