When we think about what can affect a pregnancy, what we often come up with are the actions individual mothers can take: choosing what types of food to eat, how much exercise to get, whether or not to take prenatal vitamins. But these micro-level factors aren’t the only things that can affect pregnancy outcomes. There are macro-level factors that can have a significant impact on a woman’s pregnancy. The macro-level factors that come from our social environment are called the social determinants of health. The social determinants of health are the social and economic factors that influence people’s health (What are the Social Determinants of Health?, 2016). Some examples of these determinants are race, income, class and access to health services. These social determinants operate in complex ways and often interact with each other to produce health outcomes. In this blog post, we’ll look at how two of the social determinants of health can affect pregnancy.
How do the Social Determinants of Health Impact Pregnancy?
Though each social determinant of health may work through different pathways, they can all result in negative pregnancy outcomes if you’re on the lower end of the scale.
Let’s start by looking at race. Discrimination based on race can have detrimental effects on a woman’s pregnancy. Research has shown that minority women, specifically Black and Latino women, are more likely to have excessive weight gain during pregnancy (Reid et al., 2016). On average they gain about 15 pounds more than recommended. The same research has also shown that discrimination based on race increase a woman’s chance of excessive weight gain during pregnancy by 94% (Reid et al., 2016). Weight gain during pregnancy can lead to conditions like gestational diabetes, which can lead to health issues for mother and baby later on down the line.
Imagine a pregnant woman who is living off of minimum wage. What issues do you think this could cause in her pregnancy? There are the obvious ones, such as being able to afford adequate shelter and food, but there are also outcomes that don’t come to mind immediately. Lower wage workers have less access to workplace insurance and those who do have it often receive minimal benefits (Long & Marquis, 2001). Wilson-Mitchell and Rummens’ study on uninsured immigrant, refugee and migrant mothers in Toronto showed that uninsured women have fewer prenatal visits with their doctors, that the number of visits they have is usually inadequate according to guidelines and that 6.5% of insured women don’t get any prenatal care at all (Wilson-Mitchell & Rummens, 2013). Receiving less care during pregnancy could lead to health issues being overlooked or untreated, both of which could result in poor pregnancy outcomes.
The Big Picture
It’s easy to look at each of these social determinants separately, but what about when they intersect? For example, what about an immigrant woman of colour with low income? This woman’s intersections would seriously impact her ability to access healthcare services. Some of the problems she could face are a lack of access to transportation, a language or cultural barrier that causes misunderstandings with her primary care provider or the inability to make appointments that fit her work schedule (Higgenbottom et al., 2016). All of these separate issues can lead to her receiving inadequate prenatal care, which could lead to negative pregnancy outcomes, some of which could be devastating.
The social determinants of health play a key role in the lives of pregnant women of colour. What they show us is that a woman’s decisions about her pregnancy aren’t shaped by her alone, they are also impacted by her environment and social location.