Despite improvements over time and within most areas of the world, there remain large variations in birth outcomes worldwide. While prior research has examined the health and individual level social factors that influence birth outcomes on the individual level, little if any research has examined social factors at the institutional and population level that might influence birth outcomes. The link between higher-level institutional influences and birth outcomes may, at least in part, be related to variations in the level of psychological stress experienced by women before and during pregnancy. Stress process theory has been proposed as one way of explaining disparities in physical health outcomes, in general (Pearlin et al. 2005). Stress exposure has been shown to increase the risk of cardiovascular disease (Zhang and Hayward 2006), increase inflammation (Cohen et al. 2011), increase awakening cortisol levels (McFarland and Hayward 2013), shorten telomere lengths (Mitchell et al. 2014), and tax the autoimmune system (Pudrovska et al. 2013). As we are seeing more evidence of stress affecting the body, researchers have begun to question the potential links between stress exposure and birth outcomes. This dissertation utilizes stress process theory as a potential framework to understand how stress may be altering maternal and infant health through the weathering of women’s bodies and compromised fetal development. I find support for the notion that chronic stress stemming from larger institutional pressures, found at the population level, can negatively affect birth outcomes at both the individual level and population level. In the first paper, I use data from the Cross National Socio-Economic and Religion Data (CNSERD), to conduct Poisson and negative binomial regressions to analyze institutional level stressors (e.g. high unemployment rates, limited welfare support for women) and their influences on the country level maternal and infant mortality. My findings further the understanding of higher-level institutional stressors, and show that institutional level stressors do in fact “get under the skin” and cause birth complications beyond the scope of individual influences. The second paper is conducted at the both individual and state level, utilizing NCHS vital statistics data from the U.S. 2010 birth cohort along with additional data from various national government agencies, including the U.S. Census Bureau and the Department of Agriculture. By combining this data, I create a unique data set with both individual and state level social, economic, and political measures of potential sources of stress. I utilize this data set, along with hierarchical modeling, to analyze the influence of institutional state level stressors on individual level birth outcomes: infant mortality, low birth weight low gestation, and small for gestational age (IUGR). Results of this dissertation suggest that some economic, social, and political measures of institutional stress are important for predicting birth outcomes, and the source of stress or buffers to stress vary across outcome and by location. At the country level, I find differences in sources of influence across countries’ level of economic development, but there were consistently more influences found for maternal mortality than infant mortality. Similarly, within the U.S., institutional factors explain a greater proportion of variation in the most extreme and least common negative infant outcomes. This suggests that to better address the less common negative outcomes, in particular, we should not only maintain an emphasis on the individual level risk factors that we have been addressing over the past decades, but also begin to shift our focus to larger institutional influences, such as female literacy and income inequality. Findings also show that, within the U.S., there may be several specific policy recommendations for those interested in improving birth related outcomes. For instance, median maternal education, regardless of individual women’s own education, is protective across all four-birth outcomes and higher participation in WIC at the state level is protective against low birth weight and IUGR. Thus, further state and federal-level investment in women’s education and the social safety net programs that specifically target pregnant women and women with very young children would likely help to lower the risk of poor birth outcomes and infant death in the U.S. In sum, the knowledge gained from both of these papers has vast policy implications for benefiting the future of maternal and infant health – not only in the United States, but also worldwide. / A Dissertation submitted to the Department of Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester 2018. / April 16, 2018. / Birth Outcomes, Chronic Stress, Fetal Origins, Institutional Stress, Maternal and Infant Health, Weathering / Includes bibliographical references. / Kathryn H. Tillman, Professor Directing Dissertation; Karen Randolph, University Representative; Michael McFarland, Committee Member; Elwood Carlson, Committee Member.
| Identifer | oai:union.ndltd.org:fsu.edu/oai:fsu.digital.flvc.org:fsu_653485 |
| Contributors | Otte, Stephanie Margaret (author), Tillman, Kathryn H. (professor directing dissertation), Randolph, Karen A. (university representative), McFarland, Michael J (committee member), Carlson, Elwood, 1950- (committee member), Florida State University (degree granting institution), College of Social Sciences and Public Policy (degree granting college), Department of Sociology (degree granting departmentdgg) |
| Publisher | Florida State University |
| Source Sets | Florida State University |
| Language | English, English |
| Detected Language | English |
| Type | Text, text, doctoral thesis |
| Format | 1 online resource (181 pages), computer, application/pdf |
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