Capstone Outline

1. The purpose of my paper is to inform potential mothers and medical professionals about
the issues with prenatal care in America.
2. Thesis: 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.
3. What is wrong with prenatal care in America
a. Teenage Pregnancy
i. Teenage pregnancy has been cited as one of the downfalls of prenatal care
and preconception care in America. According to Basch, “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.” (pp. 614) 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 that 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 research, “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. Teen pregnancy is an important aspect
of the American ranking on the Mother index. Teen pregnancy affects
many facets of prenatal care therefore; it is important to understand
teenage pregnancy in order to combat. Therefore, this part of the paper
will address the understanding the problem part of the paper. Teenage
pregnancy is cited as a major reason for America low ranking however,
when approach sex education the same way.
b. Cost of prenatal care
i. In America, the average cost of prenatal care without health insurance is
around 2,000 (2018, WedMD). This exorbitant amount of money is often
too much for a single mother or young mother to pay. Additionally, these
2,000 dollars don’t include any of the hospital care that the mother and
baby will require during and after labor.
ii. 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.” (https://www.nationalreview.com/corner/women-
pay-more-insurance-because-they-have-higher-health-care-costs/)
Therefore they are put at an automatic disadvantage when it comes to
health because of the exorband cost of health care plus the other add cost
 associated with have a baby. This part of the paper will strive to showcase
the struggles that low income mothers when it comes to prenatal care.
4. The evolving culture surrounding prenatal care
a. American Mother’s ideas surrounding hospital care.
i. More and more mothers are starting to lean more towards at home births.
From the years 2004 and 2014 have grown .5% and is still rising.
(https://www.scientificamerican.com/article/out-of-hospital-births-on-the-
rise-in-u-s/) 90% of these home births were planed which “speaks to some
women's growing discomfort with the standard hospital-based system of
childbirth in the U.S,” (Marian f. MacDorman). As time continues women
are starting to want a more natural and relaxed birthing experience. Thus
showing that the way the other countries approach prenatal care would be
helpful in America.
5. How to fix prenatal care

a. Prenatal care in Sweden

i. 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 “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 ). Ultra sounds 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 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.
b. Prenatal care in Japan
i. 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 it is not a
majority white country and it also has a much lower governmental budget
than America. Japan struggles with get women to prenatal health care
 classes however Japan advocates for a natural birth system which helps to
keep health care cost low and to insure equality across social classes.
Japan’s approach to prenatal care further highlights the need for a more
natural form of prenatal care.
c. Prenatal care in Greece
i. 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” (2018, Anglo Info). Additionally, organizations such as
La Leche League Greece “offers information and support to mothers who
breastfeed or want to breastfeed.” (2018, Anglo Info). 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 the yet another example of why America needs a more natural
approach to prenatal care.
d. Sex education
i. Education is an important fact to look at when understand prenatal care in
America. When sex education started becoming a part of school many sex
education programs were abstinence only. These types of programs were
not only dangerous to the teens that would eventually get pregnant but,
also to their peers who would contract many sexually transmitted diseases.
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.
(http://www.advocatesforyouth.org/component/content/article/450-
effective-sex-education)
6. Understanding that its important
a. The mothers index
i. 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. Ranking 33rd internationally should
not be good enough for the mothers of America.