We can do better: improving perinatal health in America.

The United States spends more on perinatal healthcare than any other nation, yet it consistently ranks near the bottom on most standard measures of perinatal health. This article examines how we can do better, based on the life course perspective and the ecological model. Collectively, these paradigms suggest the need for an expanded approach to improving perinatal health in America, one that emphasizes not only risk reduction during pregnancy but also health promotion and optimization across the life course. The approach needs to be both clinical and population based, addressing individual factors as well as social determinants. This article concludes with recommendations for increasing healthcare access, improving healthcare quality, investing in wellness, strengthening families and communities, and supporting research in perinatal health.