Social Inequalities in the Organization of Pregnancy Care in a Universally Funded Public Health Care System Georgina Sutherland • Jane Yelland • Stephanie Brown Published online: 8 February 2011 Ó Springer Science+Business Media, LLC 2011 Abstract To examine the social organization of preg- nancy care and the extent to which socioeconomic factors affect women’s experience of care. We consider these data in the global discussion on taking action to reduce health inequalities. This study draws on cross-sectional data from a large population-based survey of Australian women 6 months after giving birth. Only those women reporting to attend publically-funded models of antenatal care (i.e., public clinic, midwife clinic, shared care, primary medical care, primary midwife care) were included in analyses. Results showed a social patterning in the organization and experience of care with clear links between model of care attended in pregnancy and a number of individual-level indicators of social disadvantage. Our findings show model of care is a salient feature in how women view their care. How women from socially disadvantaged backgrounds navigate available care options are important consider- ations. Pregnancy care is recognized as an opportunity to intervene to give children ‘the best start in life.’ Our data show the current system of universally accessible preg- nancy care in Australia is failing to support the most vul- nerable women and families. This information can inform actions to reduce social disparities during this critical period. Keywords Pregnancy care Á Health systems Á Social inequalities Á Adversity Introduction There is a vast international literature documenting the effects of social stratification on individual and collective experiences of health [1]. Documented social disparities in women’s access to, experience of and benefits from care during pregnancy are of particular social epidemiologic interest. Investment in the early years, including during pregnancy, is recognized as an opportunity to afford gen- erational change to the most vulnerable families in society [1, 2]. Yet, evidence shows disadvantage, such as educa- tion, income, ethnicity and social exclusion are associated with delayed presentation for pregnancy care [3, 4], less contact with care providers [5], less positive experiences of care [6–8], and poorer maternal and infant health outcomes [9–12]. In Australia, as in many other high-income countries, pregnancy brings women into sustained contact with the health care system through a designated schedule of visits. There is clear opportunity to influence lifelong outcomes through appropriate and responsive care in this critical period. Yet, the way care is organized and delivered can be a social determinant of health. In general, those who are more socially advantaged derive more benefit from the system than those with less social and economic capacity. In Australia’s two-tiered health system, those with the financial means and a preference for choice may opt for private health insurance. This less heavily subsidised option of care is less accessible to people who are poor [13]. A population-based survey in one Australian state (Victoria), conducted over 20 years ago, highlighted the G. Sutherland (&) Á J. Yelland Á S. Brown Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, VIC 3052, Australia e-mail: georgina.sutherland@mcri.edu.au S. Brown General Practice and Primary Health Care Academic Centre, The University of Melbourne, Parkville, Melbourne, VIC 3052, Australia 123 Matern Child Health J (2012) 16:288–296 DOI 10.1007/s10995-011-0752-6