Inequalities in Health Outcomes Among Users of Prenatal Care

Abstract

Significant inequalities in the efficacy of prenatal care exist across the globe, even in high-income, highly developed countries where one may intuitively assume otherwise. Research shows that these inequalities are largely avoidable, and are the cause of myriad negative health outcomes including maternal and infant mortality, preterm birth, low birth weights, and more. Additionally, these health outcomes are exaggerated to shocking degrees among certain social groups. This study aims to compare inequalities in pregnancy outcomes through a comparative analysis of the prenatal care service offers in Norway, the Netherlands, and the United States. The analysis is followed by an empirical mapping of the trends of adverse health outcomes in each respective country in order to ask: what type of health system configuration results in less systemic inequality? Using the frameworks of the World Health Organization’s recommendations for a “positive pregnancy experience”, health equality/equity theory from Norman Daniels, and a prescriptive, normative approach, this thesis examined differences in the problems of inequality faced by three countries. It was found that although all three countries aligned with the WHO’s recommendations, stark inequalities remained. Therefore, no conclusions could be drawn correlating the type of system to greater or lesser inequalities. The findings indicate that greater social factors (social determinants of health) act alongside prenatal care utilization to maintain inequalities among the observed populations. Consequently, it is suggested that policies aimed at reducing inequalities in health also address the social determinants that affect one’s societal positioning.