Skip to main content

Advertisement

SpringerLink
Log in

Stillbirth in an Anglophone minority of Canada

  • Original Article
  • Published:
International Journal of Public Health

Abstract

Objectives

We assessed trends in stillbirth over time for Francophones and Anglophones of Quebec, a large Canadian province with publically funded health care and an English-speaking minority.

Methods

We calculated stillbirth rates for Francophones and Anglophones, and estimated hazard ratios (HR) by decade from 1981 to 2010, adjusting for maternal characteristics. We analyzed temporal trends by gestational interval and cause of fetal death.

Results

Stillbirth rates decreased in Quebec during the three decades, due to improved rates in Francophones. Rates decreased for Anglophones in 1991–2000, but increased in 2001–2010 at term, during the second trimester, and for most causes of fetal death. In the 2000s, the hazard of stillbirth for Anglophones was nearly the same as the hazard for Francophones in the 1980s (HR 0.93, 95 % confidence interval 0.82, 1.05).

Conclusions

Stillbirth rates declined in both Francophones and Anglophones before the turn of the century, but increased thereafter for Anglophones, suggesting that linguistic inequalities in stillbirth may be emerging in Quebec. Linguistic status may be a useful marker for surveillance of inequalities in stillbirth.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Ackermann Rau S, Sakarya S, Abel T (2014) When to see a doctor for common health problems: distribution patterns of functional health literacy across migrant populations in Switzerland. Int J Public Health 59(6):967–974

    Article  PubMed  Google Scholar 

  • Auger N, Denis G (2012) Late pregnancy abortions: an analysis of Quebec stillbirth data, 1981–2006. Int J Public Health 57(2):443–446

    Article  PubMed  Google Scholar 

  • Auger N, Park AL, Harper S (2012) Francophone and Anglophone perinatal health: temporal and regional inequalities in a Canadian setting, 1981–2008. Int J Public Health 57(6):925–934

    Article  PubMed  Google Scholar 

  • Auger N, Park AL, Daniel M (2013) Contribution of local area deprivation to cultural-linguistic inequalities in foetal growth restriction: trends over time in a Canadian metropolitan centre. Health Place 22:38–47

    Article  PubMed  Google Scholar 

  • Auger N, Gilbert NL, Naimi AI, Kaufman JS (2014a) Fetuses-at-risk, to avoid paradoxical associations at early gestational ages: extension to preterm infant mortality. Int J Epidemiol 43(4):1154–1162

    Article  PubMed  Google Scholar 

  • Auger N, Vecchiato L, Naimi AI, Costopoulos A, Fraser WD (2014b) Stillbirth rates among Haitians in Canada. Paediatr Perinat Epidemiol 28(4):333–337

    Article  PubMed  Google Scholar 

  • Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA (2014) Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet 384(9940):347–370

    Article  PubMed  Google Scholar 

  • Bouchard L, Desmeules M (2013) Linguistic minorities in Canada and health. Health Policy 9(Spec Issue):38–47

  • Brailovschi Y, Sheiner E, Wiznitzer A, Shahaf P, Levy A (2012) Risk factors for intrapartum fetal death and trends over the years. Arch Gynecol Obstet 285(2):323–329

    Article  PubMed  Google Scholar 

  • Carr A, Kershaw T, Brown H, Allen T, Small M (2013) Hypertensive disease in pregnancy: an examination of ethnic differences and the Hispanic paradox. J Neonatal Perinatal Med 6(1):11–15

    CAS  PubMed  Google Scholar 

  • Corbeil J-P, Chavez B, Pereira D (2010) Portrait of official-language minorities in Canada: Anglophones in Quebec. Analytical paper. Statistics Canada, Ottawa, pp 7–122. http://www.statcan.gc.ca/pub/89-642-x/89-642-x2010002-eng.pdf. Accessed 27 Aug 2014

  • Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L et al (2011) National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet 377(9774):1319–1330

    Article  PubMed  Google Scholar 

  • Daoud N, O’Campo P, Urquia ML, Heaman M (2012) Neighbourhood context and abuse among immigrant and non-immigrant women in Canada: findings from the Maternity Experiences Survey. Int J Public Health 57(4):679–689

    Article  PubMed  Google Scholar 

  • Flenady V, Middleton P, Smith GC, Duke W, Erwich JJ, Khong TY et al (2011) Stillbirths: the way forward in high-income countries. Lancet 377(9778):1703–1717

    Article  PubMed  Google Scholar 

  • Floch W, Pocock J (2008) Emerging trends in the socio-economic status of English-speaking Quebec : Those who left and those who stayed. In Bourhis RY (Ed) The vitality of the English-speaking communities of Quebec: from community decline to revival. University of Montreal, Montreal, pp 35–62. http://www.qcgn.ca/storage/website-resources/library/documents/publications/Bourhis%20publication.pdf. Accessed 28 Aug 2014

  • Gagnon AJ, Zimbeck M, Zeitlin J, Alexander S, Blondel B, Buitendijk S et al (2009) Migration to western industrialised countries and perinatal health: a systematic review. Soc Sci Med 69(6):934–946

    Article  CAS  PubMed  Google Scholar 

  • Geller SE, Ahmed S, Brown ML, Cox SM, Rosenberg D, Kilpatrick SJ (2004) International classification of diseases-9th revision coding for preeclampsia: how accurate is it? Am J Obstet Gynecol 190(6):1629–1633 (discussion 1633–1624)

    Article  PubMed  Google Scholar 

  • Gissler M, Alexander S, MacFarlane A, Small R, Stray-Pedersen B, Zeitlin J et al (2009) Stillbirths and infant deaths among migrants in industrialized countries. Acta Obstet Gynecol Scand 88(2):134–148

    Article  PubMed  Google Scholar 

  • Gordijn SJ, Korteweg FJ, Erwich JJ, Holm JP, van Diem MT, Bergman KA et al (2009) A multilayered approach for the analysis of perinatal mortality using different classification systems. Eur J Obstet Gynecol Reprod Biol 144(2):99–104

    Article  PubMed  Google Scholar 

  • Kitagawa EM (1995) Components of a difference between two rates. J Am Stat Assoc 50(272):1168–1194

    Google Scholar 

  • Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I et al (2011) Stillbirths: Where? When? Why? How to make the data count? Lancet 377(9775):1448–1463

    Article  PubMed  Google Scholar 

  • Lussier M-H, Trempe N (2012) The socioeconomic status of anglophones in Québec report. Institut national de santé publique Québec, Montreal, pp 1–51. http://www.inspq.qc.ca/pdf/publications/1494_SituationSocioEconoAngloQc_VA.pdf. Accessed 28 Aug 2014

  • MacDorman MF, Kirmeyer SE, Wilson EC (2012) Fetal and perinatal mortality, United States, 2006. Natl Vital Stat Rep 60(8):1–22

    Google Scholar 

  • Malin M, Gissler M (2009) Maternal care and birth outcomes among ethnic minority women in Finland. BMC Public Health 9:84

    Article  PubMed Central  PubMed  Google Scholar 

  • Patterson JA, Ford JB, Morris JM, Roberts CL (2014) Trends and recurrence of stillbirths in NSW. Aust NZ J Public Health 38(4):384–389

    Article  Google Scholar 

  • Pattinson R, Kerber K, Buchmann E, Friberg IK, Belizan M, Lansky S et al (2011) Stillbirths: how can health systems deliver for mothers and babies? Lancet 377(9777):1610–1623

    Article  PubMed  Google Scholar 

  • Platt RW, Joseph KS, Ananth CV, Grondines J, Abrahamowicz M, Kramer MS (2004) A proportional hazards model with time-dependent covariates and time-varying effects for analysis of fetal and infant death. Am J Epidemiol 160(3):199–206

    Article  PubMed  Google Scholar 

  • Public Health Agency of Canada (2009) What mothers say: The Canadian Maternity Experiences Survey. Ottawa, pp 63–67. http://www.publichealth.gc.ca/mes. Accessed 10 Dec 2014

  • Ravelli AC, Tromp M, Eskes M, Droog JC, van der Post JA, Jager KJ et al (2011) Ethnic differences in stillbirth and early neonatal mortality in The Netherlands. J Epidemiol Community Health 65(8):696–701

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Reime B, Lindwedel U, Ertl KM, Jacob C, Schucking B, Wenzlaff P (2009) Does underutilization of prenatal care explain the excess risk for stillbirth among women with migration background in Germany? Acta Obstet Gynecol Scand 88(11):1276–1283

    Article  PubMed  Google Scholar 

  • Sarfraz AA, Samuelsen SO, Eskild A (2011) Changes in fetal death during 40 years-different trends for different gestational ages: a population-based study in Norway. BJOG 118(4):488–494

    Article  CAS  PubMed  Google Scholar 

  • Silver RM, Varner MW, Reddy U, Goldenberg R, Pinar H, Conway D et al (2007) Work-up of stillbirth: a review of the evidence. Am J Obstet Gynecol 196(5):433–444

    Article  PubMed Central  PubMed  Google Scholar 

  • Smith GCS, Fretts RC (2007) Stillbirth. Lancet 370(9600):1715–1725

    Article  Google Scholar 

  • Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG et al (2009) Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 338:b2393

    Article  PubMed Central  PubMed  Google Scholar 

  • Stillbirth Collaborative Research Network Writing Group (2011) Causes of death among stillbirths. JAMA 306(22):2459–2468

    Article  Google Scholar 

  • Temel S, Birnie E, Sonneveld HM, Voorham AJJ, Bonsel GJ, Steegers EAP et al (2013) Determinants of the intention of preconception care use: lessons from a multi-ethnic urban population in The Netherlands. Int J Public Health 58(2):295–304

    Article  CAS  PubMed  Google Scholar 

  • Willinger M, Ko C-W, Reddy UM (2009) Racial disparities in stillbirth risk across gestation in the United States. Am J Obstet Gynecol 201(5):469.e461–469.e468

    Article  Google Scholar 

  • Wingate MS, Barfield WD (2011) Racial and ethnic variations in temporal changes in fetal deaths and first day infant deaths. Matern Child Health J 15(8):1135–1142

    Article  PubMed  Google Scholar 

  • Yudkin PL, Wood L, Redman CW (1987) Risk of unexplained stillbirth at different gestational ages. Lancet 1(8543):1192–1194

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This project was supported by the McGill Training and Retention of Health Professionals Project funded through Health Canada.

Author information

Authors and Affiliations

  1. Institut national de santé publique du Québec, 190, boul. Crémazie Est, Montreal, QC, H2P 1E2, Canada

    Nathalie Auger & Clarisse Toa-Lou

  2. Research Centre of the University of Montreal Hospital Centre, Montreal, Canada

    Nathalie Auger & Clarisse Toa-Lou

  3. School of Population Health, South Australian Health and Medical Research Institute, University of South Australia, Adelaide, Australia

    Mark Daniel

  4. Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark

    Laust Mortensen

  5. Department of Anthropology, McGill University, Montreal, Canada

    André Costopoulos

Authors
  1. Nathalie Auger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Daniel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laust Mortensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Clarisse Toa-Lou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. André Costopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nathalie Auger.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Auger, N., Daniel, M., Mortensen, L. et al. Stillbirth in an Anglophone minority of Canada. Int J Public Health 60, 353–362 (2015). https://doi.org/10.1007/s00038-015-0650-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00038-015-0650-6

Keywords

Search

Navigation