Late or No Prenatal Care

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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.

Importance

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]

Trends

25_fig1 With the exception of some interruption during the 1980s, there has been a downward trend in this indicator since the 1970s. 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 complicated by the states’ transition to a revised birth certificate, a process which began in 2003 and is still not complete (see Definition section). Consequently, nationwide year-to-year comparisons are problematic, and not possible at all between 2006 and 2007.(Figure 1)

Differences by Race and Hispanic Origin [6]

25_fig2In 2011, 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 2011 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 2011, 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, and eight percent for mothers of Mexican, Central or South American origin.  Similarly, among Asian or Pacific Islander women in 2011, those receiving late or no prenatal care ranged between 3.3 percent of births (among mothers of Japanese and Chinese origin), and 10 percent of births (for mothers of Hawaiian or part-Hawaiian origin). (Appendix 1)

Differences by Age

25_fig3Young women in their teens are by far the least likely to receive timely prenatal care.  In 2011, 22 percent of births to females under age 15, and 10 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 2003‐2011 are available for all states and the 50 largest U.S. cities at the KIDS COUNT Data Center:

International Estimates

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)

National Goals

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)

Related Indicators

Definition

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, in 2010, 34 states, representing 76 percent of births, and, in 2011, 36 states, representing 83 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 this report from the National Vital Statistics System.

Data Sources

Data for 2003-2006, by age 1990-1999 and 2007-2011, and Asians 2009-2011: Centers for Disease Control and Prevention, National Center for Health Statistics.  VitalStats online tool. Available at http://www.cdc.gov/nchs/vitalstats.htm.

All other data for 2007-2011: 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:   http://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_05.pdf

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: http://www.cdc.gov/nchs/hus/previous.htm  

Raw Data Source

Birth Data, National Vital Statistics System

http://www.cdc.gov/nchs/nvss.htm

 

Appendix 1 - Births to Mothers Receiving Late or No Prenatal Care, as a Percentage of All Births, by Race, Hispanic Origin, and Age of Mother, Selected Years 1970-20111

1970 1975 1980 1985 1990 1995 2000 2001 2002 20032 20042 20052 20062 20073 20083 20093 20103 20113
All Births 7.9 6.0 5.1 5.7 6.1 4.2 3.9 3.7 3.6 3.5 3.6 3.5 3.6 7.1 7.0 6.6 6.2  6.0
White 6.3 5.0 4.3 4.8 4.9 3.5 3.3 3.2 3.1 3.0 3.2 3.0 3.2 6.5 6.3 5.9 5.5  5.2
Non-Hispanic White5 - - 3.5 4.0 3.4 2.5 2.3 2.2 2.2 2.1 2.2 2.2 2.3 5.0 4.8 4.5 4.3  4.3
Black 16.6 10.5 8.9 10.2 11.3 7.6 6.7 6.5 6.2 6.0 5.7 5.7 5.7 11.7 11.3 10.6 10.2  9.8
Non-Hispanic Black5 - - 9.7 10.9 11.2 7.6 6.7 6.5 6.2 6.0 5.7 5.6 5.7 11.7 11.3 10.6 10.2  9.8
Hispanic origin4,5 - - 12.0 12.4 12.0 7.4 6.3 5.9 5.5 5.3 5.4 5.1 5.0 9.3 9.2 8.8 8.1  7.5
Mexican - - 11.8 12.9 13.2 8.1 6.9 6.2 5.8 5.6 5.5 5.0 5.0 9.7 9.6 9.3 8.4  7.8
Puerto Rican - - 16.2 15.5 10.6 5.5 4.5 4.6 4.1 3.7 3.9 4.1 4.1 7.6 7.8 6.9 6.6  6.2
Cuban - - 3.9 3.7 2.8 2.1 1.4 1.3 1.3 1.3 2.9 2.5 3.2 3.4 3.3 3.4 3.2  3.2
Central and South American - - 13.1 12.5 10.9 6.1 5.4 5.7 4.9 4.7 5.1 5.6 5.8 8.3 9.2 8.5 8.2  7.7
Other and unknown Hispanic - - 9.2 9.4 8.5 6.0 5.9 5.4 5.3 5.4 5.5 5.6 4.9 8.9 8.5 7.9 7.5  7.2
Asian or Pacific Islander - - 6.5 6.5 5.8 4.3 3.3 3.4 3.1 3.1 3.0 3.0 3.1 4.9 5.3 4.9 5.1  5.2
Asian Indian - - - - - - - - - - - - - - - 4.6 4.5  4.7
Chinese 6.5 4.4 3.7 4.4 3.4 3.0 2.2 2.4 2.1 - - - - - - 3.2 3.7 3.8
Japanese 4.1 2.7 2.1 3.1 2.9 2.3 1.8 2.0 2.1 - - - - - - 3.2 3.2 3.3
Filipino 7.2 4.1 4.0 4.8 4.5 4.1 3.0 3.0 2.8 - - - - - - 4.0 4.1 4.3
Hawaiian and part Hawaiian - - 6.7 7.4 8.7 5.1 4.2 4.8 4.7 - - - - - - 9.6 8.5 10.1
Other Asian or Pacific Islander - - 9.3 8.2 7.1 5.0 3.8 3.8 3.5 - - - - - - 6.4 6.8 6.6
American Indian or Alaska Native 28.9 22.4 15.2 12.9 12.9 9.5 8.6 8.2 8.0 7.6 7.9 8.2 8.1 13.1 12.6 11.4 11.3  11.2
1970 1975 1980 1985 1990 1995 2000 2001 2002 20032 20042 20052 20062 20073 20083 20093 20103 20113
Age
Under 15 years - - - - 20.3 15.3 16.3 16.8 14.8 15.4 15.4 15.0 15.6 23.2 26.0 22.0 22.0  22.2
15-19 years - - - - 11.9 7.6 7.2 6.9 6.6 6.4 6.3 6.3 6.4 12.0 11.8 11.1 10.6  10.2
15-17 years - - - - - - 8.6 8.4 8.0 7.6 - - - 14.1 13.4 12.7 12.5  12.2
18-19 years - - - - - - 6.4 6.2 6.0 5.6 - - - 11.1 11.0 10.3 9.9  9.4
20-24 years - - - - 8.0 5.4 5.1 4.9 4.7 4.6 4.6 4.5 4.7 9.4 9.1 8.6 8.2  7.9
25-29 years - - - - 4.4 3.3 3.1 3.1 3.0 3.0 3.0 3.0 3.2 6.2 6.1 5.8 5.5  5.3
30-34 years - - - - 3.4 2.7 2.4 2.3 2.3 2.3 2.3 2.3 2.4 4.7 4.8 4.5 4.3  4.2
35-39 years - - - - 3.8 3.0 2.6 2.6 2.5 2.4 2.5 2.4 2.5 4.6 4.7 4.5 4.4  4.3
40 years and over - - - - 5.6 3.9 3.5 3.4 3.3 3.2 3.3 3.2 3.1 5.6 5.5 5.2 5.3  5.0
"-" Indicates data not available.1Excludes live births for which trimester when prenatal care began is unknown. Data for 1970 and 1975 also exclude births that occurred in states not reporting prenatal care.2Data are for the reporting areas that used the 1989 Revision of the U.S. Standard Certificate of Live Birth for prenatal care. Reporting areas that implemented the 2003 revision of the U.S. Standard Certificate of Live Birth are excluded because prenatal care data based on the 2003 revision are not comparable with data based on the 1989 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. Although New York state began using the 2003 revision in 2004, New York City continued to use the 1989 revision, and is included in these estimates.

3Data are for the reporting areas that used the 2003 Revision of the U.S. Standard Certificate of Live Birth for prenatal care. Reporting areas that did not yet implement the 2003 revision of the U.S. Standard Certificate of Live Birth are excluded because prenatal care data based on the 2003 revision are not comparable with data based on the 1989 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, in 2010, 34 states, representing 76 percent of births, and in 2011, 36 states, representing 83 percent of births.  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.

4Persons of Hispanic origin may be of any race.

5Trend data for Hispanics and non-Hispanics are affected by expansion of the reporting area for an Hispanic-origin item on the birth certificate and by immigration. These two factors affect numbers of events, composition of the Hispanic population, and maternal and infant health characteristics. The number of states in the reporting area increased from 22 in 1980, to 23 and the District of Columbia (DC) in 1985, 48 and DC in 1990, and 50 and DC in 1993 and all later years.

Sources: 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: http://www.cdc.gov/nchs/hus/previous.htm. 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: http://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_05.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 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 2003-2006, by age 1990-1999 and 2007-2011, and Asians 2009-2011: Centers for Disease Control and Prevention, National Center for Health Statistics.  VitalStats online tool. Available at http://www.cdc.gov/nchs/vitalstats.htm. All other data for 2007-2011: National Center for Health Statistics, CDC WONDER online tool. Available at: http://wonder.cdc.gov/natality-current.html.

 

Endnotes


[1]Hagan, 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

[2]Maternal 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.html

[3]Logan, 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.

[4]Alexander, 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.

[5]Ibid.

[6]Hispanics may be any race. Estimates for whites and blacks in this report do not include Hispanics.

 

Suggested Citation:

Child Trends Databank. (2013). Late or no prenatal care. Available at: http://www.childtrends.org/?late-or-no-prenatal-care

 

Last updated: January 2014