Prenatal care is health care received during pregnancy. On kidsdata.org, timely prenatal care is measured by the number or percentage of infants born to mothers who received prenatal care during the first trimester (three months) of pregnancy. These data also are available by race/ethnicity of the infant's mother.

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).

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.

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)