The British Columbia Healthy Connections Project: findings on socioeconomic disadvantage in early pregnancy

Nicole L A Catherine, Rosemary Lever, Debbie Sheehan, Yufei Zheng, Michael H Boyle, Lawrence McCandless, Amiram Gafni, Andrea Gonzalez, Susan M Jack, Lil Tonmyr, Colleen Varcoe, Harriet L MacMillan, Charlotte Waddell, British Columbia Healthy Connections Project Scientific Team, Nicole L A Catherine, Rosemary Lever, Debbie Sheehan, Yufei Zheng, Michael H Boyle, Lawrence McCandless, Amiram Gafni, Andrea Gonzalez, Susan M Jack, Lil Tonmyr, Colleen Varcoe, Harriet L MacMillan, Charlotte Waddell, British Columbia Healthy Connections Project Scientific Team

Abstract

Background: Maternal exposure to socioeconomic disadvantage increases the risk of child injuries and subsequent child developmental and mental health problems - particularly for young mothers. To inform early intervention planning, this research therefore aimed to describe the health and social adversities experienced by a cohort of girls and young women in early pregnancy in British Columbia (BC), Canada.

Methods: Participants were recruited for the BC Healthy Connections Project (BCHCP), a randomized controlled trial examining the effectiveness of Nurse-Family Partnership, a home visitation program, in improving child and maternal outcomes. Baseline data were collected from 739 participants on trial entry. Participants were selected on the basis of preparing to parent for the first time and experiencing socioeconomic disadvantage. Analyses involved descriptive statistics and age-group comparisons.

Results: Most participants reported having low income (84%), having limited education (52%) and being single (91%) at trial entry. Beyond these eligibility criteria, other health and social adversities included: housing instability (52%); severe anxiety or depression (47%); other diagnosed mental disorders (22%); prenatal nicotine and cannabis use (27 and 21%); physical health problems (20%); child maltreatment when younger (56%); and intimate partner violence recently (50%). As well, few (29%) had received income assistance entitlements. More than two thirds (70%) were experiencing four or more forms of adversity. Age-group differences were observed for cognitive functioning, being single, low income, limited education, psychological distress and service use (p-value ≤0.05).

Conclusions: This cohort was selected on the basis of socioeconomic disadvantage. Yet all participants were experiencing substantial added adversities - at higher rates than other Canadians. Furthermore, despite Canada's public programs, these pregnant girls and young women were not being adequately reached by social services. Our study adds new data to inform early intervention planning, suggesting that unacceptably high levels of socioeconomic disadvantage exist for some young British Columbians. Therefore greater health and social supports and services are warranted for these young mothers and their children.

Trial registration: Registered August 24, 2012 with ClinicalTrials.gov Identifier: NCT01672060 . Active not recruiting.

Keywords: Adolescents; Cumulative disadvantage; Maternal health; Pregnancy; Socioeconomic disadvantage.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Participant flow

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