Prenatal care refers to health care during pregnancy. Timely prenatal care is measured by the number or percentage of infants born to mothers who received prenatal care in the first trimester (1-3 months). This information also is presented by the race/ethnicity of the mother, as a percentage and number. Early prenatal care increases the likelihood of a healthy pregnancy and birth.

High quality prenatal care greatly reduces the risk of infant mortality (1). Timely prenatal care, i.e. in the first trimester, is especially important, as it lowers the risk of other adverse birth outcomes, such as low birth weight, developmental delays, and premature birth (one of the leading causes of infant death nationwide) (2). Prenatal doctor visits also are important for the health of the mother. Through prenatal care, health professionals are able to identify and resolve potential medical problems and provide guidance and encouragement on good habits in general and for a healthy pregnancy.

Women whose pregnancies are unintended are more likely to delay prenatal care (3). Rates of unintended pregnancy are highest among young women ages 18-24, those living in poverty, those with less than a high school diploma, and African American/Black and Latina/Hispanic women (4). Reducing disparities in access to prenatal care and improving access to timely care for all women has been a U.S. public health priority for the past two decades. Healthy People 2020, an initiative of the U.S. Department of Health and Human Services that sets national public health goals, set an objective that by the year 2020, 77.9% of pregnant women would receive prenatal care beginning in the first trimester (5).

Find more information and research about prenatal care in kidsdata.org's Research & Links section.

Sources for this narrative:

1. U.S. Department of Health and Human Services, Office of Women’s Health. (2009). Prenatal care fact sheet. Retrieved from: http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.cfm
2. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity. (2011). Pediatric and Pregnancy Nutrition Surveillance System: PNSS health indicators. Retrieved from: http://www.cdc.gov/pednss/what_is/pnss_health_indicators.htm
3. Logan, C., Holcombe, E., Manlove, J., & Ryan, S. (2007). The consequences of unintended childbearing: A white paper. Washington: Child Trends, Inc. Retrieved from: http://www.childtrends.org/Files//Child_Trends-2007_05_01_FR_Consequences.pdf
4. U.S. Department of Health and Human Services. (2011). Healthy People 2020: Family planning. Retrieved from: http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=13
5. U.S. Department of Health and Human Services. (2011). Healthy People 2020: Maternal infant and child health: Pregnancy and health behaviors goal MICH-10.1.  Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=26

Increasing the rates of infants whose mothers received timely prenatal care requires access to appropriate and affordable health care (1). It also requires pregnant women to understand the importance of the care and recognize that they are pregnant, as some women delay care when they do not realize or acknowledge that they are pregnant (1). In addition, expectant mothers without health insurance coverage at the start of their pregnancy are less likely to seek timely prenatal care than insured pregnant women (1, 2).

According to research and subject experts, policy options that could influence prenatal care include:

• Supporting health insurance coverage and early enrollment for low-income pregnant women and those who may become pregnant, particularly growing numbers of immigrant women (1)
• Recruiting and training clinicians who are linguistically proficient and culturally attuned to patients who are immigrants, limited-English-speaking, and women of color (3, 4)
• Increasing availability of home visiting programs (5), including leveraging federal funding available under health care reform
• Supporting targeted public education and group prenatal care for at-risk mothers; group care can combine assessment, health education, and social support (6)

For more policy ideas and research on this topic, see kidsdata.org’s Research & Links section, or visit the Kaiser Family Foundation, and the American Congress of Obstetricians and Gynecologists. Also see Policy Implications on kidsdata.org for Teen Births, Low Birthweight and Preterm Births, and Health Care.

Sources for this narrative:

1. Braverman, et al. (2003). Promoting access to prenatal care: Lessons from the California experience. Kaiser Family Foundation. Retrieved from: http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=14290
2. Egerter, et al. (2002). Timing of insurance coverage and use of prenatal care among low-income women. American Journal of Public Health, 92(3), 423-427. Retrieved from: http://ajph.aphapublications.org/cgi/reprint/92/3/423
3. Egerter, et al. (2004). Disparities in maternal and infant health: Are we making progress? Lessons from California. University of California at San Francisco and the Henry J. Kaiser Family Foundation. Retrieved from: http://www.kff.org/womenshealth/upload/Disparities-in-Maternal-and-Infant-Health-Are-We-Making-Progress-Lessons-From-California-Issue-Brief.pdf
4. National Committee for Quality Assurance. (2009). 2009 innovative practices in multicultural health care. Retrieved from: http://www.ncqa.org/Portals/0/HEDISQM/CLAS/CLAS_InnovPrac_09.pdf
5. Pew Center on the States. (2010). The case for home visiting. Retrieved from: http://www.pewcenteronthestates.org/uploadedFiles/Mom_brief_Web_final.pdf
6. Fleischman, A. R. (2010). What happens when babies are born too early? March of Dimes Foundation, Testimony before the US House of Representatives: Prematurity and Infant Mortality. Retrieved from: http://www.modimes.org/advocacy/prevention_indepth.html

In California in 2010, 83.5% of infants were born to mothers who received prenatal care in the first trimester of pregnancy. This figure increased from 1995 to 2003, declined from 2003 to 2008, and then rose slightly again in 2009 and 2010. At the county level, the percentage of infants whose mothers receive timely prenatal care ranges widely, from 56.2% to 94.1% in 2010 among counties with available data. As in previous years, infants of white and Asian/Pacific Islander women had the highest percentages of timely prenatal care in 2010; infants of American Indian/Alaska Native women had the lowest.

• Association of Maternal and Child Health Programs
• CityMatch
• Maternal and Infant Health Research, Centers for Disease Control and Prevention
• Preconception and Pregnancy Knowledge Path, Maternal and Child Health Library at Georgetown University
• U.S. Maternal and Child Health Bureau

• Assessing the Role and Effectiveness of Prenatal Care: History, Challenges, and Directions for Future Research, 2001, Public Health Reports, Alexander & Kotelchuck
• Closing the Black-White Gap in Birth Outcomes: A Life-Course Approach, 2010, Ethnicity and Disease, Lu et al.
• Disparities in Maternal and Infant Health: Are We Making Progress? Lessons from California, 2004, Kaiser Family Foundation & University of California at San Francisco, Egerter et al.
• Does Managed Care Hurt Health? Evidence from Medicaid Mothers, 08/2007, Review of Economics and Statistics, Aizer, Currie & Moretti
• Healthy Start National Evaluation 2006: Evidence of Trends, Risk Factors, and Intervention Strategies, U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau
• Promoting Access to Prenatal Care: Lessons from the California Experience, 2003, Kaiser Family Foundation
• Recommendations to Improve Preconception Health and Health Care --- United States, 04/21/2006, Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Johnson et al.

• San Diego County Report Card on Children & Families, 2011, The Children's Initiative and Johnson Group Consulting, Inc.
• Tulare County Children’s Report Card 2010, 2011, Children's Services Network

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