A study published in the online version of BMJ Open shows that the number of stillbirths in the UK is twice as high amongst those who are the least well off, compared with the most affluent. Furthermore, the study results reveal that the uneven split occurs across all causes of stillbirth, and has not changed in 8 years.
The researchers evaluated the number of stillbirths in the UK from 2000 to 2007, focusing on the specific causes of stillbirth per 10,000 births by year of birth and deprivation levels, which were measured at area level, using the UK index of multiple deprivation. To evaluate the extent of potential inequality gaps, the team compared the most deprived 10ths with those who were least deprived.
During the 8-year period, they observed that 44 infants for every 10,000 births were stillborn, and that the rate did not change throughout the study period. They found that the rate of stillbirths amongst the most deprived 10th in England was double as high as stillbirths amongst the most affluent, and that the trend remained unchanged over the entire study period.
They noted that this inequality was evident across all specific incidents, with the exception of mechanical incidents like breech positions and that the largest inequality was noted in women with antepartum hemorrhage, i.e. who experienced bleeding before birth.
They furthermore observed that women who lived in the most deprived 10th of the UK had a three times higher risk of a stillbirth after an antepartum hemorrhage before their due date than those who lived in the most affluent 10th of the country.
The researchers note that previous pregnancies or having several pregnancies close together, tobacco consumption, and being either extremely young or old in terms of the reproductive age are all risk factors for this condition. They also note that stillbirths due to congenital abnormalities were almost three times as high amongst the most deprived women.
According to the study results, 59% of stillbirths were due to an unknown cause in the womb, which accounted for about half of the gap. Stillbirths remain relatively common irrespective of the health care improvements in developed nations. The researchers point out that the UK has one of the highest rates of stillbirths and that their findings confirm earlier trends.
The team concludes: “If the stillbirth rates seen in the least deprived areas were seen throughout the population, there would be a third fewer stillbirths in England, nearly 900 fewer every year.” They add that the fact that the stillbirth rate has dropped in other high-income countries indicates that there are factors that can be modified and therefore addressed.
Written by Petra Rattue