Abstract
BackgroundLow 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.MethodsA 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.ResultsThe 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.ConclusionWomen 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.
Highlights
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
Women with low assets SES had a higher risk for miscarriage and instrumental delivery compared to women with
For 790 women there was at least one outcome measurement available (Fig. 1), 21.8% were considered lost to follow-up
Summary
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. Evidence for the association between SES and maternal health outcomes is limited, for middle-income countries like sub-Saharan Ghana. Substantial inequities in maternal and perinatal health exists between and within countries, caused by societal contexts including health care systems and environmental circumstances [1, 2]. Low SES is associated with increased exposure to health risks, lower access to and use of health care and poorer health outcomes [2]. Maternal mortality ratios differ substantially between and within countries due to differences in SES [1]. Within countries women with a high SES often have better maternal and perinatal health outcomes [1]
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