The impact of socioeconomic position of severe maternal morbidity outcomes amongst women in the UK and Australia

Thesis

Aims: The aims of this thesis are to investigate the risk of severe maternal morbidity amongst women from different socioeconomic groups in the UK, explore why these differences exist and compare these findings to the setting in Australia.

Methods: Three separate analyses were conducted. The first used UK Obstetric Surveillance System (UKOSS) data to assess the incidence and independent odds of severe maternal morbidity by socioeconomic group in the UK. The second analysis used quantitative and qualitative data from the 2010 UK National Maternity Survey (NMS) to explore the possible reasons for the difference in odds of morbidity between socioeconomic groups in the UK. The third analysis used data from the Victorian Perinatal Data Collection (VPDC) unit in Australia to assess the incidence and odds of severe maternal morbidity by socioeconomic group in Victoria.

Results: The UKOSS analysis showed that compared with women from the highest socioeconomic group, women in the lowest ‘unemployed’ group had 1.22 (95%CI: 0.92 – 1.61) times greater odds associated with severe maternal morbidity. The NMS analysis demonstrated that independent of ethnicity, age and parity, women from the lowest socioeconomic quintile were 60% less likely to have had any antenatal care (aOR 0.40; 95%CI 0.18 – 0.87), 40% less likely to have been seen by a health professional prior to 12 weeks gestation (aOR 0.62; 95%CI 0.45 – 0.85) and 45% less likely to have had a postnatal check with their doctor (aOR 0.55; 95%CI 0.42 – 0.70) compared to women from the highest quintile. The Victorian analysis showed that women from the lowest socioeconomic group were 21% (aOR 1.21; 95%CI 1.00 – 1.47) more likely and that Aboriginal and Torres Strait Islander women were twice (aOR 2.02; 95%CI 1.32 – 3.09) as likely to experience severe morbidity.

Discussion: The results suggest that women from the lowest socioeconomic group in the UK and in Victoria have increased odds of severe maternal morbidity. Further research is needed into why these differences exist and efforts must be made to ensure that these women are appropriately prioritised in the future planning of maternity services provision in the UK and Australia.

Authors: Lindquist, A; Anthea Lindquist

• Publication date: 2013
• DOI: 10.5287/ora-xo1rqzmoz
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: Oxford University, UK
• Language: English
• Keywords: socioeconomic; morbidity; disadvantage; maternal
• Subjects: Obstetrics; Social disadvantage; Public Health; Social Inequality; Statistics (social sciences); Health and health policy