First-Trimester Prenatal Care Declines in US
A new federal report reveals a national decline in women beginning prenatal care during the first trimester, dropping from 78.3% in 2021 to 75.5% in 2024. Virginia mirrors this trend, which experts attribute to workforce shortages, facility closures, and insurance barriers. The drop reverses years of progress and increases risks for preterm birth and maternal morbidity.
- The decline in early prenatal care was most pronounced for minority groups; for Black mothers, first-trimester care dropped from 69.7% in 2021 to 65.1% in 2024. During a similar timeframe in Virginia (2021-2024), inadequate access to prenatal care increased by 16%. - In Virginia, five labor and delivery units closed between 2018 and 2024, and today only eight of the state's 28 rural hospitals provide obstetrics services. This contributes to the fact that 37.6% of counties in the state are classified as "maternity care deserts." - To address workforce shortages, Virginia passed House Bill 1904, which takes effect July 1, 2025, allowing Certified Nurse-Midwives to fulfill 24-hour on-call duty rosters for hospital nursery care if a physician is unavailable. This change is intended to help keep rural labor and delivery units from closing. - A second piece of 2025 legislation, House Bill 1923, addresses financial barriers by mandating that private insurers and Medicaid reimburse Licensed Certified Midwives and Licensed Midwives at the same rate as Certified Nurse-Midwives for providing the same services. - The Virginia Affiliate of the American College of Nurse-Midwives is collaborating with the Virginia Interfaith Center for Public Policy to address ongoing barriers preventing midwives from contracting with the state's Managed Care Organizations (MCOs). Advocates report that structural issues, such as an inability for licensed midwives to bill Medicaid until late in pregnancy, make serving Medicaid beneficiaries financially unsustainable for many small practices. - A Virginia Commonwealth University study found that 44% of the state's neighborhoods, affecting nearly 3.8 million residents, lack adequate access to primary care physicians, with rural communities experiencing the most significant shortages. - Digital health platforms are emerging to help fill care gaps. The PowerMom platform, for instance, recruits diverse participants for maternal health research and collects real-time data from wearable devices to gain a more holistic view of maternal health than what is possible through episodic clinic visits. - In Virginia, some insurers are innovating to expand access. UnitedHealthcare's "Pharmacy Care Hub" model is active in 73 community pharmacies, providing services like blood pressure screening, virtual care access via private tablets, and connections to social resources like food and housing.
