Global inequities in adverse pregnancy outcomes: what can we do?

Abstract

The Health Equity Leadership & Exchange states, “Health Equity exists when all people, regardless of race, sex, sexual orientation, disability, socio-economic status, geographic location, or other societal constructs have fair and just access, opportunity, and resources to achieve their highest potential for health.” It is clear from the wide discrepancies in maternal and infant mortalities, by race, ethnicity, location, and social and economic status that health equity has not been achieved for pregnancy care. Although the most obvious evidence of inequities is in low resource settings inequities also exist in high resource settings. In this presentation, based upon the Global Pregnancy Collaboration Workshop which addressed this issue, we explore the bases for these differences in outcome. We overview several different settings in which inequities exist in high and low resource settings. Apparent causes include social drivers of health including low income, inadequate housing, suboptimal access to clean water, structural racism and growing maternal health care deserts globally. We also ask whether maternal health inequities might extend to, and be partially due to, current research practices and conclude that this is the case. In our overview of inequities, we provide approaches to resolving these that are relevant to low and high resource. Based upon this evidence we provide recommendations, for increasing health equity in pregnancy care. Unfortunately, some of these inequities are more amenable to resolution than others. We encourage continued attention to these inequities and innovative thinking and research to seek solutions.