Adverse birth outcomes due to inequality

[orangesky1]

Guardian article today - thousands of adverse birth outcomes in the UK due to inequality - racial and socioeconomic.

This includes still birth, growth restriction, pre term delivery. Heartbreaking.

Article makes a few loose comments about possible reasons. What do you think? Is it access to nutrition, education, healthcare during pregnancy? Discrimination (overt or not) by providers? I would be interested in your thoughts.

www.theguardian.com/lifeandstyle/2021/nov/01/thousands-of-adverse-birth-outcomes-in-england-down-to-alarming-inequality

It depends on the particular deprived groups. Amongst all deprived groups both obesity and nutritional deficiency is more common. In Asian communities (particularly those from Pakistan and Bangladesh) cousin marriage is far more prevalent and the genetic impact of that has a huge impact. In poor whites, poor black British and poor black Caribbean both smoking and drinking during pregnancy are more common, both of which carry significant risks.

From the article:
Adjusting for ethnicity, maternal smoking and body mass index (BMI) substantially reduced these inequalities. That suggests that these characteristics can explain a considerable part of the socioeconomic inequalities in pregnancy outcomes.

All of the above. But it’s no surprise that rich women have better birth outcomes than poor women.

Rich women are often more able to advocate for themselves and able to research their own options and not take what a doctor says as gospel. They are also more likely to be involved in the decision making process. Poorer women are more likely to go ahead with what they have been told by a doctor and not question it as the doctor is the expert. If they are less educated to boot they may not have the confidence, resources or understanding to be able to challenge them. Often they will agree to more interventions which have poorer outcomes. For some women of different ethnic backgrounds they may have poor English and not be able to grasp scientific language that well.

There is also internal bias to deal with if you are asian and black. I felt I was expected to be compliant and had to deal with an exasperated registrar when I questioned why I needed an induction with my eldest child, pointed out that it was unlikely to work as it was so early and would likely result in a section. It wasn't explained to me, I was given a leaflet to read and they didn't expect me to be well informed. I'm an asian women and a hcp. I feel I have to shout that bit louder than a white woman to be heard and acknowledged.

My dh came with me to my midwife appointments purely because he was excited and wanted to support me. When asking whether I wanted to have tests done to see if baby had downs etc she directed the question at my dh and not me. She said there wasn't any point in doing them of we wouldn't terminate (we are Muslim so she made the assumption). Dh agreed there probably wasn't any point until I reminded them both that I was the patient, I did want all tests done and ultimately any decisions as to whether I progressed the pregnancy were mine alone. She was taken aback.

Its sadly not surprising at all.

Probably due to worse living conditions as well. We went to look at a flat a few months ago where the tenant was a heavily pregnant lady with a toddler and it was really damp/mouldy