Global Health
Investigating the relationship between long-term, stable partnership and pregnancy outcomes among women in the Mombasa Reproductive and Perinatal Health Study Hanna Shephard* Hanna Shephard Shephard Shephard Shephard Shephard Department of Epidemiology, University of Washington, Seattle, WA, USA; Pwani Research Centre, Kenya Research and Training Center, University of Washington, Mombasa, Kenya
Background: Women engaged in sex work face intersecting social and health vulnerabilities that may shape their perinatal outcomes. While marriage and long-term partnership have been associated with lower risks of stillbirth and child mortality in general populations, their relationship to pregnancy outcomes among women engaged in sex work is poorly understood. The Mombasa Reproductive & Perinatal Health (MRPH) Study was designed to generate longitudinal evidence on reproductive and perinatal health in this population.
Objective: We tested the hypothesis that being in a stable, long-term partnership during pregnancy would lead to an increased probability of live birth among women in the MRPH Study.
Methods: We collected information on participants’ (up to ten most recent) prior pregnancies, including the outcome of each pregnancy and their partnership status during each pregnancy. The exposure of this study was stable, long-term partnership or marriage during pregnancy (yes/no). The outcome was live birth versus other all other pregnancy outcomes (miscarriage, termination, stillbirth, and ectopic pregnancy). Relative risks (RR) and 95% confidence intervals (CI) were estimated using modified Poisson regression with cluster-robust standard errors to account for multiple pregnancies per participant and adjusting for maternal age and education.
Results: Among 641 gravid participants contributing 2,124 pregnancies (≈3 per participant), 81.2% of pregnancies resulted in live birth, 10.9% miscarriage, 5.6% termination, and 2.3% stillbirth. The proportion of pregnancies resulting in live birth was higher among pregnancies with a stable partnership (88.3%) compared to those without (74.5%). In unadjusted analyses, stable partnership was associated with an 18% higher probability of live birth (RR 1.18, 95% CI 1.13–1.25), and was only slightly attenuated after adjusting for age and education (RR 1.15, 95% CI 1.10–1.21).
Conclusions: Among MRPH study participants, stable, long-term partnership during pregnancy was associated with a modest but meaningful increase in the probability of live birth. Findings underscore the potential importance of relationship stability and support as protective factors in perinatal health within this group.