Joyce Caroline M, Sharma Deepti, Mukherji Arnab, Nandi Arijit
Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada.
Center for Public Policy, Indian Institute of Management Bangalore, Bengaluru, Karnataka, India.
PLOS Glob Public Health. 2024 Sep 18;4(9):e0003701. doi: 10.1371/journal.pgph.0003701. eCollection 2024.
Although India has made substantial improvements in public health, it accounted for one-fifth of global maternal and neonatal deaths in 2015. Stillbirth, abortion, and miscarriage contribute to maternal and infant morbidity and mortality. There are known socioeconomic inequalities in adverse pregnancy outcomes. This study estimated changes in socioeconomic inequalities in rates of stillbirth, abortion, and miscarriage in India across 15 years. We combined data from three nationally representative health surveys. Absolute inequalities were estimated using the slope index of inequality and risk differences, and relative inequalities were estimated using the relative index of inequalities and risk ratios. We used household wealth, maternal education, and Scheduled Caste and Scheduled Tribe membership as socioeconomic indicators. We observed persistent socioeconomic inequalities in abortion and stillbirth from rates of 2004-2019. Women at the top of the wealth distribution reported between 2 and 5 fewer stillbirths per 1,000 pregnancies over the study time period compared to women at the bottom of the wealth distribution. Women who completed primary school, and those at the top of the household wealth distribution, had, over the study period, 5 and 20 additional abortions per 1,000 pregnancies respectively compared to women who did not complete primary school and those at the bottom of the wealth distribution. Women belonging to a Scheduled Caste or Scheduled Tribe had 5 fewer abortions per 1,000 pregnancies compared to other women, although these inequalities diminished by the end of the study period. There was less consistent evidence for socioeconomic inequalities in miscarriage, which increased for all groups over the study period. Despite targeted investments by the Government of India to improve access to health services for socioeconomically disadvantaged groups, disparities in pregnancy outcomes persist.
尽管印度在公共卫生方面取得了显著进步，但在2015年，该国的孕产妇和新生儿死亡人数仍占全球的五分之一。死产、流产和堕胎导致了孕产妇和婴儿的发病和死亡。已知不良妊娠结局存在社会经济不平等现象。本研究估计了印度15年间死产、流产和堕胎率的社会经济不平等变化。我们合并了三项具有全国代表性的健康调查数据。使用不平等斜率指数和风险差异估计绝对不平等，使用不平等相对指数和风险比估计相对不平等。我们将家庭财富、母亲教育程度以及在册种姓和在册部落成员身份作为社会经济指标。我们观察到2004年至2019年期间堕胎和死产存在持续的社会经济不平等现象。在研究期间，财富分配顶端的女性每1000次怀孕的死产数比财富分配底端的女性少2至5例。在研究期间，完成小学教育的女性以及家庭财富分配顶端的女性每1000次怀孕的堕胎数分别比未完成小学教育的女性以及财富分配底端的女性多5例和20例。属于在册种姓或在册部落的女性每1000次怀孕的堕胎数比其他女性少5例，不过这些不平等在研究期结束时有所减少。关于流产的社会经济不平等证据不太一致，在研究期间所有群体的流产率都有所上升。尽管印度政府进行了有针对性的投资，以改善社会经济弱势群体获得医疗服务的机会，但妊娠结局的差异仍然存在。
