Further evidence and three potential pathways for the association between green space and improved birth outcomesThis article examines the relationship between green space and infant mortality as well as the effect of socioeconomic status (in the form of community level “deprivation”) on this relationship. In addition, the authors present a conceptual framework proposing three distinct pathways for the relationship between green space and improved pregnancy outcomes. This study examined infant mortality clusters of 715 cases (of deaths of infants less that 1 year of age) in metropolitan Lyon, France from 2000-2009 and compared them to the distribution of green space in the same area (as measured by a green space index using GPS data on local parks and forested areas). This study found that higher than expected rates of infant mortality occur in more deprived neighborhoods (as described by an index created from Census block data on education, occupation, income, unemployment and immigration status) as well as in areas with less greenness. Areas of less greenness and more deprivation substantially overlapped. However, the analysis suggests that these two factors do independently affect infant mortality rates and can both be targets for future studies and interventions. These results also suggest that social economic conditions play a role in the effect green space has on birth outcomes.
In addition, the authors present a useful conceptual framework of three possible pathways to explain how exposure to green space may lead to improved birth outcomes: a psychosocial pathway as a possible biological pathway, a hypothetical physiological pathway, and an indirect environmental pathway. The biological pathway focuses on the impact green exposure can have on maternal stress and the resulting effect on other aspects of maternal and fetal health. The physiological pathway discusses the positive effect of green space on mental health and physical health through exercise and social contact through physical activity. The last pathway considers the impact of environmental factors that are affected by the level of greenness in an area including air pollution, temperature, and noise, all of which have been shown by other studies to have negative impacts on maternal and fetal health. The full framework and references for each pathway can be found in this open access article.
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