Economic crisis and stillbirth ratios: Evidence from Southern Europe.

Cleon Tsimbos,Dimitra Petropoulou,Georgia Verropoulou

doi:10.1371/journal.pone.0259623

Cleon Tsimbos, Dimitra Petropoulou + Show 1 more

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https://doi.org/10.1371/journal.pone.0259623

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Abstract

In this paper we assess the impact of the recent European recession on stillbirth indices over the course of the 2000s and 2010s; the analysis focuses on four Southern European countries (Greece, Italy, Spain, Portugal), which were seriously affected by the sovereign debt crisis from around 2008 to 2017. We use national vital statistics and established economic indicators for the period 2000–2017; stillbirth ratios (stillbirths per 1000 livebirths) are the chosen response variable. For the purpose of the study, we employ correlation analysis and fit regression models. The overall impact of economic indicators on the stillbirth indices is sizeable and statistically robust. We find that a healthy economy is associated with low and declining levels of stillbirth measures. In contrast, economic recession appears to have an adverse effect (Greece, Italy and Spain), or an unclear impact (Portugal), on the stillbirth outcome. This study provides evidence of the adverse effect of the European sovereign debt crisis and ensuing period of austerity on a scarcely explored aspect of health.

Highlights

Late fetal deaths are referred to as stillbirths
The correlation coefficients between stillbirth ratios and Gross Disposable Income (GDI) range from -0.761 (Portugal) to -0.926 (Greece) and between stillbirth ratios and Gross National Income (GNI) range from -0.704 (Portugal) to -0.966 (Greece)
For Portugal, on the other hand, the results show that good economic conditions have a favorable effect on the stillbirth ratios, but the coefficients of the differential intercepts and differential slopes, though they have the expected sign, are not statistically significant, indicating that the difference in the quantitative relationships for the two sub-periods 2000–2008 and 2009–2017 is negligible

Summary

Introduction

Late fetal deaths are referred to as stillbirths. due to differences in definitions and reporting practices, data on stillbirths are usually of low quality. Several studies show that pregnant women with elevated levels of stress have considerably higher risks of a stillbirth, independent of age, parity, education, smoking and alcohol habits or other compromising characteristics This is plausible because maternal stress tends to release bioactive mediators and hormones that in turn can stimulate latent pathways, including, among others, neuroendocrine sites, affecting spontaneous preterm deliveries and unfavourable foetal conditions [12,13,14]. In low income countries or deprived environments, poor maternal nutrition and low body mass index can result in higher stillbirth frequency [15] These findings indicate that fetal mortality is a multifaceted phenomenon encompassing, among others, important socioeconomic aspects. Ours is the first contribution to examine the effects on stillbirth indices

Aim of the paper

Results

Discussion and conclusions