Abstract
ObjectiveTo examine socioeconomic inequalities in birth outcomes among infants born between 2008 and 2018 and assessed trends in inequalities during that period in Colombia, a middle-income country with high levels of inequality emerging from a long internal armed conflict.MethodsUsing birth certificate data in Colombia, we analysed the outcomes of low birth weight, an Apgar score <7 at 5 minutes after birth and the number of prenatal visits among full-term pregnancies. Maternal education and health insurance schemes were used as socioeconomic position (SEP) indicators. Inequalities were estimated using the prevalence/mean of the outcomes across categories of the SEP indicators and calculating the relative and slope indices of inequality (RII and SII, respectively).ResultsAmong the 5,433,265 full-term singleton births analysed, there was a slight improvement in the outcomes analysed over the study period (lower low-birth-weight and Apgar<7 prevalence rates and higher number of prenatal visits). We observed a general pattern of social gradients and significant relative (RII) and absolute (SII) inequalities for all outcomes across both SEP indicators. RII and SII estimates with their corresponding CIs revealed a general picture of no significant changes in inequalities over time, with some particular, time-dependent exceptions. When comparing the initial and final years of our study period, inequalities in low birth weight related to maternal education increased while those in Apgar score <7 decreased. Relative inequalities across health insurance schemes increased for the two birth outcomes but decreased for the number of prenatal visits.ConclusionThe lack of a consistent improvement in the magnitude of inequalities in birth outcomes over an 11-year period is a worrying issue because it could aggravate the cycle of inequality, given the influence of birth outcomes on health, social and economic outcomes throughout the life course. The findings of our analysis emphasize the importance of policies aimed at providing access to quality education and providing a health care system with universal coverage and high levels of integration.
Highlights
Maternal and birth outcomes such as birth weight and gestational age remain important public health indicators
We observed a general pattern of social gradients and significant relative (RII) and absolute (SII) inequalities for all outcomes across both socioeconomic position (SEP) indicators
relative index of inequality (RII) and SII estimates with their corresponding CIs revealed a general picture of no significant changes in inequalities over time, with some particular, time-dependent exceptions
Summary
Maternal and birth outcomes such as birth weight and gestational age remain important public health indicators. These outcomes have been shown to influence health and wellbeing during childhood and throughout the life course, having an impact on child development, cardiovascular diseases, all-cause mortality, and different social and economic outcomes in adulthood [1,2,3,4,5]. In particular, has been identified as a key determinant of birth outcomes that acts through various pathways, including access to information, health care utilization, nutrition and health-related behaviours [14]. Less-educated mothers make, on average, fewer prenatal care visits and are less likely to access skilled birth attendance care during childbirth [16]
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