Stillbirths in Colombia before and during the COVID-19 pandemic: analysis by geographic location and health insurance

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Abstract
Background: Stillbirth (SB) remains a significant public health problem worldwide, with disparities across regions and socioeconomic strata, and studies have reported inconsistent findings regarding its incidence before and during the pandemic. The aims of this study were twofold: (1) To describe the changes in the incidence of SB before and during the COVID-19 pandemic; (2) To determine whether any changes observed before and during the pandemic differed by geographic location and health insurance. Methods: We compared cross-sectional data from pregnancies resulting in either live births or SBs in Colombia before the onset of the pandemic (from January 1st to December 31st, 2019), and during the pandemic (from January 1st to December 31st, 2021). The main socioeconomic determinants considered were, area of residence, place of birth and health insurance coverage. Risk differences (RD) and incident rate ratio (IRR) from Poisson regression models with robust variance were used as measures of absolute and relative inequalities. Results: SB incidence per 1000 births was 5.53(95%CI:5.35–5.71) in 2019 and 5.94(5.75–6.13) in 2021, RD: 0.41(0.68 − 0.14), IRR adjusted: 1.05 (1-1.10). In both 2019 and 2021, women living and those giving birth in towns and rural areas, as well as women who are uninsured or have subsidized health insurance, were at the highest risk of experiencing SB compared to their respective reference categories. SB incidence among residents of towns and those with subsidized insurance increased significantly in 2021 (RD = 1.32 and 0.53, respectively), whereas no changes in inequalities were observed among rural residents or unaffiliated women. In 2021, both absolute (RD = − 9.15) and relative inequalities (IRR = 3.78 vs. 1.99, p-value for interaction < 0.001) decreased significantly for rural delivery places compared with urban areas. Conclusions: The increase in SB incidence during the pandemic was largely explained by changes in socioeconomic, obstetric, and demographic factors. Our results highlight persistent inequalities in Colombia, with heterogeneous patterns between 2019 and 2021: some disparities increased, others remained stable, and some decreased.

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