Exploring the relationship of sociodemographic changes, economic instability and the availability of health resources with birth rates

Aims: To examine the relationship among sociodemographic changes, economic instability and the availability of health resources to the birth rate in Macau. Subjects and methods: A retrospective design was used where yearly data were collected from Macau for the period from 1957 to 2006. The birth rate was the dependent variable, and sociodemographic factors, economic status and health resources were the three main explanatory variables. Results: Results showed that higher marriage rates (beta = 0.13, p = 0.015), a higher birth rate in the previous year (beta = 0.89, p = 0.001), greater public health care expenditure (beta = 0.41, p = 0.009), lower levels of educated women (beta = -0.19, p = 0.021) and fewer people working in the gambling industry (beta = -0.73, p = 0.012) were associated with a higher birth rate. Conclusions: Regression estimates support our hypothesis that the sociodemographically disadvantaged are at a significantly higher risk for live births. In contrast, greater public health care expenditure significantly increases the birth rate, as has been shown in previous studies. Based on these findings, it is suggested that more efforts be directed towards removing barriers that impede access to health care services and increasing preventive health for disadvantaged populations, particularly during periods of economic recession. In addition, efforts should be made to expand and improve the coverage of prenatal and infant health care programs in order to alleviate regional differences in the utilization of health care and improve the overall birth rate in Macau.