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Prenatal Care in America and Around the World

Jordan Gooding
Glen Allen High School
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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.

Understanding the Issue

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

inequality that it is bogged down with (2013). According to Fisher:

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


What is Wrong with prenatal care in America?

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


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


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

pregnancy) Additionally, the epidemic of teenage pregnancy has selectively placed

impoverished, uneducated, and minority mothers at a disadvantage for years and this epidemic

has been perpetuated by the United States education system.

Education is an important factor to look at when understanding prenatal care in America.

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

cultural groups at a disadvantage.

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

women’s health care overall.

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 Evolving Culture Surrounding Hospital Care

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

other countries approach prenatal care would also be helpful in America.

Cultural Comparisons and Solutions

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
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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

highlights the need for a more natural form of prenatal care.

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

care and preparation.

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



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

different backgrounds face when attempting to have a child.


(2018) Out- of- Hospital Births on the Rise in U.S. Retrieved from
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(2018) Prenatal Care in Greece Retrieved from


(2018) Prenatal Care in Japan Health Care Info Retrieved from

(2018) What it Costs to Have a Baby Retrieved from

(2017, January 31) What is prenatal care and why is it important? Retrieved from

(2013, October 7) Midwives, Not Medicine, Rule Pregnancy in Sweden, with Enduring Success

Retrieved from


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

Chriscaden, Kimberly (2016, November 7) Pregnant women must be able to access the right
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care at the right time, says WHO, Retrieved from

Dockterman, Eliana( 2015, May 6) U.S. Ranks Worst Developed Country for Maternal Health,

Retrieved from


Fisher, Max (2013, May 8) Here’s a Map of the Best and Worst Countries to be a Mother

Retrieved from


Ramnarace, Cythia (2018) 8 Surprising Fact About Prenatal Care Around The World, Retrieved


Scott, Maiken (2013, December 13) How did birth move from the home to the hospital, and back

again? Retrieved from


Williamson, Kevin (2017, May 5) Why Shouldn’t Women Pay More for Health Insurance?

Retrieved from