Late or No Prenatal Care
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Headline

The percentage of births to women receiving late or no prenatal care declined from 6.1 percent in 1990 to 3.6 percent by 2004 (preliminary estimate). (See Figure 1)

Importance

Prenatal visits are important for the health of both the infant and the mother. Health care providers can educate mothers on important health issues such as diet and nutrition, exercise, immunizations, weight gain, and abstaining from drugs and alcohol.¹ Health professionals also have an opportunity to instruct expectant parents on nutrition for their newborn, the benefits of breastfeeding, and injury and illness prevention, diagnose health-compromising conditions, and help them prepare for the new emotional challenges of caring for an infant.²

Mothers who receive late or no prenatal care are more likely to have babies with health problems. Mothers who do not receive prenatal are three times more likely to give birth to a low weight baby and their baby is five times more likely to die.³ However, there is concern among some health researchers that increased use of prenatal care alone may not be sufficient to bring further substantial improvements in birth outcomes. Many women who lack adequate care also have social risk factors related to low socioeconomic status and young age that cannot be fully addressed through more adequate prenatal care.⁴

Trends

Despite some interruption during the 1980s, there has been a long-term downward trend in the percentage of women receiving late or no prenatal care. (See Figure 1) Over the past decade, the percentage receiving late or no care dropped by more than a third, from 6.1 percent in 1990 to 3.5 percent in 2003, and was at 3.6 percent in 2004 (preliminary estimate). The largest decline took place between 1990 and 1995 (from 6.1 percent to 4.2 percent). This improvement in prenatal care occurred for all racial groups and among Hispanic women. (See Table 1)

Differences by Race and Ethnicity

In 2004, American Indian and Alaska Native women were the most likely to receive late or no prenatal care (7.9 percent of births), followed by non-Hispanic black women (5.7 percent) and Hispanic women (5.4 percent) (preliminary estimates). In contrast, only 3.0 percent of births to Asian/Pacific Islander women and 2.2 percent of births to non-Hispanic white women were to those who received late or no prenatal care in 2004. (See Figure 2)

There is substantial variation in prenatal care receipt by subgroups within both the Hispanic and Asian/Pacific Islander categories. Among Hispanics in 2003, the most recent year for which estimates are available, the percentage of women receiving late or no prenatal care ranged between 1.3 percent of births for mothers of Cuban origin to 5.6 percent of births for mothers of Mexican origin. Similarly, among Asian/Pacific Islander women, in 2002, the most recent year for which data are available, the percentage 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 and part Hawaiian origin. (See Table 1)

Differences by Age

Young women in their teens are by far the most likely to receive late or no prenatal care. In 2003, the most recent year for which estimates are available, 15.4 percent of births to girls under age 15 and 7.6 percent of births to teens ages 15 to 17 were to those receiving late or no prenatal care. Among young women ages 18 to 19, 5.6 percent of births were to young women who received late or no prenatal care. This percentage drops steadily with increasing age, reaching a low of 2.3 percent for women in their early thirties and then increases slightly among older women. (See Figure 3)

Related Indicators

Health Care Coverage, Low and Very Low Birthweight Infants

State and Local Estimates

State estimates are available from Martin JA, Hamilton BE, Sutton PD, et al. (2005). "Births: Final data for 2003." National Vital Statistics Reports, 54(2). Hyattsville, Maryland: National Center for Health Statistics. 2003. Table 34. http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf

Estimates of the percentage of births to mothers who received late or no prenatal for 1990-2001 are available for the 50 largest cities in the U.S. from The Right Start for America's Newborns: A Decade of City and State Trends.⁵
http://www.aecf.org/kidscount/rightstart/

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International Estimates

Estimates of the percentage of women who received prenatal care at least once during pregnancy are available from UNICEF's The State of the World's Children 2005.
http://www.unicef.org/sowc05/english/fullreport.html (Table 8)

National Goals

Goals of 90 percent have been set both for care beginning in the first trimester of pregnancy and for early and adequate prenatal care, as part of the Healthy People 2010 program. No goal has been set for reducing late or no prenatal care.

More information is available at:
http://www.health.gov/healthypeople/document/html/objectives/16-06.htm
(See goal 16-6)

What Works: Programs and Interventions that May Influence this Indicator

Click here to view examples of programs and interventions that research has evaluated for this indicator. View programs

Research References

¹National Institute of Child Health and Human Development. "Care Before and During Pregnancy - Prenatal Care." Accessed September 27, 2005. http://156.40.88.3/about/womenhealth/prenatal_care.cfm

²Bright Futures. (2002). "Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents" (2nd ed., rev.) Edited by Morris Green and Judith S. Palfrey. Arlington, VA: National Center for Education in Maternal and Child Health. http://www.brightfutures.org/bf2/pdf/index.html

³Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. "A Healthy Start: Begin Before Baby's Born." Accessed September 27, 2005. http://www.mchb.hrsa.gov/programs/womeninfants/prenatal.htm

⁴ Misra, D.P., and Guyer, B., "Benefits and Limitations of Prenatal Care: From Counting Visits to Measuring Content," Journal of the American Medical Association, vol. 279, No. 20, 1998. http://jama.ama-assn.org/cgi/content/short/279/20/1661

⁵Wertheimer, R., O'Hare, W., Croan, T., Jager, J., Long, M. & Reynolds, M., The Right Start for America's Newborns: A Decade of City and State Trends. Baltimore, MD: Child Trends and The Annie E. Casey Foundation, 2002. http://www.aecf.org/kidscount/rightstart2003/

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Definition

Late or no prenatal care is the percentage of births that occurred to mothers who reported receiving prenatal care only in the third trimester of their pregnancy, or reported receiving no prenatal care on their child's birth certificate.

Data Sources

Preliminary data for 2004: Hamilton, BE, Martin, JA, Ventura, SJ, Sutton, PD, and Menacker, F. (2006). "Births: Preliminary Data for 2004". National Vital Statistics Reports, 54(8). Hyattsville, MD: National Center for Health Statistics. Table D. http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_08.pdf.

Data for 2003: Martin JA, Hamilton BE, Sutton PD, et al. (2005). "Births: Final data for 2003." National Vital Statistics Reports, 54(2). Hyattsville, MD: National Center for Health Statistics. Tables 24, 25, and 33. http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf

Data for 2002 from: Martin JA, Hamilton BE, Sutton PD. Ventura SJ. Menacker F. Munson, ML. Births: Final Data for 2002. National vital statistics reports; vol 52 no 10. Hyattsville, Maryland: National Center for Health Statistics. 2003. Tables 24, 25, and 33. http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_10.pdf

Data for 2001: Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM, Sutton PD. Births: Final data for 2001. National vital statistics reports; vol 51 no.2. Hyattsville, Maryland: National Center for Health Statistics. 2002. Tables 24, 25, and 33. http://www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_02.pdf

Data for 2000: Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM. Births: Final data for 2000. National vital statistics reports; vol 50 no.5. Hyattsville, Maryland: National Center for Health Statistics. 2002. http://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_05.pdf

Data for 1970-1999: Eberhart MS, Ingram DD, Makuc DM, et al. Urban and Rural Health Chartbook. Health, United States, 2001. Hyattsville, Maryland: National Center for Health Statistics, 2001, Table 6. http://www.cdc.gov/nchs/products/pubs/pubd/hus/2010/2010.htm#hus01 (See Table 6)

Raw Data Source

Birth Data, National Vital Statistics System
http://www.cdc.gov/nchs/nvss.htm

Approximate Date of Next Update

Winter 2007

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