Trends in social determinants of child health and perinatal outcomes in European countries 2005-2015 by level of austerity imposed by governments: a repeat cross-sectional analysis of routinely available data

Abstract

Objective: To assess whether the level of austerity implemented by national governments was associated with adverse trends in perinatal outcomes and the social determinants of children’s health (SDCH) in rich countries. Design: Longitudinal ecological study of country-level time trends in perinatal outcomes and SDCH and from 2005 to 2015. Setting and participants: 16 European countries using available data from the International Monetary Fund, the Organisation for Economic Co-operation and Development and Eurostat. Main outcome measures: Trends in perinatal outcomes (low birth weight (LBW); infant mortality) and the SDCH: child poverty rates; severe material deprivation in families with primary education; preschool investment in three time periods: 2005-2007, 2008-2010 and 2012-2015. Outcomes were compared according to the cyclically adjusted primary balance (CAPB, differences between 2013 and 2009) as a measure of austerity, stratified in tertiles. Generalised estimating equation models of repeated measures were used to assess time trend differences in three periods. Results: Countries with higher levels of austerity had worse outcomes, mainly at the last study period. Material deprivation increased during the period 2012-2015 in those countries with higher CAPB (interaction CAPB-period 2012-2015, B: 5.62: p<0.001), as did LBW (interaction CAPB-period 2012-2015, B: 0.25; p=0.004). Conclusions: Countries that implemented more severe austerity measures have experienced increasing LBW, and for families with primary education also increasing material deprivation, worsening the negative impact of economic crisis. Reversing austerity policies that impact children is likely to improve child health outcomes.