- Prenatal Care
- Infant Mortality
- Low Birthweight and Preterm Births
- Teen Births
- Why This Topic Is Important
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 to increase the percentage of pregnant women who receive prenatal care beginning in the first trimester from 70.8% to 77.9% by the year 2020 (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 on Women’s Health. (2009). Prenatal care fact sheet. Retrieved from: http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html
2. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2011). Pregnancy Nutrition Surveillance System health indicators. Retrieved from: http://www.cdc.gov/pednss/what_is/pnss_health_indicators.htm
3. Guttmacher Institute. (2015). Fact sheet: Unintended pregnancy in the United States. Retrieved from: http://www.guttmacher.org/pubs/FB-Unintended-Pregnancy-US.html
4. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2014). Healthy People 2020: Family planning. Retrieved from: http://www.healthypeople.gov/2020/topics-objectives/topic/family-planning
5. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2014). Healthy People 2020: Maternal, infant, and child health, MICH-10.1. Retrieved from: http://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives
- How Children Are Faring
In 2013, 84% of California infants were born to mothers who received prenatal care in the first trimester of pregnancy. This figure has held relatively steady in recent years, though it is down from a high of 87% in 2003. At the county level, the percentage of infants whose mothers receive timely prenatal care ranges widely, from 49% to 93% in 2013 among counties with available data. As in previous years, infants of White (88%) and Asian/Pacific Islander women (87%) had the highest percentages of timely prenatal care in 2013; infants of American Indian/Alaska Native women (69%) had the lowest.
- Policy Implications
Ensuring that all pregnant women receive timely prenatal care requires that women understand the benefits of prenatal care, have access to affordable care, and feel comfortable during the process (1, 2). The Affordable Care Act offers new provisions supporting pregnant mothers, such as requiring that all state-based plans include maternity care in their coverage, and funding new home visiting programs and other support services (3). However, improving access to prenatal care for all women in California remains a major public health goal.
According to research and subject experts, policy options that could influence prenatal care include:
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.
- Supporting health insurance coverage and early enrollment for low-income pregnant women and those who may become pregnant (1)
- Supporting targeted public education and group prenatal care; group care can combine risk assessment, health education, and social support (2, 4)
- Increasing availability of home visiting programs, including leveraging federal funding available under health care reform (5)
- Recruiting and training clinicians who provide individualized, linguistically proficient, and culturally sensitive care to patients who are immigrants, limited-English-speaking, and women of color (1, 2, 6)
Sources for this narrative:
1. Braveman, P., et al. (2003). Promoting access to prenatal care: Lessons from the California experience. Kaiser Family Foundation. Retrieved from: http://kff.org/womens-health-policy/report/promoting-access-to-prenatal-care-lessons-from
2. Novick, G. (2009). Women’s experience of prenatal care: An integrative review. Journal of Midwifery and Women’s Health, 54(3), 226-237. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754192/
3. National Partnership for Women and Families. (2012). Why the Affordable Care Act matters for women: Better care for pregnant women and mothers. Retrieved from: http://go.nationalpartnership.org/site/DocServer/PREGNANT_WOMEN.pdf?docID=10006
4. Ickovics, J. R., et al. (2011). Effects of group prenatal care on psychosocial risk in pregnancy: Results from a randomized controlled trial. Psychology and Health, 26(2), 235-250. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3311036/
5. Pew Center on the States. (2010). The case for home visiting. Retrieved from: http://www.pewstates.org/research/reports/the-case-for-home-visiting-85899373065
6. National Committee for Quality Assurance. (2009). Innovative practices in multicultural health care. Retrieved from: http://www.ncqa.org/HEDISQualityMeasurement/Research/HealthCareDisparities.aspx
- Websites with Related Information
- Before, Between & Beyond Pregnancy, National Preconception Health and Health Care
- California Dept. of Public Health: Maternal, Child and Adolescent Health Division
- California Maternal Quality Care Collaborative
- California Perinatal Quality Care Collaborative
- CityMatCH, University of Nebraska Medical Center
- Every Woman California, Preconception Health Council of California
- Good Health Before Pregnancy: Preconception Care, American Congress of Obstetricians and Gynecologists
- March of Dimes
- Preconception and Pregnancy Knowledge Path, National Center for Education in Maternal and Child Health
- Womenshealth.gov: Preconception Health, U.S. Dept. of Health and Human Services, Office on Women's Health
- Key Reports and Research
- Advancing Preconception Health in the United States: Strategies for Change, 2016, Upsala Journal of Medical Sciences, Verbiest, S., McClain, E., & Woodward, S.
- Changes in Insurance Coverage, Access to Care, and Health Care Affordability for Women of Childbearing Age, 2015, Urban Institute and March of Dimes, Shartzer, A., et al.
- Child Trends Databank: Late or No Prenatal Care, 2015
- CHIP Coverage for Pregnant Women, 2016, March of Dimes
- Folic Acid, 2017, March of Dimes
- Infant Mortality by Age at Death in the United States, 2016, NCHS Data Brief, Ely, D. M., et al.
- Infant Mortality Linked to Lack of Preconception and Interconception Care, 2016, Association of State and Territorial Health Officials (ASTHO), Zeeck, E.
- Maternity Care in California: Delivering the Data, 2016, California Health Care Foundation
- Opportunities and Strategies for Improving Preconception Health Through Health Reform: Advancing Collective Impact for Improved Health Outcomes, 2015, Association of Maternal and Child Health Programs
- Policies to Promote Child Health, 2015, The Future of Children
- Preconception Care: Maximizing the Gains for Maternal and Child Health, 2013, World Health Organization
- Preconception Interventions, 2014, Reproductive Health, Belizan, J. (Ed.)
- Pregnancy Intentions, Maternal Behaviors, and Infant Health: Investigating Relationships with New Measures and Propensity Score Analysis, 2015, Demography, Kost, K., & Lindberg, L.
- Racial and Ethnic Disparities in Obstetrics and Gynecology, 2015, Obstetrics & Gynecology, Committee Opinion No. 649, American College of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women
- Tdap and Influenza Immunization in Pregnant Women: 2015 Maternal and Infant Health Assessment Survey, 2016, California Department of Public Health, Immunization Branch
- County/Regional Reports
- 2014 Solano Children's Report Card, Children's Network of Solano County
- 2018-19 California County Scorecard of Children's Well-Being, Children Now
- Community Health Assessment and Community Health Improvement Plan, Los Angeles County Dept. of Public Health
- Key Indicators of Health by Service Planning Area, 2017, Los Angeles County Dept. of Public Health
- Live Well San Diego Report Card on Children, Families, and Community, 2017, The Children's Initiative & Live Well San Diego
- Orange County Community Indicators Report, Orange County Community Indicators Project
- San Mateo County All Together Better, San Mateo County Health
- The 24th Annual Report on the Conditions of Children in Orange County, 2018, Orange County Children's Partnership
- Trends in Timely Prenatal Care Across Los Angeles County and Why It Matters, 2017, Children's Data Network, USC Suzanne Dworak-Peck School of Social Work, McCroskey, J., et al.
- More Data Sources For Prenatal Care
- CDC WONDER, Centers for Disease Control and Prevention
- Maternal and Child Health Bureau: National Survey Publications and Chartbooks, U.S. Dept. of Health and Human Services
- Maternal and Infant Health Assessment (MIHA), California Dept. of Public Health & University of California, San Francisco
- PeriStats, March of Dimes Perinatal Data Center
- Pregnancy Risk Assessment Monitoring System (PRAMS), Centers for Disease Control and Prevention
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