Socio-demographic associations with pregnancy loss among Bakiga and Indigenous Batwa women in Southwestern Uganda

•The extent of pregnancy loss differed significantly between Batwa (149.8/1000 pregnancies) and Bakiga women (96.3/1000 pregnancies).•The socio-demographic associations with pregnancy loss differed for Bakiga and Indigenous Batwa women.•The incidence stillbirth among Indigenous Batwa women was among the highest in the global literature.•Nuanced and stratified Indigenous health data is critical for meaningful maternal health programming to reduce pregnancy loss. To assess the extent of pregnancy loss (i.e., miscarriage and/or stillbirth) and examine its association with socio-demographic characteristics among Bakiga and Indigenous Batwa women in Kanungu District, southwest Uganda. As part of a larger community-based, participatory project, a retrospective survey of maternal health histories was conducted in ten Batwa and ten Bakiga communities (n = 555 participants) collecting data on self-reported pregnancy loss (i.e., miscarriage and stillbirth) and socio-demographic characteristics. Socio-demographic associations with pregnancy loss (i.e., total miscarriages and stillbirths) were examined using multivariable Poisson and negative binomial regression. Batwa women experienced pregnancy loss more commonly than Bakiga women did (149.8/1000 vs. 96.3/1000 pregnancies). In the final adjusted model for Batwa women, being in the middle (RR 1.92; CI: 1.21–3.07) and highest (RR 1.79; CI: 1.14–2.82) wealth tertiles (compared to lowest wealth tertile) and living in Community X (RR 4.33; CI 2.27–8.28) (compared to all other communities) were associated with increased pregnancy loss. For Bakiga women, the proportion of pregnancy loss was higher for those who reported drinking alcohol during pregnancy (RR: 1.54; CI: 1.04–2.13) and being food insecure (RR 1.39; CI: 1.02–1.91). The proportion of, and the socio-demographic associations with, pregnancy loss differed for Bakiga and Indigenous Batwa women. These differences underscore the importance of collecting Indigenous health data to understand not only the extent of, but also the varied contextual circumstances that are associated with pregnancy loss. This nuanced and stratified information is critical for planning meaningful health programming to reduce pregnancy loss for Indigenous women.