Childbirth outcomes and ethnic disparities in Suriname: a nationwide registry-based study in a middle-income country

Verschueren et al. Reproductive Health (2020) 17:62 https://doi.org/10.1186/s12978-020-0902-7 RESEARCH Open Access Childbirth outcomes and ethnic disparities in Suriname: a nationwide registry-based study in a middle-income country Kim J. C. Verschueren1* , Zita D. Prüst1, Raëz R. Paidin2,3, Lachmi R. Kodan1,4,5, Kitty W. M. Bloemenkamp1, Marcus J. Rijken1,5 and Joyce L. Browne5 Abstract Background: Our study aims to evaluate the current perinatal registry, analyze national childbirth outcomes and study ethnic disparities in middle-income country Suriname, South America. Methods: A nationwide birth registry study was conducted in Suriname. Data were collected for 2016 and 2017 from the childbirth books of all five hospital maternity wards, covering 86% of all births in the country. Multinomial regression analyses were used to assess ethnic disparities in outcomes of maternal deaths, stillbirths, teenage pregnancy, cesarean delivery, low birth weight and preterm birth with Hindustani women as reference group. Results: 18.290 women gave birth to 18.118 (98%) live born children in the five hospitals. Hospital-based maternal mortality ratio was 112 per 100.000 live births. Hospital-based late stillbirth rate was 16 per 1000 births. Stillbirth rate was highest among Maroon (African-descendent) women (25 per 1000 births, aOR 2.0 (95%CI 1.3–2.8) and lowest among Javanese women (6 stillbirths per 1000 births, aOR 0.5, 95%CI 0.2–1.2). Preterm birth and low birthweight occurred in 14 and 15% of all births. Teenage pregnancy accounted for 14% of all births and was higher in Maroon women (18%) compared to Hindustani women (10%, aOR 2.1, 95%CI 1.8–2.4). The national cesarean section rate was 24% and was lower in Maroon (17%) than in Hindustani (32%) women (aOR 0.5 (95%CI 0.5–0.6)). Cesarean section rates varied between the hospitals from 17 to 36%. Conclusion: This is the first nationwide comprehensive overview of maternal and perinatal health in a middle income country. Disaggregated perinatal health data in Suriname shows substantial inequities in outcomes by ethnicity which need to be targetted by health professionals, researchers and policy makers. Keywords: Perinatal registry, Maternal mortality, Stillbirths, Middle-income country, Suriname, Ethnicity, Racial, Disaggregate Plain English summary In middle-income country Suriname we studied all hospital births to describe childbirth outcomes and to discover inequities by ethnicity. In 2016 and 2017, 18.290 women gave birth to a baby in either of the five hospitals, which * Correspondence: 1 Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, Utrecht, The Netherlands Full list of author information is available at the end of the article represents 86% of all national births in Suriname. There were 20 maternal deaths, resulting in a maternal mortality ratio of 112 per 100.000 live births. There were 285 stillbirths beyond 28 weeks of gestation, resulting in a late stillbirth rate of 16 per 1000 births. Stillbirth rate was highest in Maroon women (25 per 1000 births) and lowest in Javanese women (6 per 1000 births). Teenage pregnancies accounted for 14% of all births, was highest in Indigenous (21%) and Maroon (18%) women, and lowest in Hindustani (10%) and Chinese (3%) women. Babies with low birth © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Verschueren et al. Reproductive Health (2020) 17:62 weight accounted for 15% of all births and were most frequently seen in Hindustani women (18%). The cesarean section rate was 24%, but varied from 17 to 36% between the five hospitals. Hindustani women were almost twice more likely to receive a cesarean section than Maroon women (32 vs. 17%). Disaggregating perinatal health data is encouraged to identify and help target inequity within the health system. In conclusion, there are substantial inequities by ethnicity with Maroon women experiencing the highest risk on adverse outcomes (maternal mortality, stillbirth, increased preterm birth, low apgar score). The inequitable access to care experienced by women of African-descent requires policy makers to review possible interventions. Background Maternal and perinatal vital registration systems are essential to monitor outcomes of pregnant women and their offspring, identify inequities in service provision and health outcomes and facilitate quality control in perinatal care [1, 2]. Following lessons learned from the Millennium Development Goals (MDGs), the Sustainable Development Goals (SDGs) call for statistics “disaggregated by income, gender, age, race, ethnicity, migratory status, disability, geographic location and other characteristics relevant in national contexts” to monitor progress and identified inequities in health outcomes [2–4]. The Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016–2030 is a roadmap for ending all preventable maternal and newborn deaths (including stillbirths) and is central to the achievement of the SDGs [5]. This strategy urgently calls for the extension and strengthening of health information systems to generate high quality data and evidence to measure progress and be able to reach the target of a global maternal mortality ratio (MMR) under 70 per 100.000 live births and stillbirth rate (SBR) under 12 stillbirths per 1000 births [2, 6]. National childbirth registries have been established in several high income countries [7–9]. Low and middleincome countries (LMIC) are increasingly investing in robust national information on maternal and perinatal health indicators for SDG monitoring. However, given the complexity of establishing a well-functioning registry system, data collection in these countries is often not uniform, lack important indicators and data are frequently missing [1]. In many (currently, 34) Latin American and Caribbean countries, the Perinatal Information System (SIP), a digital clinical record and lo (...truncated)