Social Correlates of Fetal Mortality

The relationship between socioeconomic status and fetal loss is not clear. U.S. data from a number of sources indicate that while some support may be found for the inference of a higher fetal death rate among very low income groups, the relationship is by no means a simple one. An analysis is made of intensive interviews done in the Detroit Area Study in 1962, and of 2 follow-up interviews. The group interviewed was a random sample of white women in the Detroit metropolitan area who had a 1st (372), 2nd (372) or 4th (369) live birth in July 1961. Follow-up was done in 1962 and 1963. Any pregnancy not resulting in a live birth was classified as a fetal death. Fetal deaths were highest for those under 20, lowest for those 20-24 and thereafter increased with age. At each parity, having had a fetal death in the past doubled the probability of having one in the follow-up period. Women who had had as many as 2 fetal deaths prior to the 1st interview had the highest rate of all. For the period from marriage to 1st interview the death rate was negtively related to parity. During the follow-up period it was found that rates increased for each parity but the increase was not proportional. There was a sharp rise after the 4th parity that could not be accounted for by age or parity and was thus thought to be attributable to induced abortion. No consistent relationship between either family or husband's income and fetal loss could be found at the initial interview. Information from the follow-up, however, indicated a clearly positive correlation between fetal death and income. At each parity having an income of over $5000 was associated with a higher fetal death rate. 2 hypotheses were suggested to explain the statistic; improved reporting may have been greater for higher income groups, or higher income groups were better able to secure abortions. Instability of income as measured by husband's employment record meant higher fetal loss rates, again perhaps due to an increase in abortion during periods of unemployment. Regarding wife's employment, at each parity those who worked in the interval between the 1st interview and the follow-up had a higher fetal death rate than those who did not. Analysis of questions on expected and preferred family size revealed that women who expected to have fewer children than they preferred experienced a higher rate of loss. Women who said that none of their pregnancies had come too soon and that both they and their husbands had wanted another child when the last pregnancy occurred had higher rates. For 4th parity women in the follow-up the fetal death rate was much higher for those saying their pregnancy came too soon than for others, suggesting use of abortion as a means of birth control.