One in Four Pregnant Women in the US Miss Early Prenatal Care

A significant report reveals that approximately one in four pregnant women in the United States do not receive prenatal care during their first trimester. The findings, published by the maternal and infant health nonprofit March of Dimes, indicate that only around 75% of infants born last year were delivered by mothers who initiated prenatal care early in their pregnancies.

Dr. Michael Warren, chief medical and health officer at March of Dimes, emphasized the importance of early prenatal care, stating, “Getting that prenatal care started early is important.” He pointed out that the trend of late initiation of care has been worsening over the past four years. Many women, as noted by Dr. L. Joy Baker, an obstetrician-gynecologist based in LaGrange, Georgia, often seek care late, sometimes as late as their third trimester.

Dr. Baker shared her experiences, noting that she frequently sees patients for the first time just days or weeks before they give birth. “I accept patients up until delivery, and sometimes there are patients that we have not seen at all,” Baker stated. This growing trend poses serious risks for both mothers and their babies.

Systemic Barriers to Care

The report highlights several systemic barriers that hinder timely access to prenatal care. One of the significant issues is the existence of maternity care deserts, areas with limited or no access to obstetric care providers. Dr. Warren noted that more than a third of counties in the United States lack an obstetrician, family physician, or certified nurse-midwife, affecting over 2 million women of reproductive age.

Consequently, women residing in these areas often face long distances to obtain necessary care. Dr. Baker pointed out that many of her patients cite difficulties such as trouble obtaining Medicaid, housing insecurity, or food instability as factors delaying their prenatal visits. “There are a variety of reasons why folks may present late to care,” she explained.

Inadequate or delayed prenatal care can lead to severe complications, including conditions like preeclampsia or gestational diabetes. Dr. Baker illustrated this point with a recent case in which a woman arrived for her first prenatal visit at 37 weeks and was found to have dangerously high blood sugar levels. “Had we seen her early and diagnosed her diabetes prior to pregnancy, we could have treated her, helped her control her sugars, and significantly reduce the risk to mom and baby,” she remarked.

Impact of Insurance and Accessibility

The March of Dimes report reveals a concerning correlation between insurance type and maternal health outcomes. Pregnant women on Medicaid experience higher preterm birth rates compared to those with private insurance, with rates of 11.7% versus 9.6% respectively. This discrepancy highlights issues in reimbursement for prenatal care, which Dr. Divya Sooryakumar from Every Mother Counts emphasized, stating that prenatal and postpartum care should be adequately reimbursed to ensure better access.

In addition to financial barriers, logistical challenges also impede access to care. In some regions, women may have to travel up to four hours for appointments due to a lack of nearby healthcare facilities. Sooryakumar noted that during times of increased immigration enforcement, many families delay seeking care out of fear, further exacerbating prenatal health issues.

The overall picture of maternal health in the United States remains troubling. Dr. Warren warned, “Every year in this country, we lose over 20,000 babies in their first year of life. We lose over 600 moms, either during pregnancy or delivery, or during that first year postpartum.” The need for systemic changes in maternal healthcare is urgent, as the country prepares to enter 2025.

Programs aimed at improving outcomes are emerging in some states. For example, Tennessee has implemented smoking cessation initiatives for pregnant women, which have been linked to improved health outcomes for both mothers and infants. Illinois has introduced case management programs to support women facing socioeconomic challenges.

Despite these efforts, a national strategy is essential to address the barriers that women face in accessing prenatal care. Dr. Warren stressed the need for comprehensive insurance coverage and a robust public health infrastructure to reverse the trend of inadequate prenatal care. Without significant improvements, the maternal health crisis is likely to worsen, impacting the well-being of both mothers and their children in the years to come.