Professional Documents
Culture Documents
Introduction
All over the world, there are many stigmas that surround women’s health care and more
specifically, prenatal care. Almost all health professionals understand that a “healthy pregnancy
is one of the best ways to promote a healthy birth” (What is prenatal care and why is it
important)? However, in America, there has been a stagnation in the effort being put forth to
improve the quality of prenatal care for women of all backgrounds. In The Complete Mothers’
Index of 2015, the United States ranked 33. The index compares maternal health, children’s
wellbeing, educational status, economic status, and political status to determine the overall
quality of women’s health care as it pertains to pregnancy. By these standards, America ranked
low on the list for an industrialized country. As the results of this index were published, many
Americans have wrestled with the cause of such a low ranking and have looked for an answer
that explains what America can do better and what America can take from other countries to
improve its prenatal care. This ranking was shocking to many women because compared to the
median income of countries that were ranked higher than America, America’s median income
was either equal to or higher than those countries’ median incomes. When endeavoring to solve
the problems with prenatal care in America, America should understand why the problem has
occurred, and strive to change the culture of America in order to address the disparity that
women from different backgrounds face when attempting to have a child in America.
America is a country that has struggled with inequality on many fronts and this struggle
has been extended to prenatal care. When analyzing what separates American prenatal care from
other countries, at the top there are many key differences. Countries such as Sweden, Finland,
and Norway all have rather homogenous populations and gross national incomes higher than the
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United States, excluding Finland’s, which is 4,650 American dollars lower. While American
median income is one of the highest on the index, this number is misleading due to the disparity
among classes in America. The gap between rich and poor in America is much higher than the
gap in other European countries. In the article, “Here’s a map of the best and worst countries to
be a mother,” author Max Fisher endeavors to explain America’s low ranking in terms of the
The U.S., it turns out, has the second-highest preterm birth rate in the world,
meaning that babies are born too early, and the highest first-day infant death
rate in the developed world. Adolescent birth rates are also unusually high.
These adolescent births lead to “the United States [having] over half a million preterm births a
year, the sixth largest number in the world” (Fisher, 2013). All of the preterm births have
crippled America’s prenatal care standing in the world and have shown a light on the incessant
disparity between the quality of prenatal care between the social classes in America, which
consequently shows the disparity between the quality of prenatal care between races in America.
The disparity between race, income, and access to affordable quality care enable American
prenatal care to outperform high ranking countries in some regions of America, while other
regions struggle to provide their mothers with care comparable to that of an undeveloped
country.
Teenage pregnancy has been cited as one of the downfalls of prenatal care and
preconception care in America. In Charles E. Basch’s research article on “Teen Pregnancy and
the Achievement Gap Among Urban Minority Youth,” he endeavors “to outline the prevalence
and disparities of teen pregnancy among school-aged urban minority youth, causal pathways
through which non-marital teen births adversely affect academic achievement, and proven or
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promising approaches for schools to address this problem” (Basch, pp. 614). According to
Basch:
the birth rate among non-Hispanic Blacks was more than three times as high,
and the birth rate among Hispanics was more than four times as high as the
birth rate among non-Hispanic whites.
Teen mothers were less likely to complete high school and furthermore go to college. This lack of
education affects two captions on the mother index, education and income because people with lower levels
of education often make less than those with higher levels of education. Additionally, the most interesting
segment of this article was Basch’s take on the cyclic nature of teenage pregnancy. According to Basch’s
research:
daughters of teen mothers were 66% more likely to become teen mothers. In
all likelihood, an unmarried teen mother and her child will live in poverty,
further perpetuating a cycle of poverty and subsequent non-marital teen births.
This cycle of teen pregnancy has only served to hurt teen mothers and tank the American
prenatal care ranking in the world. The risks associated with teenage pregnancy coincide with the
risks associated with women that do not seek prenatal care. The risk of low birth weight or
premature birth, anemia, pregnancy induced hypertension, higher rate of infant mortality, and the
greater risk of Cephalopevic disproportion all effect teenage mothers and mothers who do not
receive prenatal care more than adult aged mothers who receive prenatal care. (American
impoverished, uneducated, and minority mothers at a disadvantage for years and this epidemic
When sex education started becoming a part of schools, many sex education programs were
abstinence only. These types of programs were not only dangerous to the teens that would
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eventually get pregnant, but also to their peers who would contract many sexually transmitted
diseases. Abstinence only sex education curricula are not only dangerous for various health
reasons, they are also dangerous for their social implications. Additionally, this type of social
teaching might conflict with what the student has already learned at home, thus putting certain
The initial intent of sex education was to provide parents an alternative when they might
have been uncomfortable talking about intercourse and the dangers or repercussions of it.
However, sex education became a way that a specific set of morals could be forced upon
students in a manner that would end up hurting them in the end. The national government must
develop a program that teaches safe sex rather than abstinence in order to reduce the rates of
teenage pregnancy. Thus causing the prenatal care ranking in America to increase and improving
The Cost
Another area of disparity between social and cultural classes when it comes to prenatal
care is the cost of health care in America. Having a baby is an expensive process that can cause
great strain on new the young mother that would be affected by the teenage pregnancy epidemic.
In America, the average cost of prenatal care without health insurance is around $2,000 (2018,
WebMD). This exorbitant amount of money is often too much for a single mother or young
mother to pay. Additionally, these $2,000 don’t include any of the hospital care that the mother
and baby will require during and after labor. When prenatal care is combined with having an
uncomplicated vaginal birth, the cost totals around $11,600. Additionally, for an uncomplicated
cesarean section and prenatal care, the cost totals $17,800. These figures are only for hospital
charges and they don’t include any of the supplies that the mothers will need when they leave the
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hospital with their baby. While some of this cost will be covered by health care insurance, in
America, “per-capita lifetime health-care expenditures for women run $361,200, or nearly
$100,000 more than per-capita lifetime health-care expenditures for men” (Williamson, Kevin).
Therefore, women are put at an automatic disadvantage when it comes to health because of the
exorbitant cost of health care plus the other added costs associated with have a baby. Asking a
young, impoverished mother to pay more than ten thousand dollars to give birth is ridiculous and
it is clear why so many of these mothers choose to cut cost when it comes to prenatal care in
order to try and pay for some of the other costs associated with having a baby.
The ideology surrounding prenatal care is a pendulum. With one end of the pendulum
representing expensive medicalized care and the other representing home-birthing and natural
alternatives. From the colonial period until the 1760s, women would have their babies in their
own homes and their female relatives, friends, and a midwife would help with the process.
However, because of the limited medical understanding surrounding birth, women and babies
would die. Around the 1760s, “upper class women started to want to have doctors at their births”
(Maragret Marsh). This desire was brought about because women started to think that having a
doctor during the time of birth was safer that just having the friend or family member. This trend
gain even more popularity as time went on. “In 1900, about half the babies were delivered by
midwives. By 1935, only fifteen percent were delivered by midwives.” Thus, the struggle
between midwives and doctors began. During this time, female doctors were not allowed
therefore, the only medical capacity that women could serve in was as a nurse or a midwife. This
caused them to think that they were better suited to handle births while male doctors felt that
their medical training made them more equipped to handle birth. In the 20th century, medicalized
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births started to become more popular, not because of the added safety, but because of the use of
pain-numbing drugs. Throughout the 1940s, 50s, and 60s, women expressed a desire to have
pain-free births, and this type of birth could only be obtained in a hospital at a steep cost.
However, during the late 1900s and the early 2000s, the pendulum of medicalized care
started to swing back in favor of midwives and home births. More and more mothers are starting
to lean toward at-home births. Between the years of 2004 and 2014, home-births have grown .5%
and are still rising (Out- of- Hospital Births on the Rise in U.S.). Ninety percent of these home
births were planned, which “speaks to some women's growing discomfort with the standard
hospital-based system of childbirth in the U.S.” (Soctt, Maiken). As time continues, women are
starting to want a more natural and relaxed birthing experience. This resurgence of home births
can help keep costs down for some women. The practice of natural home birthing not only help
to keep the cost of the birth low but they also affect the amount of money that can be spent on
prenatal care and the amount of money that is required for prenatal care, showing that the way
More than 11,000 babies die on the same day that are born in the United states every
year. This is 50% more first-day deaths than all other industrialized countries combined. Twenty
three percent of these babies die due to infection. These infections could be prevented with
adequate prenatal care. America has one the best health care systems in the world, however,
there is still so much we can learn from other countries. Women all over the world have different
types of prenatal care practices. Although, it is recommended that women have at least 4 prenatal
check-ups during their nine months of pregnancy, some women won’t even have one. Although,
women in third world countries tend to have fewer prenatal checkups. Their checkups tend to be
Prenatal Care 8
much longer than American visits. These checkups can range from 45 minutes to two hours.
American women on average tend to have about 15 prenatal checkups that last for about twenty
to thirty minutes with most of the time being spent with a nurse practitioner. Another prenatal
care practice that women in other parts of the world use is message therapy. This helps to relax
the mother and the baby. Stress is linked to several infant diseases and one of the leading
pregnancy issues in America is high blood pressure, due to stress. These practices should be
investigated more if they could create a more peaceful environment for the expectant mother and
her baby.
In the article, Midwives, Not Medicine, Rule Pregnancy in Sweden, with Enduring
Success written by the New York Daily News, the author compared some of the low cost
mechanisms that allow Sweden to keep prenatal care costs low while also insuring high quality
maternal care. According to the article, Swedish health professionals view pregnancy as “a
natural process” (2013, October 7, New York Daily News). This indicates that “most women
under 40 [do] not need more medicalized care”. Not medicalizing women whose pregnancies
are not in any danger is a key method to keep the cost of prenatal care down. Another cost-
effective medical practice that Sweden employs is that “during a normal pregnancy without
complications, just one ultrasound will be done over the whole nine months — and not a single
gynecological exam” (2013, October 7, New York Daily News). Ultrasounds can drive up the
cost of prenatal care visits because they require higher copays and a technician that can read the
machine. Many American women enjoy several ultrasounds that serve no real purpose other than
to waste money and to drive up the overall cost of prenatal care. Additionally, gynecological
exams require a gynecologist which will drive the price up even more. Understanding how
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Sweden faces its problems with prenatal care can help America fix its own problems with
prenatal care because the issues that America struggles with are not unique to just America.
Japan’s approach to prenatal care is very interesting because it is a country that struggles
with economic disparity between classes worse than America. Additionally, Japan is ranked
higher than America and is not a majority white country, and it also has a much lower
governmental budget than America. Many critics of the Mothers Health Index Ranking believe
that America’s diversity culturally and economically is its weak point when it comes to prenatal
care. However, Japan showcases that a country that must deal with gross economic disparity can
overcome its struggles. Japan struggles with getting women to prenatal health care classes
however, Japan advocates for a natural birth system which helps to keep health care cost low and
also helps to insure equality across social classes. Japan’s approach to prenatal care further
The natural approach to carrying a child and birthing it can be seen throughout many
countries. In Greece, prenatal care classes are somewhat scarce, however, there are several
organizations that advocate for a natural birth that is relatively free from antibiotics and other
costly medications. Organizations such as Birth Voice “aim to facilitate natural childbirth by
offering monthly classes for pregnant women” (Anglo Info., 2018). Additionally, organizations
such as La Leche League Greece “offers information and support to mothers who breastfeed or
want to breastfeed.” (Anglo Info., 2018). By offering cost effective methods to promote a healthy
pregnancy, Greece and Sweden have made prenatal care more available to the women in their
countries, while at the same time keeping financial strains on their health care system low and
their ranking in the world when it comes to prenatal care high. This shows yet another example
of why America needs a more natural approach to prenatal care. Natural birthing practices affect
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not only the cost of the physical delivering of the baby, but also the cost that goes into prenatal
The countries that outperform America do so not because they spend exorbitant amounts
of money on their mothers or because their populations are easier to deal with than America’s.
They do so because they utilize the tools available to them. Natural birth is a tool that is available
to American mothers and instead of it being frowned upon or not even talked about by health
professionals, it needs to be an option for child bearing that is taken seriously. Medical
professionals should strive to provide the best quality affordable care that they can for their
mothers no matter how much a mother can pay for that care. Although, offering a more natural
approach to birth will cause hospitals and doctors to lose financially, and the benefits severely
out-weigh the consequences of skipping prenatal care in order to pay for some of the other costs
associated with having a child. If doctors want to provide mothers with the best prenatal care,
then they need to put aside their personal feelings, and do what is best for the mothers and their
babies. Natural birth is a resource that America has not capitalized on to the detriment of its
mothers.
Conclusion
America is a country that enjoys being first, however, Americans have dropped the ball
when it comes to prenatal care. Ranking 33rd internationally should not be good enough for the
mothers of America. American citizens need to ask themselves whether prenatal care is the best
that it can be in America. Since the answer to that question is no, America must dive into the
cause of such a low ranking and develop plans to help combat what plagues the nation. America
was built on the principles of life, liberty, and the pursuit of happiness, however, if women’s
healthcare, in regard to prenatal care, continues in the direction it is headed, then America has
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failed to insure every woman’s right to life, and by doing this, America has thus failed the
unborn child’s right to life. Prenatal care in America is an embarrassment to a country as wealthy
as America. The disparity between the quality of care that women receive should be remedied
through the adoption of natural prenatal care practiced around the world. The women of America
have been asking for a more natural approach to child birth which is evident through their choice
to have their babies in their homes. The trend of less medicalized care that other countries
advocate for could be the tool that saves American health care. America is a country full of
inequality between race, gender, and income status. Prenatal care is the unique time when all of
these inequalities can be compounded. Between women having to pay for more health care than
their male counterparts to African American and Hispanic American teenagers being more likely
to get pregnant due to the broken American education system. Additionally, impoverished
women of any race were also put at a severe disadvantage. With the usage of natural birth
practices, America can remedy the gross over-sight of prenatal care. When endeavoring to solve
the problems with prenatal care in America, America should understand why the problem has
occurred, and strive to change the culture in order to address the disparity that women from
References
(2018) Out- of- Hospital Births on the Rise in U.S. Retrieved from
https://www.scientificamerican.com/article/out-of-hospital-births-on-the-rise-in-u-s/
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to/greece/healthcare/pregnancy-birth/prenatal-care
http://japanhealthinfo.com/pregnancy-and-childbirth/prenatal-care/
https://www.webmd.com/baby/features/cost-of-having-a-baby#1
(2017, January 31) What is prenatal care and why is it important? Retrieved from
https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care
(2013, October 7) Midwives, Not Medicine, Rule Pregnancy in Sweden, with Enduring Success
rule-pregnancy-sweden-article-1.1478407
Basch, Charles “Teen Pregnancy and the Achievement Gap Among Urban Minority Youth.”
Journal of School Health, 2011, pp. 614-618
Chisholm, Andrea (2016, December) Prenatal Care and Testing Retrieved from
https://swedishhospital.com/
Chriscaden, Kimberly (2016, November 7) Pregnant women must be able to access the right
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http://www.who.int/mediacentre/news/releases/2016/antenatal-care-guidelines/en/
Dockterman, Eliana( 2015, May 6) U.S. Ranks Worst Developed Country for Maternal Health,
report/
Fisher, Max (2013, May 8) Here’s a Map of the Best and Worst Countries to be a Mother
Retrieved from
https://www.washingtonpost.com/news/worldviews/wp/2013/05/08/heres-a-map-of-the-
best-and-worst-countries-to-be-a-mother/?utm_term=.7a890c96a309
Ramnarace, Cythia (2018) 8 Surprising Fact About Prenatal Care Around The World, Retrieved
from https://www.thebump.com/a/prenatal-care-facts-around-world
Scott, Maiken (2013, December 13) How did birth move from the home to the hospital, and back
the-hospital-and-back-again/
Williamson, Kevin (2017, May 5) Why Shouldn’t Women Pay More for Health Insurance?
because-they-have-higher-health-care-costs/