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Why This Topic Is Important
Women need high quality health care before, during, and after pregnancy—this promotes the long-term health of both mothers and children and reduces serious health risks including infant death (1, 2, 3). Since nearly half of all pregnancies are unintended, and many women may not realize they are pregnant during the critical first weeks of their baby's development, experts are increasingly focused on promoting the health of reproductive-age women before conception (1, 3). High quality preconception care should be part of routine health care and should include reproductive planning, address medical conditions and pregnancy risk factors such as weight or heart problems, link women to services for non-medical issues like substance abuse or mental health problems, and educate women about important habits in case of pregnancy (2, 3).

Once women become pregnant, prenatal care in the first trimester is critical as it lowers the risk of adverse birth outcomes (3). Through prenatal care, health professionals can identify and resolve medical problems, refer women to services for non-medical issues, and provide health education in general (3). Prenatal care also helps to ensure that pregnant women receive needed vaccinations, including Tdap and the flu shot, which can protect the mother and baby from certain infections (4).

Inequities in access to prenatal care by race/ethnicity and other demographic factors have persisted for decades (3, 5, 6). Reducing these disparities and improving access to preconception and prenatal care for all women has long been a U.S. public health priority. The federal Healthy People 2020 initiative has set national objectives to improve access to preconception and prenatal care, as well as objectives to increase healthy behaviors before and during pregnancy (1).
Find more information on this topic in kidsdata.org's Research & Links section.

Sources for this narrative:

1.  U.S. Department of Health and Human Services. (n.d.). Healthy People 2020: Maternal, infant, and child health. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health

2.  Verbiest, S., et al. (2016). Advancing preconception health in the United States: Strategies for change. Upsala Journal of Medical Sciences, 121(4), 222-226. Retrieved from: https://www.tandfonline.com/doi/full/10.1080/03009734.2016.1204395

3.  Secretary's Advisory Committee on Infant Mortality. (2013). Final recommendations for a national strategy to reduce infant mortality. U.S. Department of Health and Human Services. Retrieved from: https://www.hrsa.gov/advisory-committees/infant-mortality/reports.html

4.  March of Dimes. (2018). Vaccinations and pregnancy. Retrieved from: https://www.marchofdimes.org/pregnancy/vaccinations-and-pregnancy.aspx

5.  American College of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women. (2015). Racial and ethnic disparities in obstetrics and gynecology. Obstetrics and Gynecology, 126, e130-134. Retrieved from: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Racial-and-Ethnic-Disparities-in-Obstetrics-and-Gynecology

6.  As cited on kidsdata.org, Infants whose mothers received prenatal care in the first trimester, by mother's race/ethnicity. (2019). California Department of Public Health.
Policy Implications
There is substantial evidence that preconception health care (before pregnancy) and timely prenatal care (in the first trimester) can improve maternal and infant health outcomes (1). While the U.S. has made progress in maternal and child health in recent years—through provisions for pregnant and reproductive-age women in the Affordable Care Act and other public health efforts—it still trails behind most other industrialized countries in maternal and infant mortality rates (1). California fares better than the nation as a whole on many key measures of birth outcomes, e.g., infant and maternal mortality, preterm births, and low birthweight (2, 3). However, much room for improvement exists in California, particularly in addressing inequities in health outcomes and access to care by race/ethnicity and other demographic factors (3, 4).

Policymakers have a role in helping to ensure that all women (and men) of reproductive age have access to continuous, affordable, comprehensive, culturally-sensitive health care before conception, during pregnancy, and after childbirth (5, 6). It is especially important to safeguard recent policy gains, while continuing to advance health care quality and access.

Policy and program options that could influence preconception and prenatal care include:
  • Supporting evidence-based public education campaigns to increase awareness among women and men of reproductive age about the importance of preconception health, life planning, and the need to receive regular health care before, during, and after pregnancies; such campaigns should include information on how to access health care and other resources, and should use a variety of methods to reach different age and racial/ethnic groups at all income levels (6)
  • Raising awareness among leaders and health care professionals about preconception health care, what it entails, and how it can improve population health and reduce health care costs; also, increasing awareness of inequities by race/ethnicity and other factors, and the potential effects of practitioner bias (5, 6, 7)
  • Supporting recruitment of health care providers from diverse racial/ethnic groups and promoting physician education to provide individualized, comprehensive, linguistically proficient, and culturally-sensitive preconception and prenatal care (5, 6, 7)
  • Maintaining insurance coverage benefits for pregnant and reproductive-age women (e.g., preventive care, maternity care, and support services such as home-visiting programs), especially for lower-income women; and continuing efforts to improve insurance enrollment and renewal processes (1, 8)
  • Promoting efforts to identify and apply best practices for incorporating preconception care into routine health care; also, promoting research to identify and test interventions for addressing structural and cultural barriers to care (6, 7)
For more on this topic, see kidsdata.org’s Research & Links section, or visit the American College of Obstetricians and Gynecologists or Before, Between and Beyond Pregnancy. Also see Policy Implications on kidsdata.org for Health Care, Low Birthweight and Preterm Births, and Infant Mortality.

Sources for this narrative:

1.  Association of Maternal and Child Health Programs. (2015). Opportunities and strategies for improving preconception health through health reform: Advancing collective impact for improved health outcomes. Retrieved from: http://www.amchp.org/Transformation-Station/Documents/AMCHP%20Preconception%20Issue%20Brief.pdf

2.  As cited on kidsdata.org, (i) Infant mortality per year (California & U.S. Only); (ii) Infants born at low birthweight; (iii) Preterm births. (2019). California Department of Public Health & Centers for Disease Control and Prevention.

3.  Joynt, J. (2016). Maternity care in California: Delivering the data. California Health Care Foundation. Retrieved from: https://www.chcf.org/publication/2016-edition-maternity-care-california-delivering-data

4.  California Department of Public Health, Maternal, Child and Adolescent Health Division. (2016). MIHA report, 2013-2014: Data from the Maternal and Infant Health Assessment (MIHA) Survey. Retrieved from: https://www.cdph.ca.gov/Programs/CFH/DMCAH/MIHA/CDPH%20Document%20Library/MIHA-AnnualReport-2013-2014-County-Regional.pdf

5.  American Academy of Family Physicians. (2015). Preconception care. Retrieved from: https://www.aafp.org/about/policies/all/preconception-care.html

6.  Verbiest, S., et al. (2016). Advancing preconception health in the United States: Strategies for change. Upsala Journal of Medical Sciences, 121(4), 222-226. Retrieved from: https://www.tandfonline.com/doi/full/10.1080/03009734.2016.1204395

7.  American College of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women. (2015). Racial and ethnic disparities in obstetrics and gynecology. Obstetrics and Gynecology, 126, e130-134. Retrieved from: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Racial-and-Ethnic-Disparities-in-Obstetrics-and-Gynecology

8.  March of Dimes. (n.d.). CHIP coverage for pregnant women. Retrieved from: https://www.marchofdimes.org/MOD-IssueBrief-Chip-Coverage-Pregnant-Women-November-2016.pdf
How Children Are Faring
Among California infants born in 2016, 84% had mothers who received prenatal care during the first trimester of pregnancy. This figure has held relatively steady in recent years, although it is down from a high of 87% in 2003. Across counties with data, the percentage of infants born in 2016 whose mothers received timely prenatal care varied widely, from 50% (Modoc) to 91% (San Mateo). In 2016, as in previous years, infants born to white (88%) and Asian/Pacific Islander women (85%) had the highest percentages of timely prenatal care among groups with data; infants born to American Indian/Alaska Native women (70%) had the lowest.