Abstract
BackgroundThis paper identifies patterns of health inequalities (consistency and magnitude) of socioeconomic disparities for multiple maternal and child health (MCH) outcomes that represent different health care needs of mothers and infants.MethodsUsing cross-sectional national data (unweighted sample = 6,421, weighted =76,508) from the Canadian Maternity Experiences Survey linked with 2006 Canadian census data, we categorized 25 health indicators of mothers of singletons into five groups of MCH outcomes (A. maternal and infant health status indicators; B. prenatal care; C. maternal experience of labor and delivery; D. neonatal medical care; and E. postpartum infant care and maternal perceptions of health care services). We then examined the association of these health indicators with individual socioeconomic position (SEP) (education and income), neighborhood SEP and combined SEP (a four-level measure of low and high individual and neighborhood SEP), and compared the magnitude (odds ratios and 95% confidence intervals) and direction of the associations within and between MCH outcome groups.ResultsWe observed consistent positive gradients of socioeconomic inequalities within most groups and for 23/25 MCH outcomes. However, more significant associations and stronger gradients were observed for the MCH outcomes in the maternal and infant health status group as opposed to other groups. The neonatal medical care outcomes were weakly associated with SEP. The direction of associations was negative between some SEP measures and HIV testing, timing of the first ultrasound, caesarean section, epidural for vaginal births, infant needing non-routine neonatal care after discharge and any breastfeeding at 3 or 6 months.Gradients were steep for individual SEP but moderate for neighborhood SEP. Combined SEP had no consistent gradients but the subcategory of low individual-high neighborhood SEP often showed the poorest health outcomes compared to the categories within this SEP grouping.ConclusionBy examining SEP gradients in multiple MCH outcomes categorized into groups of health care needs, we identified large and consistent inequalities both within and between these groups. Our results suggest differences in pathways and mechanisms contributing to SEP inequalities across groups of MCH outcomes that can be examined in future research and inform prioritization of policies for reducing these inequalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-014-0393-z) contains supplementary material, which is available to authorized users.
Highlights
This paper identifies patterns of health inequalities of socioeconomic disparities for multiple maternal and child health (MCH) outcomes that represent different health care needs of mothers and infants
We decided to present unadjusted parameter estimates (ORs and 95% confidence intervals (95% CI)) for these associations since adjusting for potential confounders of age and parity in the multivariable models changed the associations with socioeconomic position (SEP) by less than 5% for almost all the MCH outcomes, and, for a few, by just over 5%
The magnitude of inequalities by the SEP measures Comparing the magnitude of the MCH inequalities (the unadjusted Odds ratio (OR) (UORs) in the highest and lowest SEP categories, Figures 1, 2, 3, 4, and 5), we found that mothers’ education had the highest ORs and larger inequalities, which was followed by combined SEP, and household low income cut-off point (LICO)
Summary
This paper identifies patterns of health inequalities (consistency and magnitude) of socioeconomic disparities for multiple maternal and child health (MCH) outcomes that represent different health care needs of mothers and infants. Income can help mothers purchase items to meet basic needs, such as food, medication, and transportation to maternal and child health care services, while maternal education reflects not just the individual and household economic dimension of SEP, and access to information and knowledge, problem-solving skills, social networks and involvement, and social prestige, all of which might be important for MCH [4]. A systematic review of studies in industrialized countries showed that income is less frequently associated with birth outcomes than education [18] This might be different in low-income countries where income is critical for MCH [21]. Information on SEP inequalities for each of these SEP measures can help generate hypotheses for future research on pathways and areas of intervention
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