Pregnancy is a major life event that involves dramatic changes to a pregnant person’s body and brain. These changes are well documented but often ignore the role that pregnancy plays in a mother’s social life and cultural world. While pregnancy is often celebrated and even revered across the globe, it is experienced differently depending on the social factors surrounding the pregnant mother. Factors such as age, social class, race/ethnicity, and gender identity all intersect with the pregnancy experience. One phenomenon that is universally shared amongst pregnant women is navigating the social expectations and cultural influences during the 40 weeks of gestation. These pressures have a direct impact on the mother’s physical and mental well being as well as on the developing child. In this section, we will take a closer look into social and cultural factors that influence pregnancy experiences and outcomes.

3.10.1 Systemic Issues and Social Inequalities

In Chapter 1 we learned that our society has been structured in a way that creates social inequalities. These are caused by biases and practices embedded within systems such as the school system, housing, healthcare, or government. Their pervasive presence creates unnecessary barriers for people (oppression) and can impact many facets of one’s life. Social and group identities play a crucial role in the opportunities people are afforded and the barriers they face. Pregnant people are a vulnerable group that are uniquely impacted by social issues. This is further compacted by facets of their identity such as race, social class, and gender.

Gender is a social construct based on biological sex. Our society has different roles and norms assigned to people depending on whether they are born a male or female. This type of binary system does not allow for much diversity or acceptance for people born as intersex or whose gender identity differs from the standard male or female. Cisgender means that a person’s gender identity coincides with the sex assigned at birth. Transgender means that a person’s gender identity does not match with the sex assigned at birth. In pregnancy, transgender men face unique challenges navigating the healthcare system and stigmas related to their identity. This will be discussed later in this section.

Racism is a system of advantage based on race or perceived race. Pregnant women from racial minority groups such as Native American/Indigenous, African American/Black, and Latina/Hispanic experience race differently than White women due to the power structures that advantage White people over others. In pregnancy, women of color experience higher rates of maternal mortality, complications during pregnancy and labor, and adverse impacts to their developing child at much higher rates than their White counterparts (Kozhimannil, et al., 2011).

In a report published by the CDC, it is noted that there are multiple factors that contribute to pregnancy related mortality and racial disparities (Peterson et al, 2019). Implicit bias or the unconscious beliefs and attitudes that influence our judgments and actions, exists in the health care system. This bias along with structural racism impacts the way providers interact with their patients, the level of care provided to an expecting mother, and treatment decisions. Mistreatment in medical settings is experienced more frequently by women of color, resulting in unnecessary medical interventions and impacting feelings of safety and quality of the pregnancy experience (Vedam et al., 2019).

Classism is a system of advantage based on socioeconomic status. Pregnant women from a higher social class have access to quality healthcare, nutrition, and resources before, during and after their pregnancy. Pregnant women from lower socioeconomic groups often have limited to no access to preventative or prenatal care or nutritious foods to support their changing bodies. They also live in neighborhoods that contain environmental toxins, many of which are known to cause disruption or defects in fetal development.

It is important to note that gender, race, and class are not the only social categories that impact expecting mothers.

There is also prejudice and discrimination based on ability (ableism), sex (sexism), language, and citizenship status, to name a few. A pregnant person may have several intersecting identity labels which can result in compounded oppression and increased risks over their pregnancy and throughout parenthood.

3.10.2 Gender and Pregnancy

Gender is a very powerful social construct that impacts a person’s development. Society has constructed gender as a binary system (male/female) and assigned specific norms, rules, and expectations to what each gender should and should not be. Behaviors and practices that do not fit standard gender norms are often met with criticism, discrimination and even hostility. People experience pregnancy differently depending on their gender identity. Gender impacts the way we treat the developing fetus and the cultural and social rituals associated with parenthood. It also impacts how we raise and socialize children. These experiences will be described below.

3.10.2.1 Gendering the Unborn Child

The role gender plays in a child’s life begins before they are born. In the past, many expecting parents would engage in cultural rituals or wives tales to determine the sex of the child. This might include the ring test which requires a ring attached to a string. The way it moves determines whether the baby will be a boy or a girl. With the advancement of technology, expecting parents no longer need to guess their baby’s sex. They could know it relatively early in the pregnancy through ultrasound and genetic testing. Gender reveal parties and videos on social media are all the rage in today’s culture. Why are we so obsessed with gender?

As mentioned earlier, gender is a powerful social construct that influences the way we interact with the world. Expecting parents are often pressured by their families and friends to know the sex of the baby in order to prepare for the baby’s arrival. Knowing the sex of the baby early on helps parents and family determine the gender path for that child. Gender influences what clothes people will buy, the kind of toys they will purchase, and how they might decorate the nursery. On the surface, these types of distinctions may seem harmless but it is important to connect gender to larger societal issues.

When we look deeper into gender construction, we see that biological sex is tied to assumptions about behavior, abilities and genetics. We expect boys and girls to be and do certain things. Think about the messages we give girls when we decorate their rooms in “feminine” colors and give them dolls and a dollhouse to play with. Or about the messages we give boys when we decorate their rooms in “masculine” colors and give them a construction set and sports toys to play with? We as a society are enforcing narrow and often troublesome social stereotypes early on in a child’s development. We are telling girls that they are delicate, passive and should sit and play with household items so that they can grow up and care for their home. We tell boys that they are tough and active and should learn skills so they can grow up and have careers. Moreover, we tell ourselves gender norms are essentially true because things “have always been this way” even though if you were born 100 years ago, boys would be dressed in pink and girls in blue (Maglaty, 2011)!

Gender socialization teaches children how to behave, how to dress, what types of jobs they can have, and how they should act towards others of the opposite gender. This puts undue limits and pressures on children rather than allowing them to determine their own paths in life. Children who do not conform to gender expectations are often bullied or ridiculed. They may develop issues related to gender identity and expression that impact them well into adulthood. It is important to think about the role of gender during pregnancy and throughout the development of the child.

3.10.2.2 Transgender Men

Transgender people account for 0.6% of the U.S. population (Williams Institute, 2022). Transgender pregnant men belong to an even smaller minority group and they face specific challenges due to their gender identity. Many transgender men retain their female reproductive organs which means they are able to get pregnant. Once pregnant, the level of care they need to maintain a healthy pregnancy and delivery is similar to cisgender pregnant women. Some transgender men choose to “transition” using hormone therapy. The use of testosterone may impact fertility as well as pregnancy (Gorton et al, 2005).

The stigmas and cultural pressures surrounding transgender pregnancy lead to misunderstanding and lack of care or empathy for this group. Some transgender pregnant men report not being taken seriously by medical staff or having to educate staff about their gender identity. These types of negative experiences can lead to behaviors that prevent transgender men from seeking prenatal and postpartum care. For example, a study concluded that 30.8% of transgender men delayed or did not seek support from healthcare providers due to the prejudice and discrimination they experienced (Jafee et al, 2016).

Along with stigma in the medical world, transgender men also face scrutiny socially due to misconceptions and beliefs about gender. It is important to think about how social context and cultural norms impact this group. Transgender men deserve to have a healthy pregnancy and can have a positive experience given the appropriate support. The healthcare system can educate providers in understanding the unique needs of diverse populations. Social norms and expectations can shift if we focus our attention on creating environments in which all children can thrive.

3.10.3 Cultural Perceptions and Age

In most societies worldwide, pregnancy elevates one’s social status. A pregnant woman is celebrated and becomes the ultimate symbol of womanhood and femininity. An expecting father is congratulated for his virility and masculinity. It is important to note that pregnancy is viewed differently depending on the context and time in history. Expectant mothers must navigate through all of these messages during one of the most important transitions of their lives. Age is one of the factors that plays a role in the perceptions and beliefs around motherhood.

3.10.3.1 Teenage Pregnancy

As authors we have heard many stories by our own friends and family members who have experienced abuse and lack of support by the professionals in charge of caring for them. Below, we will share a personal story to open the discussion around teenage pregnancy.

An important question that you might be wondering the answer to here is “why?” Why did this happen?

Cultural perceptions around pregnancy and pregnant mothers are demonstrated within social and familial interactions, the media, the work world and in the medical field. These perceptions influence what we think mothers should be like, look like, and what they should do when they are pregnant. They also influence our thoughts and beliefs about who should be a mother and how they should mother. For example, modern western society may view teenage pregnancy unfavorably because we believe that a teenager is unfit to parent.

A teenage mother or father may not be celebrated in the same way as an older person might be and therefore not earn any social status, or support, as a result. On the contrary, as the story showed, the expectant mother and father may encounter discrimination. Compare this to a teenage pregnancy 100 years ago. Not only would pregnancy during adolescence be considered normal but also expected given the context of that period in time.

The mother in the scenario was young, but she was also Latina and the nurse was White. While racialized interactions are not a specific focus in this section, race plays a role in the way pregnant people are treated. Age further compounds these experiences. Teenage pregnancy is associated with a variety of stigmas and stereotypes that can be harmful to the pregnant mother and developing child. They may be deemed irresponsible, financially and emotionally unstable or “bad”. They may face scrutiny by their families, peers, school staff, and medical professionals. This type of treatment can lead to negative coping behaviors such as avoiding prenatal care, missing school, or withdrawing from their friends and family.

There have been several studies that look into the connection between stigmatized teenage mothers and pregnancy outcomes. One such study shows that stigmatized pregnant mothers are at increased risk of abuse and social isolation (Weimann et al, 2005). Researchers who study stigmatized groups argue that these negative associations may be one of the underlying causes of health disparities. Stigmatized groups face increased stress, internalization of negative perceptions, lack of resources and more (Hatzenbuelher et al, 2013). This impact is even more pronounced when teenage mothers have adverse experiences based on their race and social class.

It is important to understand the risks factors associated with teenage pregnancy but it is more important to treat all expecting mothers and their partners with respect and dignity. Teenage mothers who receive adequate prenatal care and support from their family, friends, and community have positive outcomes during pregnancy, labor, and parenthood. Regardless of age, social class or race, pregnant mothers of any age should get the level of healthcare they deserve.

3.10.3.2 Pregnancy in Advanced Maternal Age

Older pregnant women also face pressures associated with their age, although this differs from expecting teens. Despite the fact that women in today’s society delay pregnancy later than ever before, there exists stigmas for older women. Women are often questioned for their choices to either not have children, or to have children after they have established careers, achieved financial stability or some other reason. Men who become fathers at older ages face little to no commentary regarding their choice to raise children later in life. The discrepancy between these perceptions connects heavily to gender norms and what is expected for a female.

The term geriatric pregnancy was used to describe the pregnancy of a woman over 35 years old. The term geriatric is also used to describe older adults, often ages 65 or older. The medical field now uses the term advanced maternal age to describe older expecting mothers. The associations between being an older mother as compared to being a senior adult are clear and have negative associations. The age of 35 is used as a distinct marker for advanced maternal age although there is no distinct age when a pregnancy suddenly becomes high risk. Rather, risk is associated with the gradual aging process.

Older women are often bombarded with messages that pregnancy in advanced age is dangerous or selfish, creating stigmas around delayed pregnancy (Cardin, 2020). Risks associated with age are often exaggerated and do not take into account one’s individual choices, environmental and social circumstances, or genetics. Data does show that there are certain risks that increase with age but most older women are able to have a healthy pregnancy without major complications (Chervenak, 1991). Modern medical advancements allow all pregnant people to access tests and procedures to measure risk or health issues, regardless of age.

There are many positive outcomes associated with delaying pregnancy and motherhood. A study concluded that older maternal age results in less behavioral and emotional issues in children, regardless of demographic and socioeconomic factors (Trillingsgaard & Sommer, 2018). Older parents are generally financially and emotionally stable which leads to positive protective factors for children.