Abstract
BackgroundStillbirth is a sensitive indicator for access to, and quality of health care and social services in a society. If a particular population group e.g. migrants experiences higher rates of stillbirth, this might be an indication of social deprivation or barriers to health care. This study examines differences in risk of stillbirth for women of different regions of origin compared to women from Germany in order to identify high risk groups/target groups for prevention strategies.MethodsWe used the BQS dataset routinely compiled to examine perinatal outcomes in Germany nationwide. Participation of hospitals and completeness of data has been about 98% in recent years. Data on all live births and stillbirths were obtained for the period 2004 to 2007 (N = 2,670,048). We calculated crude and stratified mortality rates as well as corresponding relative mortality risks.ResultsA significantly elevated stillbirth rate was found for women from the Middle East and North Africa (incl. Turkey) (RR 1.34, CI 1.22-1.55). The risk was slightly attenuated for low SES. An elevated risk was also found for women from Asia (RR 1.18, CI 1.02-1.65) and from Mediterranean countries (RR 1.14, CI 0.93-1.28). No considerable differences either in use and timing of antenatal care or preterm birth and low birthweight were observed between migrant and non-migrant women. After stratification for light for gestational age, the relative risk of stillbirth for women from the Middle East/North Africa increased to 1.63 (95% CI 1.25-2.13). When adjusted for preterm births with low birthweight, women from Eastern Europe and the Middle East/North Africa experienced a 26% (43%) higher risk compared with women from Germany.ConclusionsWe found differences in risk of stillbirth among women from Middle East/North Africa, especially in association with low SES and low birthweight for gestational age. Our findings suggest a need for developing and evaluating socially and culturally sensitive health promotion and prevention programmes for this group. The findings should also stimulate discussion about the quality and appropriateness of antenatal and perinatal care of pregnant women and newborns with migrant backgrounds.
Highlights
Stillbirth is a sensitive indicator for access to, and quality of health care and social services in a society
Stratified analyses In stratified analyses, we examined the effect of the previously described factors on the relative differences in the relative risk of stillbirth for women with migrant backgrounds compared with women without migrant backgrounds (Additional File 2 Table S3), in order to identify possible confounders or effect modifications
Using the German perinatal database, we found relative differences in the risk of stillbirth for women of different regions of origin compared with women from Germany
Summary
Stillbirth is a sensitive indicator for access to, and quality of health care and social services in a society. If a particular population group e.g. migrants experiences higher rates of stillbirth, this might be an indication of social deprivation or barriers to health care. Births in 1995 to 18.9 in 2009, with the highest rates being observed in south Asia and sub-Saharan Africa [3] It is, a topic of high public health relevance in high-income countries because of the disparities in stillbirth rates among different ethnic groups in these societies [4]. In Europe and the USA, several studies have shown disparities in stillbirth, perinatal and infant mortality among ethnic groups compared with the host population of each country [5,6,7,8,9,10,11]. A recent systematic literature review on differences in stillbirths and infant deaths between migrant and non-migrant populations in industrialized countries shows inconsistent results. The distribution of risk factors for stillbirth, such as preterm birth [13,14,15], low birthweight [16,17,18], congenital anomalies [19,20], and inappropriate use of antenatal care [21,22,23], varies between ethnic groups in European countries
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