Authors
Kirill Danishevski
Dina Balabanova
Martin McKee
Ellen Nolte
Nina Schwalbe
Natalia Vasilieva
1 - Open Society Institute, US
2 - London School of Hygiene and Tropical Medicine, UK
3 - Moscow Medical Sechenov Academy, Russia
Abstract
Background. Perinatal mortality in Russia remains considerably higher than in western industrialised countries yet the underlying reasons have been subject to relatively little detailed research. This study takes advantage of a unique information system implemented in an otherwise typical Russian region to explore the determinants and consequences of adverse pregnancy outcomes. Aim. To describe the distribution of pregnancy outcomes (birthweight, ponderal index, pre-term delivery) in a Russian region, in 2000, comparing them with other industrialised countries and identifying their socio-demographic determinants. To assess the impact of the distribution of birthweight on perinatal mortality. Methods. The study included all births and perinatal deaths recorded as occurring in Tula oblast, Russia, in year 2000. There were 11,172 births, including 116 stillbirths and 74 dying within 7 days. Results. Perinatal mortality in Tula in 2000 was 16.8/1,000 births, slightly higher than the figure for Russia overall. The frequency of low birthweight, low ponderal index and pre-term birth were higher in Tula than in other industrialised countries. Mean birthweight increased with increasing education and was higher in married than single mothers, and ethnic Russians than others. After adjustment for maternal age, parity and baby’s sex, birthweight was 250 g less in those with secondary or less education compared with those with university education. The gradient was steeper than in other industrialised countries. Ponderal index behaved similarly, although the association was only significant for maternal education. Once born, survival is substantially lower at all birthweights than in Sweden, chosen as it has the lowest perinatal mortality in Europe. However, had the Swedish birthweight distribution applied, the perinatal mortality rate would only have fallen to 14.4/1,000, although disaggegation by birthweight reveals fewer than expected deaths at under 1,000 g. If this is adjusted for, the estimated perinatal mortality rate for Tula would be 21/1,000. Conclusions. A new system for collecting data on obstetric care in Russia has provided valuable information that can be used to inform the development of effective policies, and which could usefully be implemented elsewhere. At present, despite the introduction of international definitions of birth outcomes, Russian data appear still to underestimate perinatal mortality, even in an Oblast with enhanced data collection. There are wide inequalities in foetal development, especially in relation to maternal education, and the adverse outcomes seen in Russia appear to be due to a combination of both an adverse profile of foetal development, implying the need for policies that improve the health of prospective mothers, and poor survival, implying the need for more effective care for new-born infants.
