The Relationship Between the Social Determinants of Health and Preterm Birth in Iran Based on the WHO Model: A Systematic Review and Meta-analysis

Despite medical advances, preterm birth is still a global problem in all countries (1,2). According to the WHO, preterm birth is defined as babies born alive before 37 weeks of pregnancy (3). Preterm Delivery is the leading cause of infant mortality in 24% of the cases (4,5). Statistics released from developed countries such as the United States, the United Kingdom, and Scandinavian countries reveal the growth of this problem in the past 2 decades (5). In general, the prevalence of preterm birth is 9.6%, but its distribution varies across the world, as 85% of the cases occur in Asia and Africa (6). In Iran, the prevalence of preterm birth is between 5.6% and 34.9%; in the United States, the prevalence has been reported as 12%-13% (7,8). In the Global Burden of Disease analysis, preterm birth has the highest rate of mortality and lifelong complications. In addition to the complications and costs of being born preterm and the threat of neonatal death, disabilities are also higher in these children when they reach school age, such as cerebral palsy, neurodevelopmental disorders, digestive problems, respiratory diseases, and serious disorders in acquiring the skills needed to perform daily life activities (9,10). Several factors are associated with preterm birth, including certain social determinants. Given the conceptual framework of these determinants, recognizing the cause of these diseases is very important (8). In today's world, health perspectives have become broader in scope and the non-medical determinants of health have become more emphasized as a result. Each of these determinants severely affects health per se or in interaction with the other determinants and causes inequalities in health (11). According to the conceptual framework of the WHO Commission on Social Determinants of Health (CSDH), the key factors