This annual report - Taranaki District Health Board

deprivation in some parts of the world, this relationship was not identified in a New Zealandstudy, although in this study it was not possible to differentiate between spontaneous andinduced preterm births [158].Understanding the link between deprivation and adverse pregnancy outcomesThe link between socioeconomic deprivation and adverse pregnancy and subsequent childhealth outcomes is likely to represent the cumulative effect of individual, familial,community and societal forces [149]. Risk factors such as smoking, poor dietary habits,higher fertility, teenage pregnancy and alcohol use are associated with bothsocioeconomic status and adverse birth outcomes, acting as steps in the causal pathwaylinking deprivation and adverse pregnancy outcomes [152]. Lower socioeconomic statushas also been linked to reduced access to antenatal care [143]. Barriers to accessing orengaging with care (identified as substance abuse, family violence, lack of recognition orcomplexity or seriousness of condition, maternal mental illness, cultural barriers, languagebarriers, ineligibility to access free care and ‘other’, which included late booking and nonattendance)were identified as the most common contributory factors to perinatal relateddeaths in New Zealand in 2010 [138].Young Maternal AgeDefinitions and New Zealand DistributionNew Zealand has a high teenage birth rate by OECD standards: in 2008 the number ofbirths per 1,000 women aged 15 to 19 years was 22.05, compared to the OECD averageof 16.34 per 1,000 [159,160]. Teenage pregnancy is strongly linked to social disadvantage,which acts as both a contributing factor and consequence of teenage pregnancy andparenthood [161,162,163]. Nationally, there is a clear social gradient in rates of teenagechildbirth [164]. From 2006 to 2010 the teenage childbirth rate was 51 per 1000 live birthsamong those living in the most deprived areas and 10 per 1000 live births among those inthe least deprived areas (RR 5.31, 95% CI 5.03 to 5.61). The teenage birth rate also variesby ethnicity. The average annual rate of live births for women aged 15 to 19 years during2005 to 2007 was higher for Māori (63 per 1,000 women) and Pacific (43 live births per1,000 women) women than for European/Other (22 per 1000 women) and Asian (7 per1,000 women) women [165]. However, these differences should be viewed in the contextof the higher birth rates for Māori and Pacific women at all ages up to 30 years. It has alsobeen suggested that young Māori women who become pregnant are less likely to have atermination of pregnancy than European women [166].Internationally, research indicates that a combination of access to skills and services andthe chance to gain the education and employment needed to succeed in society isassociated with lower rates of teenage pregnancy [162]. Factors related to teenagepregnancy operate at a number of levels and include: individual factors such as selfesteemand age at first intercourse; family factors such as a mother who was pregnant asa teenager, or being in care; education factors such as truancy and lack of qualifications;community factors such as social norms related to sexual activity; and social factors suchas childhood poverty, employment prospects and housing and social conditions [162].However, the relationship between these factors is complex.Associations between young maternal age and pregnancy outcomesTeenage pregnancy and parenthood are linked to a variety of adverse social and healthoutcomes, including low birthweight, higher infant and child mortality, postnatal depression,a higher rate of childhood accidents, lower levels of education, reduced employmentopportunities, longer-term welfare dependency and the intergenerational transfer ofpoverty [162,167,168]. In New Zealand between 2007 and 2010, teenage mothers were athigher risk of stillbirth and neonatal mortality due to preterm birth, fetal growth restrictionand perinatal infection, compared to mothers aged 20 to 39 years (perinatal relatedmortality 14 per 1000, compared to 10.4 per 1000) [138]. A similar pattern was also seenfor rates of SUDI, which were highest among mothers aged under 20 years, followed bythose aged 20 to 24 years between 2004 and 2008 (RR 4.96, 95% CI 3.43 to 7.17 forwomen under 20 years, and RR 3.29, 95% CI 2.35 to 4.62 for women aged 20 to 24 yearscompared to women aged 30 to 34 years). Teenage pregnancy has also been associatedIn-Depth Topic: Adversity in Pregnancy - 280