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The contribution of maternal working conditions to socio-economic inequalities in birth outcome
Stockholm University, Faculty of Social Sciences, Department of Sociology.
2008 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 66, no 6, 1297-1309 p.Article in journal (Refereed) Published
Abstract [en]

The aims of this study were to examine the association between maternal working conditions and birth outcomes, and to determine the extent to which these contributed to class inequalities in six birth outcomes. We used an existing job exposure matrix developed from survey data collected in 1977 and 1979 to apply occupational-level information on working conditions to the national Swedish Registry, including approximately 280,000 mothers and 360,000 births during the period 1980–1985. Data were analysed using multivariate logistic regressions. Low levels of job control, high levels of physical demands and job hazards were more common in manual compared to non-manual classes. The self-employed had intermediate levels of such exposures. Job exposures, particularly low levels of job control, were generally and significantly associated with higher risks for low birthweight, very low birthweight, small for gestational age, all preterm, very preterm and extremely preterm births, but not with mortality. Compared to middle non-manuals (the reference group), lower non-manual and manual classes had higher risks for all birth outcomes, and these risks were nearly all significant. The highest odds ratios were found for skilled and unskilled manual workers in the manufacturing sector, with ratios between 1.35 and 2.66 (all significant). Job control explained a considerable proportion of inequalities in all birth outcomes. Job hazards contributed particularly to very low birthweight and extremely preterm birth, and physical demands to low birthweight and all preterm births. In conclusion, class differences in maternal working conditions clearly contributed to class differences in low birthweight (explained fraction 14–38%), all preterm births (20–46%), very (14–46%) and extremely (12–100%) preterm births. For very low birthweight and small for gestational age, there was a similar contribution in the manufacturing sector only. For all birth outcomes, class differences could still be detected after working conditions were taken into consideration.

Place, publisher, year, edition, pages
Elsevier Ltd , 2008. Vol. 66, no 6, 1297-1309 p.
Keyword [en]
Working conditions; Birth outcome; Socio-economic inequalities; Sweden
National Category
Social Sciences
URN: urn:nbn:se:su:diva-24241DOI: 10.1016/j.socscimed.2007.11.036ISI: 000254266900005OAI: diva2:197080
Part of urn:nbn:se:su:diva-6803Available from: 2007-05-03 Created: 2007-05-03 Last updated: 2010-09-14Bibliographically approved
In thesis
1. The first injustice: Socio-economic inequalities in birth outcome
Open this publication in new window or tab >>The first injustice: Socio-economic inequalities in birth outcome
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Adverse birth outcomes like preterm birth and infant mortality are unevenly distributed across socio-economic groups. Risks are usually lowest in groups with high socio-economic status and increase with decreasing status.

The general aim of this thesis was to contribute to the understanding of the relation between socio-economic status and birth outcomes, focussing on maternal education and class, studying a range of birth outcomes. More specific aims were to investigate the relation between maternal education and infant health, to study the combined influence of maternal childhood and adult social class on inequalities in infant health and to explore the contribution of maternal working conditions to class inequalities in birth outcomes. The studies are population based, focussing on singletons births 1973-1990. During the period under study, educational differences in birth outcomes increased, especially between those with the lowest and highest education. The low birth weight paradox emerged, suggesting that the distribution of determinants for low birthweight infants differs for these groups.

Further, an independent association was found between maternal childhood social class and low birthweight and neonatal mortality, but not for postneonatal mortality. Since this was found for the two outcomes closest to birth, this indicates that the association is mediated through the maternal body.

Finally, there is a contribution of maternal working conditions to class inequalities in birth outcome. Lower job control, higher job hazards and higher physical demands were all to some degree related to increased risk of the following adverse birth outcomes: infant mortality, low birthweight, very low birthweight, foetal growth, preterm birth, very and extremely preterm birth. Working conditions demonstrated disparate associations with the birth outcomes, indicating a high complexity in these relationships.

Place, publisher, year, edition, pages
Centre for Health Equity Studies, CHESS, 2007. 142 p.
Health Equity Studies, ISSN 1651-5390 ; 8
Sweden, socio-economic inequalities, birth outcome, infant mortality, low birthweight paradox, working conditions
National Category
Research subject
urn:nbn:se:su:diva-6803 (URN)978-91-7155-429-1 (ISBN)
Public defence
2007-05-25, Aula Svea, Socialhögskolan, Sveaplan, Stockholm, 13:00
Available from: 2007-05-03 Created: 2007-05-03Bibliographically approved

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