Abstract
BackgroundPostpartum women who experience socioeconomic disadvantage are at higher risk for poor health outcomes than more advantaged postpartum women, and may benefit from access to community based postpartum health services. This study examined socioeconomically disadvantaged (SED) postpartum women's health, and health service needs and utilization patterns in the first four weeks post hospital discharge, and compared them to more socioeconomically advantaged (SEA) postpartum women's health, health service needs and utilization patterns.MethodsData collected as part of a large Ontario cross-sectional mother-infant survey were analyzed. Women (N = 1000) who had uncomplicated vaginal births of single 'at-term' infants at four hospitals in two large southern Ontario, Canada cities were stratified into SED and SEA groups based on income, social support and a universally administered hospital postpartum risk screen. Participants completed a self-administered questionnaire before hospital discharge and a telephone interview four weeks after discharge. Main outcome measures were self-reported health status, symptoms of postpartum depression, postpartum service needs and health service use.ResultsWhen compared to the SEA women, the SED women were more likely to be discharged from hospital within the first 24 hours after giving birth [OR 1.49, 95% CI (1.01–2.18)], less likely to report very good or excellent health [OR 0.48, 95% CI (0.35–0.67)], and had higher rates of symptoms of postpartum depression [OR 2.7, 95% CI(1.64–4.4)]. No differences were found between groups in relation to self reported need for and ability to access services for physical and mental health needs, or in use of physicians, walk-in clinics and emergency departments. The SED group were more likely to accept public health nurse home visits [OR 2.24, 95% CI(1.47–3.40)].ConclusionAlthough SED women experienced poorer mental and overall health they reported similar health service needs and utilization patterns to more SEA women. The results can assist policy makers, health service planners and providers to develop and implement necessary and accessible services. Further research is needed to evaluate SED postpartum women's health service needs and barriers to service use.
Highlights
Postpartum women who experience socioeconomic disadvantage are at higher risk for poor health outcomes than more advantaged postpartum women, and may benefit from access to community based postpartum health services
Of the 1000 women who entered the study at the four sites, socioeconomic status could only be determined for 726 participants due to missing data regarding family income and/or social support and/or Parkyn Postpartum Screen Scores; 295 women fell into the socioeconomically disadvantaged (SED) group and 431 women fell into the socioeconomically advantaged (SEA) group
The postpartum period presents a unique window of opportunity for community-based health and social service providers and programs to contribute to the elimination of health disparities experienced by SED women and in turn their children
Summary
Postpartum women who experience socioeconomic disadvantage are at higher risk for poor health outcomes than more advantaged postpartum women, and may benefit from access to community based postpartum health services. Women who are socioeconomically disadvantaged often experience inequities in health and health care In their daily lives they face chronic stressors such as poverty, lack of social support, isolation, racism, violence, language barriers, and low levels of education [2,3]. During the postpartum period SED women experience higher rates of postpartum depression, with reported rates between 22% and 30% [5,6,7,8] compared to 13% overall prevalence in the general population [9,10] They are more likely to suffer from iron deficiency than their more SEA counterparts [11]. In addition SED postpartum women have more problems adjusting to the parenting role [12], report higher rates of intimate partner violence [13,14], are less likely to breastfeed [15] and are less likely to have a partner [16]
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