The issue of maternal health equity

Why is equity important?
Equity in health is recognised as a basic human right, meaning that all people ought to have the same opportunity for a healthy life and strategies for coping with illness, regardless of their race, ethnicity, culture, language, gender, age, economic conditions, social status, environment, and other social factors such as place of residence, occupation, religion, or education. Research shows that inequities in health exist whether socio-economic position is measured in terms of material resources, such as income, education or wealth, or as a relative position based on a social hierarchy, such as occupational rank, gender- or ethnicity-based differences. Such social and economic inequities in health negatively influence not just the lives of individuals in disadvantaged positions, but are also detrimental to entire communities and societies. Understanding how inequities in health arise and identifying effective interventions to reduce them is of great importance to all societies.How do differences in socio-economic position lead to different maternal health outcomes?
In maternal health, it has been noted that:1In this article, we look at four of the many pathways through which inequities in maternal health arise, spanning a wide breadth of influences, from girls’ childhood nutrition to accessing obstetric care at the time of childbirth. In these examples, we use household wealth as a measure of women’s socio-economic position, classifying women into five groups within their country of residence: poorest, poor, middle, richer and richest.“[a] link between poverty and maternal health has been clear for more than a century, and is lent support by extensive evidence from rich countries. The reasons for these differences are not well understood. Large discrepancies exist between the rich and the poor in the uptake of antenatal and delivery services, but this is unlikely to be the sole explanation. Indeed, historical and contemporary research shows that there are many dimensions to disadvantage in addition to economic factors, which operate through subtle and indirect pathways to influence outcomes.”
Access to healthcare
As discussed previously, access to good quality obstetric care at the time of delivery is crucial to averting the majority of maternal mortality and morbidity. However, there are large inequities in access to good care, where poorer and more disadvantaged groups of women use less health care.
Accumulation of disadvantage over a woman’s life course
Socio-economic disadvantage can accumulate from conception through childhood and into adulthood. Numerous mechanisms can lead, over time, to poorer health among women from disadvantaged groups. These mechanisms ultimately combine with poorer access to healthcare at the time of pregnancy and delivery to result in higher maternal mortality and morbidity.One example of the importance of early childhood on maternal health in adulthood relates to early childhood nutrition. Short stature in adulthood is heavily influenced by poor nutrition and frequent infection in the early years of life. In adulthood, short women are far more likely to experience obstructed labour, which is one of the most common preventable factors underlying maternal and perinatal morbidity and mortality in low- and middle-income countries. Further, short stature is associated with fistula and is an independent risk factor for caesarean delivery. Moreover, while obstructed labour can be successfully managed with a caesarean section, women from disadvantaged groups often have less opportunity to access good quality emergency obstetric care on a timely basis.
Quality of care
In the UK in the 1930s, maternal mortality was higher among women of the highest social class. Women from the working classes were more likely to deliver at home with highly experienced midwives and had lower mortality than women from affluent areas who often delivered in hospitals, where doctors attending deliveries were more likely to administer more interventionist medical care, at a time when interventions were not effective and potentially harmful, in large part due to hospital-acquired infections.
What can be done about maternal health inequities?
In this article, we highlight examples of the complex ways in which inequities in maternal health are produced. Reducing inequities depends largely on a better understanding of how they are produced in each context, and on a commitment from policy-makers to ensure that a country’s health system delivers acceptable, affordable and good quality care to all women, from early childhood throughout their entire reproductive lifespan.Programmes designed to expand coverage of effective maternal services among disadvantaged groups and narrow inequities in maternal health have been implemented in many countries. Some strategies include:- Increasing the demand for good quality health services
- Expanding the provision of maternal care services
- Improving the quality of maternal care
- Ensuring affordability of maternal care.
Improving the Health of Women, Children and Adolescents: from Evidence to Action

Our purpose is to transform access to education.
We offer a diverse selection of courses from leading universities and cultural institutions from around the world. These are delivered one step at a time, and are accessible on mobile, tablet and desktop, so you can fit learning around your life.
We believe learning should be an enjoyable, social experience, so our courses offer the opportunity to discuss what you’re learning with others as you go, helping you make fresh discoveries and form new ideas.
You can unlock new opportunities with unlimited access to hundreds of online short courses for a year by subscribing to our Unlimited package. Build your knowledge with top universities and organisations.
Learn more about how FutureLearn is transforming access to education