Economic challenges contribute to rise in stillbirths among immigrants in Spain

Poor access to prenatal care, education cited as contributors

November 15, 2013 — Immigrant women who live in regions of Spain with high unemployment rates are three times more likely to have stillborn infants than Spanish-born women living in more thriving areas of the country, according to a study by an international team of scientists led by Harvard School of Public Health (HSPH). Many poor women with low levels of education who have migrated in recent years to Spain from Sub-Saharan Africa and other developing countries were particularly affected, the researchers reported.

The study was published in the October 2013 issue of the European Journal of Epidemiology. The study is believed to be the first to show the effect of unemployment on stillbirth at a national level.

Poor access to prenatal and other medical care for undocumented immigrants in Spain contributes to the number of stillbirths. “Currently, the Spanish government has banned access to preventive care for undocumented immigrants,” said lead author Miguel Angel Luque Fernandez, researcher in the Department of Epidemiology at HSPH. “But it is more expensive for a health care system to deal with stillbirths than healthy newborn infants in terms of socioeconomic and human costs. Instead of banning prenatal care for undocumented migrant women, governments should reinforce access to preventive health care for immigrant pregnant women and provide them support.”

The study included 1,920,235 single, live births and 5,560 stillbirths from 2007 to 2010 in Spain. Women living in regions of Spain with the highest unemployment rates had a 160% greater chance of delivering a stillborn than those living in areas with lower unemployment. The odds of stillbirth were nearly twice as high for African-born women than for Spanish-born women, and also were nearly double for women with low educational attainment compared to women with higher education levels.

Over the last decade, Spain has experienced a dramatic demographic change due to immigration. In 2007, 24% of reproductive-age women in Spain were foreign-born as compared with 10 years earlier. In addition, foreign-born women typically have twice the number of pregnancies as native Spanish women, which may contribute to the higher number of stillbirths.

Pre-existing medical conditions, such as malnutrition, malaria, HIV, and other infections, contribute to the higher risk of stillbirths among newly arriving foreign-born women in Spain, particularly those emigrating from Sub-Saharan African countries, the authors wrote.

“Socio-economic adversity and related psychosocial stressors are important determinants of the health and wellbeing of mothers and children. This study demonstrates the link between macroeconomic changes and history of social inequity and health outcomes in the most vulnerable populations,” said senior author Michelle Williams, Steven B. Kay Family Professor of Public Health at HSPH; chair, Department of Epidemiology at HSPH, and director of the Harvard Catalyst Health Disparities Research Program.

Bizu Gelaye, program director of the Multidisciplinary International Research Training Program, based in the Department of Epidemiology at HSPH, also participated in the study, as did researchers from John Hopkins School of Public Health in Baltimore; the University of Cape Town, South Africa; the Hospital Las Cruces in Bilbao, Spain; the University of Alcala de Henares, Madrid, Spain; and the University of Newcastle, Australia.

Marge Dwyer