The Production of Inequality in High-Risk Pregnancy

How do socioeconomically advantaged individuals maintain their health advantage? Prior work shows how high socioeconomic status (SES) individuals secure advantages in areas such as housing or the labor market and provides longstanding evidence of health inequalities across SES. However, we have a more limited understanding of the mechanisms behind how high-SES individuals leverage structural advantage to improve their own health. This article draws on in-depth interviews with people diagnosed with gestational diabetes mellitus (GDM), a high-risk pregnancy condition that requires an intensive treatment regimen over a short timeframe, to reveal how socioeconomic advantage translates into health advantage. Socioeconomic advantage creates inequalities in health through multiple pathways, including excess financial resources that can be used to acquire health-relevant resources and access to flexible time to dedicate toward strict GDM management. Socioeconomically advantaged participants can thus respond to a diagnosis with GDM more quickly and efficiently than can disadvantaged participants. The divergent approaches to managing GDM that I uncover support advantaged individuals’ hyper-compliance with treatment guidelines, what I call going “above and beyond,” that translate into qualitatively different interactions with healthcare professionals than those of low-SES individuals, compounding structural (dis)advantage. Explicating the mechanisms through which high-SES individuals maintain health advantage identifies new directions for studying the production of inequality.