Journal of Iranian Social Studies

Examining stillbirth at the intersection of contextual inequalities in Iran

Document Type : Original Article

Authors

Hananeh Sadeghi 1
Fatemeh Torabi 2
Hassan Eini-Zinab 3
Mahmoud Ghazi Tabatabaei 4
heidarzadeh Mohammad 5

1 Department of Social Sciences, University of Tehran. Tehran.Iran

2 Associate Professor of Demography, Faculty of Social Sciences, University of Tehran. Tehran. Iran

3 Department of Community Nutrition, Shahid Beheshti Medical University. Tehran. Iran.

4 University of Tehran. Tehran. Iran

5 Zahedan University of Medical Sciences, Zahedan. Iran

https://doi.org/10.22034/jss.2023.1973966.1741
Abstract
Although Iran has achieved stillbirth target of Every Newborn Action Plan (≤12 stillbirths per 1000 total births by 2030) at national level, there are still notable contextual inequalities (spatial and socioeconomic) in stillbirth. The purpose of this study is to explain the inequality in stillbirth, using the intersectionality approach that McGibbon proposes in the field of the right to access health care. We used the Iranian Maternal and Neonatal Network (IMAN) for the period of 2013-2020. The indicators extracted from this study showed that mothers who experience several disadvantages at the same time (like non-Iranian mothers who gave birth in the fifth geographic region of Iran (the east), or uninsured mothers over 45 years), experience stillbirth more frequently compared to their counterparts. We came to this conclusion that the intersection of three areas of social determinants of health (maternal education level, type of hospital, type of insurance), the isms (nationality and maternal age) and geographic or spatial contexts (urban-rural residency, the geographical area of birthplace) can create synergy with each other and cause some groups of mothers who belong to the most vulnerable strata of the society to be oppressed more. The main policy suggestion of this research is to reduce stillbirth by considering the intersection of inequalities instead of individual axes of inequality.
 

Keywords

Inequality
intersectionality
stillbirth
Iran
ریتزر، جورج و داگلاس جی. گودمن. (۱۳۹۰). نظریه ی جامعه­شناسی مدرن، (ترجمه­ خلیل میرزایی و عباس لطفی زاده)، تهران: جامعه­شناسان.
سالنامه ی آماری ۱۳۹۷. سازمان ثبت احوال کشور. قابل دسترس در www.sabteahval.ir.
قاسمی، الهام. (۱۴۰۰)، مطالعه ی تعیین کننده های بهره مندی مهاجران افغانستانی در ایران از خدمات کنترل عفونت های مقاربتی و نحوه ی هم افزایی آن ها و پیشنهاد راهکار برای آن: یک رویکرد اینترسکشنال، رساله دکتری ، دانشگاه علوم پزشکی تهران.
معاونت بهداشت. دفتر سلامت جمعیت، خانواده و مدارس، ادراه­ی سلامت نوزادان، بسته­ی خدمتی مراقبت از نوزاد سالم در کشور.
معاونت بهداشت. دفتر سلامت جمعیت، خانواده و مدارس، ادراه­ی سلامت نوزادان، سامانه ملی مادر و نوزاد ایران. مرکز تحقیقات کودکان دانشگاه علوم پزشکی تبریز.
Bauer G. R. (2014) “Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity”. Social Science & Medicine, 110, 10–17.
Bowleg L. (2012) “The problem with the phrase “women and minorities”: Intersectionality, an important theoretical framework for public health”. American Journal of Public Health, 102, 1267–1273.
Bowleg, L., & Bauer, G. (2016) “Invited Reflection: Quantifying Intersectionality”. Psychology of Women Quarterly, 40 (3), 337–341. 
Caiola, C., Docherty, S. L., Relf, M., & Barroso, J. (2014) “Using an intersectional approach to study the impact of social determinants of health for African American mothers living with HIV”. ANS. Advances in nursing science, 37 (4), 287–298.
Coley, S. L. and Nichols, T. R. (2016) “Race, Age, and Neighborhood Socioeconomic Status in Low Birth Weight Disparities Among Adolescent Mothers: An Intersectional Inquiry”, Journal of Health Disparities Research and Practice: Vol. 9 : Iss. 4 , Article 1.
de Bernis L, Kinney MV, Stones W, et al. (2016) “Stillbirths: ending preventable deaths by 2030”. Lancet, 387(10019):703-716.
Ebrahimi N, Shahin S, Koolaji S, Ghanbari A, Mehdipour P, Masinaei M, et al. (2023) Predicting Iran’s achievement to Sustainable Development Goal 3.2: A systematic analysis of neonatal mortality with scenario-based projections to 2030. PLoS ONE.18(4): e0283784.
Ghasemi, E., Majdzadeh, R., Rajabi, F, et al. (2021) “Applying Intersectionality in designing and implementing health interventions: a scoping review”. BMC Public Health, 21, 1407.
Guarnizo-Herreño CC, Torres G, Buitrago G. (2021) “Socioeconomic inequalities in birth outcomes: An 11-year analysis in Colombia. PLoS ONE, 16(7): e0255150.
Hajipour M, et al. (2019) “the Pre-Pregnancy Risk Factors of Stillbirth in Pregnant Iranian Women: A Population-Based Case-Control Study”. Health Scope, 8(3):e64034.
Harari, Lexi & Lee, Chioun. )2021( “Intersectionality in quantitative health disparities research: A systematic review of challenges and limitations in empirical studies”, Social Science & Medicine, vol. 277(C).
Hankivsky, O., Reid, C., Cormier, R, et al. (2010) “Exploring the promises of intersectionality for advancing women's health research”. Int J Equity Health 9, 5.  
Heard, Emma, Fitzgerald, Lisa, Wigginton, Britta and Mutch, Allyson. (2019) “Applying intersectionality theory in health promotion research and practice”, Health Promotion International 35 (4) 866-876.
Holman, D., Salway, S., Bell, A, et al. (2021) “Can intersectionality help with understanding and tackling health inequalities? Perspectives of professional stakeholders”. Health Research Policy and Systems, 19 (1). 97.
Jansen, P.W. (2009) “Social inequalities in pregnancy outcomes and early childhood behaviour: the Generation R study”. Erasmus University Rotterdam.
Kaforau, L., Tessema, G. A., Jancey, J., Dhamrait, G., Bugoro, H., & Pereira, G. (2022) “Prevalence and risk factors of adverse birth outcomes in the Pacific Island region: A scoping review”. The Lancet regional health. Western Pacific, 21, 100402.
Khalili N, Heidarzadeh M, Habibelahi A, Tayefi B, Ramezani M, Rampisheh Z, Tehrani-Banihashemi A, Mirbaha F, Raji F, Babaee E, Taghizadeh Asl R, Moradi-Lakeh M, Naghavi M, Mokdad AH (2020) “Stillbirth in Iran and associated factors (2014-2016): A population-based study”. Med J Islam Repub Iran 34-38.
Khatri, R. B., Alemu, Y., Protani, M. M., Karkee, R., & Durham, J. (2021) “Intersectional (in) equities in contact coverage of maternal and newborn health services in Nepal: insights from a nationwide cross-sectional household survey”. BMC public health, 21(1), 1098.
Lawn, J.S., Yakob, M.Y., Haws, R.A., et al. (2009) “3.2 Million Stillbirths: Epidemiology and Overview of the Evidence Review”. BMC Pregnancy Childbirth, 9, 52.
López, Nancy and Vivian L. Gadsden. )2016( “Health Inequities, Social Determinants, and Intersectionality,” in Perspectives on Health Equity & Social Determinants of Health, edited by K. Bogard, V.M. Murry and C. Alexander. Washington DC: National Academy of Medicine.
Marandi, S. A., Farrokhzad, N., Moradi, R., Rezaeizadeh, G., Shariat, M., & Nayeri, F. S. (2019) “Review of the Iranian Newborns' Health, Survival, and Care and Future Challenges”. Archives of Iranian medicine, 22(7), 403–409.
McGibbon & McPherson. (2011) “Applying Intersectionality & Complexity Theory to Address the Social Determinants of Women’s Health”. Women's Health and Urban Life, 10 (1) 59-86.
Mikkonen, J. & Raphael, D. (2010) “Social Determinants of Health: The Canadian Facts”. Toronto: York University.
Raphael, D. (2009) “Social Determinants of Health. (2nd Ed.) ”. Toronto: Canadian Scholar’s Press.
Raphael, D. (2004) “Strengthening the social determinants of health: The Toronto Charter for a healthy Canada”. In D. Raphael (Ed.). The Social Determinants of Health: Canadian Perspectives (361-365). Toronto: Canadian Scholar’s Press.
Reeske, A., Kutschmann, M., Razum, O. et al. (2011) “Stillbirth differences according to regions of origin: an analysis of the German perinatal database”, 2004-2007. BMC Pregnancy Childbirth 11, 63
Safaei Nezhad A, Akrami F, Kharaghani R, Rastegari L. (2018) “Maternal, Fetal, and Delivery Risk Factors for Stillbirth: A Population-Based Study” jccnursing, 11(3), 1-6
Tehrani-Banihashemi, A., Ramezani, M., Khalili, N., Pournik, O., Taghizadeh-Asl, R., Habibelahi, A., Heidarzadeh, M., & Moradi-Lakeh, M. (2021) “Progress towards Every Newborn Action Plan (ENAP) implementation in Iran: obstacles and bottlenecks”. BMC pregnancy and childbirth, 21(1), 379.
Tesema, G. A., Gezie, L. D., & Nigatu, S. G. (2020) “Trends of stillbirth among reproductive-age women in Ethiopia based on Ethiopian demographic and health surveys: a multivariate decomposition analysis”. BMC pregnancy and childbirth, 20(1), 193.
World Health Organization & United Nations Children's Fund (‎UNICEF).‎ (‎2015)‎ “Every newborn action plan: progress report”, World Health Organization. 
Journal of Iranian Social Studies
Volume 16, Issue 4
Winter 2023
Pages 77-106

  • Receive Date 22 November 2022
  • Revise Date 02 April 2023
  • Accept Date 14 May 2023
  • First Publish Date 09 November 2023
  • Publish Date 09 November 2023

Home

Submit Manuscript

Reviewers

Contact Us