A research report submitted to the Faculties of Health Sciences and Humanities, Schools of Public Health and Social Sciences, University of Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Arts in the field of Demography and Population Studies, October 2017Background: Various international and national commitments and interventions that focus
on improving maternal, newborn and child health have been established in South Africa.
Irrespective of these efforts, adverse pregnancy outcomes (stillbirths and miscarriages)
remain invisible within policies and programmes intended to reduce this public health burden
thus leading to its high rate in South Africa. This mismatch of burden to action is due to
several factors that keep stillbirths and miscarriages hidden, notably underreporting which
leads to a lack of data and a lack of consensus on priority interventions and, social taboos that
reduce the visibility of stillbirths and the associated family morning. While studies have
identified a number of individual demographic and socioeconomic factors associated with
stillbirths and miscarriages, the role of household socioeconomic factors remain unexplored.
Poor socioeconomic conditions within a household have broadly been linked with poor health
and negative birth outcome among pregnant women. This study therefore sought to identify
demographic and household socioeconomic associated with stillbirths and miscarriages in
South Africa.
Methods: This study utilized secondary data from the 2010 – 2014 South African General
Household Survey (SAGHS). The study sample comprises of women of reproductive age 15
49 years who were resident in the households selected to participate in the SAGHS. A sample
of 248,057 women were included in the study; these are women who reported to have been
pregnant in the last 12 months preceding the survey from 2010-2014. The population of
interest in this study are South African women whose pregnancy has ended in a stillbirth and
or a miscarriage. The outcome variable was pregnancy outcomes (stillbirths, miscarriages and
others) while predictor variables include household wealth status, maternal age, source of
drinking water, type of toilet facility, sex of household head, province of residence,
household electricity, population group and HIV status. Data analysis was done in three
stages. First, univariate analysis was done to provide descriptive results of the study
population. The second staged involved a bivariate analysis producing odds ratios to examine
the association between each predictor variable with each pregnancy outcome. The third
stage included an unadjusted (bivariate) and adjusted (multivariate) multinomial logistic
regression producing relative risk ratios (RRRs) to examine the demographic and household
socioeconomic determinants of stillbirths and miscarriages.
Results: The levels of stillbirths were 0.17% and 0.37% in 2013 compared to 0.11% and
0.12% respectively. The stillbirth rate (SBR) from 2010-2014 was 25.7 per 1000 births while
miscarriage rate was 24.5 per 1000 pregnancies. Results from the multinomial logistic
regression showed that maternal age, race, sex of household head, province of residence,
source of drinking water, type of toilet facility, geographic type, household wealth index,
hypertension and HIV positive status are significant determinants of stillbirths and
miscarriages among women in South Africa. Advanced maternal age (34-39 and 40-44
years), rural residence, being Black, use of other type of toilet facilities, poor wealth quintile,
Northern Cape province, being 000HIV positive and drinking piped water are associated with
an increased risk of stillbirths and miscarriages.
Conclusion: This study found that demographic and household socioeconomic factors are
associated with pregnancy outcomes (stillbirths and miscarriages) among women aged 15-49
years in South Africa. This study has demonstrated the fact that household socioeconomic
factors are important in understanding the determinants of stillbirths and miscarriages. Thus,
the outcomes of pregnancy are not separable from the socioeconomic conditions of the
pregnant women within a household as maternal poverty can translate to poor foetal health.
Interventions on maternal, newborn and child health should also be more targeted at these
pregnancy outcomes as stand-alone health indicators to address the dearth of data and to
ensure proper monitoring. Furthermore, women in remote areas who do not have access to
electricity, toilet facilities and other important assets in their household should be prioritized
by programs on poverty alleviation. Lastly, it is crucial that quality obstetric care services
should be made available, accessible and affordable for women in remote areas. This may
improve the outcomes of pregnancy through early detection of pregnancy complications.XL201
