Fewer women received early and adequate prenatal care in 2023, new data released this week by the US Centers for Disease Control and Prevention (CDC) shows.
The small year-over-year decline comes amid tectonic shifts in women’s rights and access to reproductive healthcare in the US and in spite of a federal government initiative meant to improve prenatal care access. Seventeen states ban abortion at conception or soon after.
Prenatal care is “one of the potentially core measures of the quality of care,” said Eugene Declercq, a professor of community health sciences at Boston University who studies maternal health.
“If people get into prenatal care early, the potential for identifying problems and addressing them is dramatically increased,” he said.
The data shows that from 2022 to 2023, there was a 1% decline in the number of pregnant patients who received prenatal care in their first trimester, dropping from 77% to 76.1%, the second such decline in two years.
The decline in early prenatal care was accompanied by a 5% rise in the number of patients who received no prenatal care at all. A similar trend happened from 2021-2022. Before 2021, early prenatal care numbers were slowly moving in a positive direction.
The decline in the number of women who received prenatal care comes in spite of a concerted federal government effort to boost numbers. Increasing prenatal care was a key metric included in Healthy People 2030, a federal government initiative to reduce health disparities stemming from two Biden administration executive actions.
The new data draws from the National Vital Statistics System, which gathers data from every US birth certificate. Although the year-to-year rate is very stable, an indication of reliability, it is self-reported by patients – generally considered less reliable than data based on medical records. Perhaps the most important note about the data is that it is only “descriptive” in Declercq’s words – it only shows that a trend likely is happening but not why.
Dr Veronica Gillispie-Bell, medical director of the Louisiana Pregnancy Associated Mortality Review and medical director of quality at Ochsner Health Women’s Services said: “The trend in decreased access to prenatal care is concerning.”
“Again, it’s unclear why we are seeing this trend … Further analysis is needed to determine if these trends are consistent across the entire population or driven by certain geographic areas,” she added.
Many experts point to a possible connection to “maternity care deserts” – a term coined by the infant health non-profit March of Dimes for counties with no maternity care providers or facilities. About one-third of all counties in the US are considered maternity care deserts, and the ranks are growing.
“There have been many hospital closures, staffing shortages, clinic closures – and all of those things lead to worsening of access for timely and sufficient prenatal care,” said Dr Amanda Williams, a member of the March of Dimes National Mission Advisory Council.
“We also see increased distances families have to travel to get care, and that’s particularly of note for high-risk care for our most vulnerable patients,” she said.
Health economists and doctors believe the growth in maternity care deserts is down not only to abortion restrictions, which have pushed some doctors to leave states that threaten punishments for providing standard care, but also to the dynamics of private health insurance.
Maternity care is reimbursed worse on average than other specialties. That makes obstetrics wards “loss leaders” in hospitals, or a department that brings in little money. That has led some hospitals to shutter wards.
Both abortion restrictions and poor reimbursement rates tend to be more dramatic in more conservative rural and southern states.
For instance, CDC data shows just 66% of patients in Florida received first trimester care in 2023, the worst in the nation. By contrast, 89.2% of Vermonters receive early prenatal care, ranking at the top. This follows national trends for overall health, where patients in northeastern states fare better than peers in the south-east and south-west.
“Whatever differences there are from one year to another, they’re dwarfed by the differences across states,” said Declercq. “That’s a combination of population – some states have more people who are higher risk for less prenatal care. It’s also state policies and their supportiveness.”
Still, there are bright spots. Maternal mortality is declining from its mid-pandemic peak.
Williams said the March of Dimes is pressing states legislators to fund “underutilized” solutions that can make a difference – such as bringing broadband internet to rural areas and thus giving patients access to telehealth prenatal care.
“It’s not just a nice to have,” said Williams about prenatal care. “These are actionable moments in pregnancy that lead to better outcomes for both the parent and the child.”
