Abstract:
Background: Numerous studies have explored the
association between educational inequalities and
stillbirth but most have failed to elaborate how low
educational attainment leads to an increased risk of
stillbirth. We hypothesised that use of biomass fuels
and consumption of unsafe water related to low
educational attainment could explain the stillbirth
burden in Ghana attributable to socioeconomic
disadvantage.
Methods: Data from the 2007 Ghana Maternal Health
Survey, a nationally representative population-based
survey were analysed for this study. Of the10 370
women aged 15–49 years interviewed via structured
questionnaires for the survey, 7183 primiparous and
multiparous women qualified for inclusion in the
present study. Results: In a logistic regression analysis that adjusted
for age, area of residence, marital status and ethnicity
of women, lower maternal primary education was
associated with a 62% (OR=1.62; 95% CI 1.04 to
2.52) increased lifetime risk of stillbirth. Biomass fuel
use and consumption of unsafe water mediated 18%
and 8% of the observed effects, respectively. Jointly
these two exposures explained 24% of the observed
effects. The generalised additive modelling revealed a
very flat inverted spoon-shaped smoothed curve which
peaked at low levels of schooling (2–3 years) and
confirms the findings from the logistic regression
analysis.
Conclusions: Our results show that biomass fuel use
and unsafe water consumption could be important
pathways through which low maternal educational
attainment leads to stillbirths in Ghana and similar
developing countries. Addressing educational
inequalities in developing countries is thus essential for
ensuring household choices that curtail environmental
exposures and help improve pregnancy outcomes.
