Exploring inequalities in birth outcomes by maternal citizenship: evidence from Lombardy

This study examines disparities in neonatal outcomes between Italian and foreign mothers in Lombardy for the years 2010–2023 using individual-level administrative data from Birth Assistance Certificate (CEDAP). Logistic regression and multilevel models with hospital-level random effects assess the influence of maternal citizenship on outcomes, adjusting for maternal, pregnancy, and delivery characteristics. The initially higher risk of low birth weight among foreign mothers disappears after adjustment, while disparities in preterm birth and Apgar scores persist. However, multilevel models do not reveal any evidence of hospital-based discrimination. Persistent differences may reflect behavioral or genetic factors. Findings highlight the need for broader data and targeted public health and educational efforts to reduce maternal and neonatal health disparities.