title: Inequalities in perinatal and maternal health.
abstract: OBJECTIVE
  To describe inequalities in perinatal and maternal mortality, and morbidity from an international high-income country perspective. Measures of inequalities are socioeconomic status, ethnic background, and living area.
  
  
  RESULTS
  Despite decreasing overall perinatal and maternal mortality in high-income countries, perinatal and maternal health inequalities persist. Inequalities in fetal, neonatal, and maternal adverse outcome relate to specific groups of risk factors. They commonly have a background in so-called structural risk factors, that is low level of education and income, being a migrant and living in disadvantaged areas. Structural risk factors therefore drive inequalities, and simultaneously represent the common perspective to judge perinatal and maternal health gaps. The effect of risk factors is further magnified in urban areas through risk accumulation.As mother and child share their background, neonatal, and maternal adverse health outcome patterns coincide, resulting in similar inequalities and similar epidemiological trends. The structural background explains the difficulty of improving this.
  
  
  CONCLUSIONS
  Inequalities in perinatal and maternal outcome persist in women from lower socioeconomic groups, from specific ethnic groups, and from those living in deprived areas. In view of the lifelong consequences, these marked social disparities pose an important challenge for the political decision makers and the healthcare system.
authors: Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. j.degraaf@erasmusmc.nl
authors: Johanna P
authors: JP
authors: de Graaf
authors: Eric A P
authors: EA
authors: Steegers
authors: Gouke J
authors: GJ
authors: Bonsel
mesh_terms: D019049:Developed Countries; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008428:Maternal Mortality; D008429:Maternal Welfare; D009765:Obesity / Q000453:epidemiology* / Q000208:ethnology; D018743:Perinatal Care / Q000592:standards / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000208:ethnology; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000208:ethnology; D012307:Risk Factors; D012923:Social Class; D012931:Social Environment; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000208:ethnology