Abstract
BackgroundSeveral risk factors predisposing women and their live-borns to adverse outcomes during pregnancy have been documented. Little is known about sanitation being a factor contributing to adverse pregnancy outcomes in India. The role of sanitation in adverse pregnancy outcomes remains largely unexplored in the Indian context. This study is an attempt to bring the focus on sanitation as a factor in adverse pregnancy outcome. Along with the sanitation factors, few confounder variables have also been studied in order to understand the adverse pregnancy outcomes.MethodsThe study is based on the fourth round of National Family Health Survey (NFHS-IV) covering 26,972 married women in the age-group 15–49. The study variables include the mother’s age, Body Mass Index (BMI), education, anemia, and Antenatal care (ANC) visits during their last pregnancy. The household level variable includes place of residence, religion, caste, wealth index, access to toilet, type of toilet, availability of water within toilet premises, and facility of hand wash near the toilet. Children study variables include Low Birth Weight (LBW), the order of birth (Parity), and the death of the children of the women in the last 5 years. The target variable Adverse Pregnancy Outcome (APO) was constructed using children born with low birth weight or died during the last pregnancy.ResultsWe calculated both adjusted as well as unadjusted odds ratios for a better understanding of the association between sanitation and adverse pregnancy outcomes. Findings from the study showed that women who did not have access to a toilet within the house had a higher risk of adverse pregnancy outcome. In the multivariable model, no association was observed for adverse pregnancy outcome among women who did not have access to toilet and women who used shared toilet. Teenage (15–19 years), uneducated, underweight and anemic mothers were more likely to face APO as compare to other mothers in similar characteristics group.ConclusionsOur findings contribute to the decidedly less available literature on maternal sanitation behaviour and adverse pregnancy outcomes. Our results support that sanitation is a very significant aspect for women who are about to deliver a baby as there was an association between sanitation and adverse pregnancy outcome. Education on sanitation practices is the need of the hour as much as it needs to follow.
Highlights
Several risk factors predisposing women and their live-borns to adverse outcomes during pregnancy have been documented
Adverse pregnancy outcomes can occur by any of the four possible ways: when women lose their baby during early pregnancy, i.e., miscarriage or spontaneous abortion, when women lose their baby during late pregnancy, i.e., stillbirths, when women have baby earlier than expected, i.e., preterm birth, or when women have a baby with low birth weight
An attempt was made to understand if there was any association between maternal sanitation behavior and adverse pregnancy outcomes by using Demographic Health Survey (DHS) data, known as NFHS (National Family Health Survey), in India
Summary
Several risk factors predisposing women and their live-borns to adverse outcomes during pregnancy have been documented. This study is an attempt to bring the focus on sanitation as a factor in adverse pregnancy outcome. Along with the sanitation factors, few confounder variables have been studied in order to understand the adverse pregnancy outcomes. The significance of sanitation in the follow up of Adverse Pregnancy Outcomes (APOs), which includes both preterm births and low births weight [1, 2], is widely studied in developed as well as developing countries [3,4,5]. Poor sanitation, and poor waste management during the period of pregnancy may increase the risk of infection in the mother and may lead to low birth weight babies and preterm deliveries [35, 36]
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