Social Influences on Maternal Health: A Norwegian Register-Based Study.

Background: Maternal health is an important health indicator globally, and a major women's health issue. Efforts to improve maternal health can help ensure that women, their offspring, and their families reach their full potential for health and well-being.

Objectives: We analysed how social factors influence adverse maternal health outcomes and non-spontaneous delivery.

Methods: We leveraged data from the population-based Norwegian register, including use of the Medical Birth Registry of Norway (MBRN), the Norwegian Patient Registry (NPR), Statistics Norway (SSB) and the Norwegian Control and Payment of Health Reimbursements Database (KUHR), to analyse the relationships between education, income and immigrant status, and 11 adverse health and non-spontaneous delivery. The study included data from 596,306 pregnancies registered in Norway between 2009 and 2018.

Results: We found that the frequency of adverse health outcomes and of non-spontaneous delivery decreased with each increase in educational attainment and income. Compared to completion of lower secondary education or less, achieving a graduate-level education was associated with a 36% lower risk of an adverse maternal health outcome after adjusting for age, parity and county. The risk was 18% lower for the highest compared to the lowest income quintile. The highest educated group had 35% lower risk of non-spontaneous delivery than the lowest educated, with the same adjustments. The highest income group had a 16% lower risk of such deliveries than the lowest. Descendants of immigrants face higher risk of adverse health outcomes than immigrants. Higher maternal age partly mitigates the higher health risk among women with low income and education.

Conclusions: Even though access to care is more equitable in Norway than in many other countries, we still found a pattern of risk associated with social determinants of health.