US Sees Decline in Early Prenatal Care
The proportion of pregnant individuals in the U.S. initiating prenatal care in the first trimester has continued to fall, reversing years of progress. The trend is attributed to workforce shortages and the closure of some prenatal programs due to lack of funding and staff, with notable disparities for minority women.
- The decline in first-trimester prenatal care saw the proportion of pregnant people receiving early care drop from 78.3% in 2021 to 75.5% in 2024. During this same period, the percentage of individuals receiving late or no prenatal care rose from 6.3% to 7.3%. - A significant factor is the rise of "maternity care deserts," with over one-third of U.S. counties lacking any birthing facilities or obstetric providers. In Virginia, 30.8% of counties are classified as maternity care deserts, and the state has experienced a 25% reduction in the number of birthing hospitals since 2012. - Stark racial disparities persist; on average from 2022-2024, 82.4% of White mothers received early prenatal care, compared to 66.4% of Black mothers and 64.4% of American Indian/Alaska Native mothers. Socioeconomic factors are estimated to account for more than half of the Black-white gap in initiating prenatal care. - Integrating certified nurse-midwives (CNMs) into the healthcare system is an evidence-based strategy to improve outcomes; midwifery-led care is linked to lower rates of C-sections and preterm births, and higher patient satisfaction. A fully integrated midwife workforce could potentially avert 41% of maternal deaths globally. - In response to workforce shortages, the bipartisan "Midwives for MOMS Act" has been introduced in Congress to create grants for expanding and diversifying the midwifery workforce. Professional groups like the American College of Nurse-Midwives are advocating for the bill to help address health inequities. - Digital health platforms and remote monitoring tools are emerging as a key innovation to supplement in-person visits and improve access. Technologies such as FDA-approved remote fetal monitors and AI-enhanced ultrasound devices allow for more continuous, patient-centered pregnancy management. - In Virginia, state-level policy changes like the extension of Medicaid coverage to 12 months postpartum and reimbursement for doula services have been followed by some positive trends. Between 2022 and 2023, the state saw a 10.1% increase in the timeliness of prenatal care.
