An Investigation of Ethnic and Socioeconomic Inequalities in Stillbirth Rates Using National Perinatal Mortality Surveillance Data for England

Background: Stillbirths, where a baby dies before or during birth, are a major public health issue. Stillbirth rates in the UK were higher than many high-income countries and targets have been set to reduce rates by 2025. Stillbirth rates differ by geography, socioeconomic deprivation and ethnicity, but research of the complex intersectionality between social risk factors is limited.

Methods: I investigated the use of perinatal mortality surveillance data linked with routine birth notification data to monitor stillbirth inequalities, exploring the availability and measurement of ethnicity and socioeconomic status across the UK. This study makes an original contribution to the field through the use of person centred methods to describe the complex intersectionality between ethnicity and socioeconomic status, identifying groups of women with similar social factors and exploring differences in stillbirth rates between these groups. I used variable centred methods of analysis to look at stillbirth inequalities by disaggregated ethnicity, exploring time trends and differences in cause of stillbirth between ethnic groups. Finally, I compared the two methods to provide further insight on stillbirth inequalities in England and optimal ways of monitoring them in the future.

Key Findings: The monitoring of socioeconomic and ethnic inequalities in stillbirth rates is hindered by a lack of harmonised data across the UK and a lack of detailed information for live births. However, the use of measures of multiple deprivation provided little improvement over the measure of income deprivation currently in use by MBRRACE-UK perinatal mortality surveillance. Person centred methods of analysis allowed for the complex intersections between factors to be explored. However, this was at the loss of information on individual risk factors. Variable centred methods showed persistent inequalities, highlighting the importance of reporting on disaggregated ethnic groups, with Indian, Pakistani and Bangladeshi ethnicities having different stillbirth risk, and different socioeconomic backgrounds.