Inequalities emerge early in the life course. Indeed, with striking evidence of a social gradient in maternal health and wellbeing even before birth, some might argue the dice are already loaded in the womb. Later in this volume Young sets out the compelling economic case for investment in the first 1001 days. This chapter brings together evidence about the social patterning of outcomes during pregnancy and the first years of life, adding a social justice dimension to the case for investment in prevention in early childhood.