Although there were substantial declines on this measure in the 1990s for all races, black, Hispanic, and Native American mothers are more than twice as likely as white mothers to receive either late or no prenatal care.
Prenatal visits are important for the health of both infant and mother. Health care providers can educate mothers on important health issues, such as their diet and nutrition, exercise, immunizations, weight gain, and abstaining from drugs and alcohol. Health professionals also have an opportunity to instruct expecting parents on nutrition for their newborn, the benefits of breastfeeding, and injury and illness prevention, as well as monitor for health-compromising conditions, and help them prepare for the new emotional challenges of caring for an infant.1
Mothers who receive late (defined as beginning in the third trimester of pregnancy) or no prenatal care are more likely to have babies with health problems. Mothers who do not receive prenatal care are three times more likely to give birth to a low-weight baby, and their baby is five times more likely to die.2 However, some health researchers have concerns about the value of prenatal care as an indicator. Women who seek prenatal care are more likely to have higher incomes and intended pregnancies, which makes it difficult to measure the unique effects of prenatal care.3 Prenatal care does not always address, and may not be as effective among, women with specific social and medical risks.4 Adequacy of care (defined by the frequency and timing of visits), however, has been correlated with positive outcomes and may also confer benefits such as reduced likelihood of post-partum depression and infant injuries.5
With the exception of some interruption during the 1980s, there has been a long-term downward trend since the 1970s in this indicator. The percentage of births where the mother received late or no prenatal care dropped by more than a third from 1989 to 2003, from six to four percent. Between 2003 and 2006 there was little apparent change, until an increase in 2007; however, comparisons are greatly complicated by the states’ transition to a revised birth certificate, a process which began in 2003 and is still not complete (see definition). Consequently, nationwide year-to-year comparisons are problematic, and not possible at all between 2006 and 2007 (Figure 1)
Differences by Race and Hispanic Origin6
In 2010, American Indian and Alaska Native women were the most likely to receive late or no prenatal care (11percent of births), followed by black (10 percent) and Hispanic women (eight percent). In contrast, only five percent of births among Asian or Pacific Islander women, and four percent of births among white women in 2010 were births where the mother received late or no prenatal care. (Figure 2) There is substantial variation in prenatal care receipt by subgroups within both the Hispanic and Asian/Pacific Islander categories. Among Hispanics in 2010, the percentage of women receiving late or no prenatal care ranged between three percent for mothers of Cuban origin, to six percent for mothers of Puerto Rican origin, to eight percent for mothers of Mexican, Central or South American origin. Similarly, among Asian or Pacific Islander women in 2002 (the most recent year for which these data are available), those receiving late or no prenatal care ranged between 2.1 percent of births among mothers of Japanese and Chinese origin, and 4.7 percent of births for mothers of Hawaiian or part-Hawaiian origin. (Appendix 1)
Differences by Age
Young women in their teens are by far the least likely to receive timely prenatal care. In 2010, 22 percent of births to females under age 15, and 11 percent of births to teens ages 15 to 19, were to those receiving late or no prenatal care. This proportion drops with increasing age, reaching a low of four percent for women in their thirties, and then increases slightly to five percent among older women. (Figure 3)
State and Local Estimates
Estimates of the percentage of births to mothers who received late or no prenatal for 2003-2009 are available for all states and the 50 largest U.S. cities at the KIDS COUNT Data Center:
Estimates of the percentage of women who received prenatal care at least once during pregnancy (2003-2008) are available from UNICEF’s The State of the World’s Children 2009. (Table 8)
The Healthy People 2020 initiative has set a goal of increasing the proportion of pregnant women who receive care in the first trimester from 71 percent in 2007 to 78 percent in 2020, as well as a goal to increase the proportion of pregnant women who receive early and adequate prenatal care from 70.5 percent in 2007 to 77.6 percent in 2020.
More information is available here. (goal MICH 10)
Late or no prenatal care is calculated as the percentage of births that occur to mothers who, on their child’s birth certificate, reported receiving prenatal care only in the third trimester of their pregnancy, or reported receiving no prenatal care. Beginning in 2003, states and other jurisdictions began adopting a new revision of the standard birth certificate. National data for years prior to 2003 are not strictly comparable with data for subsequent years, because the 1989 revision asks for the month that prenatal care began, while the 2003 revision asks for the date of the first prenatal visit.
Because of this inconsistency, data from states using different versions of the birth certificate are not comparable. Data through 2006 reflect only those jurisdictions which had not yet adopted the 2003 certificate revision. (In 2003, 48 states and DC, representing 94 percent of births, used the 1989 revision. In 2004, 41 states and DC, representing 80 percent of births, used the 1989 revision. In 2005 it was 37 states and DC, representing 69 percent of births. In 2006 it was 32 states and DC, representing 65 percent of births.) Data for 2007 forward include only those jurisdictions that have adopted the 2003 certificate revision. (In 2007, 21 states, representing 53 percent of births, were using the 2003 revision. In 2008, 27 states, representing 65 percent of births, were. In 2009, 28 states, representing 66 percent of births were using the 2003 revision, and in 2010, 34 states, representing 76 percent of births, were using the 2003 revision.) Although New York State began using the 2003 revision in 2004, New York City continued to use the 1989 revision until 2008, and is excluded for 2007. For details on this change, see http://www.cdc.gov/nchs/nvss/vital_certificate_revisions.htm.
Data for 2009-2010, and 2003-2006, and by age 1990-1999: Centers for Disease Control and Prevention, National Center for Health Statistics. VitalStats online tool. Available at http://www.cdc.gov/nchs/vitalstats.htm.
Data for 2007-2008: National Center for Health Statistics, CDC WONDER online tool. Available at: http://wonder.cdc.gov/natality-current.html
Data for 2002: Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Menacker, F., Munson, M,L. (2003). Births: Final data for 2002. National Vital Statistics Reports,52 (10). Hyattsville, Maryland: National Center for Health Statistics. Tables 24, 25, and 33. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_10.pdf
Data for 2001: Martin, J. A., Hamilton, B. E., Ventura, S.J., Menacker, F., Park, M. M., Sutton, P. D. (2002) Births: Final data for 2001. National Vital Statistics Reports,51 (2). Hyattsville, Maryland: National Center for Health Statistics. Tables 24, 25, and 33. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_02.pdf
Data for 2000: Martin, J. A., Hamilton, B. E., Ventura, S. J., Menacker, F., Park, M. M. (2002) Births: Final data for 2000. National Vital Statistics Reports, 50(5). Hyattsville, Maryland: National Center for Health Statistics. Available at:
Data for 1970-1999: Eberhart, M. S., Ingram, D. D., Makuc, D. M., et al. (2001). Urban and rural health chartbook: Health, United States, 2001. Hyattsville, Maryland: National Center for Health Statistics. Table 6. Available at:
Raw Data Source
Birth Data, National Vital Statistics System
Recommended Citation: Child Trends (2012). Late or No Prenatal Care. Retrieved from www.childtrendsdatabank.org/?q=node/243.
Last Updated: November 2012
1Hagan, J. F., Shaw, J. S., and Duncan, P. M., Eds. (2008). Bright Futures: Guidelines for health supervision of infants, children, and adolescents. (3rd Ed.) J. Elk Grove Village, IL: American Academy of Pediatrics Available at: http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html
2Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. Prenatal services. http://www.mchb.hrsa.gov/programs/womeninfants/prenatal.htm
3Logan, C., Moore, K., Manlove, J., Mincieli, L., Cottingham, S. (2007). Conceptualizing a “Strong Start”: Antecedents of positive child outcomes at birth and Into early childhood. Child Trends Research Brief. Child Trends: Washington, D.C.
4Alexander, G.R., Kotelchuck, M. (2001). Assessing the role and effectiveness of prenatal care: History, challenges, and directions for future research. Public Health Reports, 116(4). 306-16.
5Alexander, G.R., Kotelchuck, M. Op. cit.
6Hispanics may be any race. Estimates for whites and blacks do not include Hispanics.