and birth. contributing factors the cdc cites multiple causes for the racial gap in maternal mortality. they say that most pregnancy related deaths are the combined result of 3-4 contributing factors. some of these factors include higher rates of chronic conditions in minor communities, lower rates of prenatal care, and lower rates of insurance coverage. furthermore, teen pregnancy rates are higher in minority communities, which is a risk factor for pregnancy or birth complications. black and indigenous women can also encounter racial bias held by healthcare providers, which affects the quality of care given to treat or prevent a fatal disease. for example, an nih report states that black women are two to three times more likely to die of hemorrhage or embolisms during pregnancy or the postpartum period. outside of provider-patient interactions, structural factors can contribute to the racial gap in maternal mortality. this includes the gap in access to primary and preventative care as well as other social determinants of health such as education and community support. religion there are many factors that influence maternal health and the access of resources. one of these factors that recent studies have highlighted is religion. for example, one such study stated that, due to the insensitivity and lack of knowledge that physicians showed immigrant muslim women in canada, their health information and treatment suffered. the health care that they received from physicians did not provide information in respect to their religious or cultural practices and did little to provide cultural adjustments and emotional support. in order to provide a safer and more comfortable environment for muslim women, it was proven that they needed more support that would connect with the immigrant community and health-related information. discrimination based on religion is a factor that effects the maternal health care of women from different backgrounds. there is not a lot of discussion on the studies that reflect the hardships that women go through in terms of their religion and maternal care. stigmatizing certain maternal and reproductive practices is common within the context of religion. for example, in a study that focused on interviewing women who have had abortions, one participant used the word "guilt" 16 times in her one-hour interview. she cited that the cause of her guilt was because of her catholic upbringing. the overall data showed that there was a strong relationship between religion and self-stigma. among the women who identified as a practicing christian, 65% made statements that proved self-stigma effects. there is a lot of stigma and norms regarding religion that, in turn, place women at risk when receiving health-care. other religious practices and traditions have shown to influence maternal health in a negative way. practitioners of apostolicism in zimbabwe have been associated with higher maternal mortality. results of a study showed the dangerous associations that religion may have on maternal health. the general trend shows that apostolicism promotes high fertility, early marriage, non-use of contraceptives and low or non-use of hospital care. there are delays in recognizing danger signs, deciding to seek care and receiving appropriate health care. future studies can look at how societal traditions or expectations such as gender roles may combine with religion to result in poorer maternal health care. although factors of religion can negatively influence maternal health care, other studies show the necessity of understanding different religious beliefs and practices. in ghana, interviews of women showed the benefits of transparent religious beliefs and practices while pregnant and in labor. spiritual interventions done by pastors in pregnancy included prayer, revelations, reversing negative dreams, laying of hands and anointing women. religious artifacts used among the women during pregnancy and labor were anointing oil, blessed water, stickers, blessed white handkerchief, blessed sand, bible and rosary. the women made many connections to these practices and to their religion such as god having the capability to reduce labor pain and to provide a safe and successful delivery. the results concluded that spirituality is an integral part of the care of pregnant women in ghana. in order to ensure the safety of these women, their religious practices should not be in secrecy. the presence of artifacts implies that women do not have the freedom to practice their religion at home. it was concluded that pastors should be sensitive to their role in the labor process and that revelations and spiritual interventions should not lead to pregnancy or labor complications. future studies in religion and maternal health care will focus on the role of pastors, familiar support, and the views of midwives or health care professionals in different societies around the world. effects on child health and development prenatal health prenatal care is an important part of basic maternal health care. it is recommended expectant mothers receive at least four antenatal healthcare visits, in which a health worker can check for signs of illness – such as underweight, anaemia or infection – and monitor the health and status of the fetus. during these visits, women are counselled on nutrition and hygiene to optimize their health prior to, and following, delivery. these visits can also include health maintenance of any pre-existing health conditions the woman may have had prior to becoming pregnant - such as diabetes, hypertension, or renal disease. in collaboration with her healthcare provider, the patient can develop a birth plan which outlines how to reach care and what to do in the event of an emergency. the model centeringpregnancy (group prenatal care) is a relatively new addition to prenatal healthcare, and has shown to improve both birth outcomes and patient & provider satisfaction. specifically, a randomized controlled trial indicated a 33 percent reduction in preterm birth (n=995), and the decrease was even more pronounced for black/african american participants. centeringpregnancy provides physical exams, education, and peer support to a group of pregnant women who all have a similar due date. research in race concordant group prenatal care (like the embrace group at ucsf) has not yet been researched enough to indicate improved outcomes. nonetheless, race concordant care has been proven to improve patient experience and patient & provider communication. moreover, newborn-physician racial concordance was significantly associated with mortality improvements for black infants. poverty, malnutrition, and substance use may contribute to impaired cognitive, motor, and behavioral problems across childhood. in other words, if a mother is not in optimal health during the prenatal period (the time while she is pregnant) and/or the fetus is exposed to teratogen(s), the child is more likely to experience health or developmental difficulties, or death. the environment in which the mother provides for the embryo/fetus is critical to its wellbeing well after gestation and birth. a teratogen is "any agent that can potentially cause a birth defect or negatively alter cognitive and behavioral outcomes." dose, genetic susceptibility, and time of exposure are all factors for the extent of the effect of a teratogen on an embryo or fetus. prescription drugs taken during pregnancy such as streptomycin, tetracycline, some antidepressants, progestin, synthetic estrogen, and accutane, as well as over-the-counter drugs such as diet pills, can result in teratogenic outcomes for the developing embryo/fetus. additionally, high dosages of aspirin are known to lead to maternal and fetal bleeding, although low-dose aspirin is usually not harmful. newborns whose mothers use heroin during the gestational period often exhibit withdrawal symptoms at birth and are more likely to have attention problems and health issues as they grow up. use of stimulants like methamphetamine and cocaine during pregnancy are linked to a number of problems for the child such as low birth weight and small head circumference and motor and cognitive developmental delays, as well as behavioral problems across childhood. the american academy of child and adolescent psychiatry found that six-year-olds whose mothers had smoked during pregnancy scored lower on an intelligence test than children whose mothers had not. cigarette smoking during pregnancy can have a multitude of detrimental effects on the health and development of the offspring. common results of smoking during pregnancy include pre-term births, low birth weights, fetal and neonatal deaths, respiratory problems, and sudden infant death syndrome (sids), as well as increased risk for cognitive impairment, attention deficit hyperactivity disorder (adhd) and other behavioral problems. also, in a study published in the international journal of cancer, children whose mothers smoked during pregnancy experienced a 22% risk increase for non-hodgkin lymphoma. although alcohol use in careful moderation (one to two servings a few days a week) during pregnancy are not generally known to cause fetal alcohol spectrum disorder (fasd), the us surgeon general advises against the consumption of alcohol at all during pregnancy. excessive alcohol use during pregnancy can cause fasd, which commonly consist of physical and cognitive abnormalities in the child such as facial deformities, defective limbs, face, and heart, learning problems, below average intelligence, and intellectual disability (id). although hiv/aids can be transmitted to offspring at different times, the most common time that mothers pass on the virus is during pregnancy. during the perinatal period, the embryo/fetus can contract the virus through the placenta. gestational diabetes is directly linked with obesity in offspring through adolescence. additionally, children whose mothers had diabetes are more likely to develop type ii diabetes. mothers who have gestational diabetes have a high chance of giving birth to very large infants (10 pounds (4.5 kg) or more). this is a cause of macrosomia. neonates with macrosomia have significantly increased rates of hypoglycemia compared to infants of mothers without diabetes. this is because macrosomic neonates are used to high levels of circulating blood sugars in utero, which results in naturally high levels of insulin. at birth, when the gestational source of blood sugar is abruptly removed, this causes the neonates to experience severe drops in blood sugar. because the embryo or fetus's nutrition is based on maternal protein, vitamin, mineral, and total caloric intake, infants born to malnourished mothers are more likely to exhibit malformations. additionally, maternal stress can affect the fetus both directly and indirectly. when a mother is under stress, physiological changes occur in the body that could harm the developing fetus. additionally, the mother is more likely to engage in behaviors that could negatively affect the fetus, such as tobacco smoking, substance use, and alcohol use. childbirth and sexually transmitted infections genital herpes, rubella, cytomegalovirus, varicella, parvovirus b19, and enteroviruses can be passed to the baby through the birth canal during delivery. in pregnancies where the mother is infected with the virus, 25% of babies delivered through an infected birth canal become brain damaged, and 1/3 die. hiv/aids can also be transmitted during childbirth through contact with the mother's body fluids or transmission to the fetus via the placenta. mothers in developed countries may often elect to undergo a caesarean section to reduce the risk of transmitting the virus through the birth canal, but this option is not always available in developing countries. postpartum period