Social Determinants of Health and Adverse Pregnancy Outcomes among Multigravida Women: A Cross-Sectional Analysis from Belagavi District, Karnataka, India

Abstract

Background: Social determinants such as economic status (SDoH), education, healthcare access, living conditions, and social support influence maternal and neonatal outcomes. Adverse pregnancy outcomes (APOs) remain a major public health concern in India. The objectives were to assess the association between social determinants of health and past pregnancy outcomes among multigravida women in Belagavi district. Methodology: Baseline data from 251 multigravida women aged 18-49 years, enrolled from four Belagavi talukas in 2025, were analysed. Sociodemographic characteristics and five SDoH domains (economic stability, education, healthcare access, neighbourhood/environment, social/community context) were assessed; APOs were defined as miscarriage, stillbirth, or abortion in any prior pregnancy Results: Women with higher education, employment, better economic status, healthcare access, joint family support, and strong social connections had more favourable pregnancy outcomes. Low social connection was the strongest predictor of adverse outcomes (AOR = 11.48, 95% CI: 3.11-42.36, p <0.001), while domicile, religion, housing type, and health insurance showed no significant association. Conclusions: Economic stability, healthcare access, education, and social support are significantly associated with pregnancy outcomes. These associations suggest that addressing social determinants alongside medical care may be important in reducing adverse pregnancy outcomes and improving maternal and neonatal health in similar settings.