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Association of marital status and years of schooling with perinatal outcome: The influence of pre-natal care as an intermediate variable

1982; De Gruyter; Volume: 10; Issue: 2 Linguagem: Inglês

10.1515/jpme.1982.10.2.105

1619-3997

Aníbal Faúndes, Ellen Hardy, J.F De La Jara Diaz, José Aristodemo Pinotti,

Child and Adolescent Health

The association between mother's education and perinatal mortality, and between marital status and proportion of preterm deliveries was analyzed using data from 20,000 women and newborns delivered at the Hospital Barros Luco-Trudeau in Santiago, Chile. A highly significant correlation was found, but after being controlled by pre-natal care, that association disappeared for those mothers with good pre-natal care, remaining only as a part of the association for women who did not attend the pre-natal clinics or did not follow minimal standards of care. The definition used for "good pre-natal care" was much less demanding than WHO recommendation. We required a minimum of only 5 visits, starting before the 5th month of the pregnancy and with blood pressure and body weight registered at each visit. Pre-natal assistance was provided mostly by registered midwives, with occasional consultation by physicians. The efficiency of a low cost health activity, such as pre-natal care, in improving infant health is held in contrast with the inefficiency of high cost technology when applied to developing countries' health problems.This paper studies the association between mother's education and perinatal mortality, and between marital status and prematurity; the role of prenatal care (PNC) as a variable which may explain these associations is stressed. Over 20,000 births were registered during late 1969 and mid 1971 at the department of Obstetrics and Gynecology of the Barros Luco-Trudeau Hospital in Santiago, Chile. The population observed was strictly low income, with a low educational level; they either had medical social security insurance, or could not pay at all. A precoded obstetrics form was used to record data which were stored on a computer tape. PNC was defined as good if the mother had had a minimum of 5 visits, starting before the 5th month of pregnancy; a much less demanding definition than the one recommended by the World Health Organization. The highest proportion of preterm deliveries, 26%, was in the single women group, followed by women in consensual union, or commonlaw marriage, 24%, and by married women, 21.3%. Perinatal mortality rate was 47.2/1000 in women with 2 years of schooling, 37/1000 with 3-8 years, and 29.5/1000 with 9 or more years of schooling. When PNC was considered only 35% of single women, and 37% of those in common law unions had good PNC, compared to 57% of married women. 40% of women with little education had good PNC, as compared to 48% of those with 3 or more years of school, and 53% of those with higher education. Preterm deliveries were 26.4% among women with poor or no PNC, and 17.3% among women with good PNC. Perinatal mortality was 42% and 24.6%, respectively. The proportion of preterm deliveries in women with good PNC was .195 in single, .175 in common law union, and .170 in married women; the same proportions, but with poor or no PNC, were .289, .262, and .258 among the same groups, showing that the difference for marital status was no longer significant among women with good PNC. Perinatal mortality was significantly lower for good PNC among women with elementary education, but there were no differences in the group with up to 2 years of schooling nor in the group with some secondary school education; however, perinatal mortality between women with up to 2 years of schooling and women with some high school education were significant for those with no or poor PNC. These results show that appropriate PNC is much more important than educational status or marital status in improving perinatal outcome. More efforts must be made to bring primary health care to the largest possible segment of the population. It also seems that high medical technology aimed at reducing perinatal risk may be very effective in industrialized countries, but in developing countries simple, low-cost prenatal care would probably be more effective.