A growing body of new data shows that prenatal care in the United States is moving in the wrong direction. Health experts say the trend could have serious consequences for both mothers and babies if it continues.
A federal report released by the Centers for Disease Control and Prevention found that fewer women are beginning prenatal care early in pregnancy, even though early care is widely known to improve health outcomes.
The Numbers Show a Clear Decline
According to the CDC data, the share of U.S. births to women who began prenatal care in the first trimester fell from 78.3% in 2021 to 75.5% in 2024.
At the same time, later care has increased. Prenatal care starting in the second trimester rose from 15.4% to 17.3%. The percentage of women starting care in the third trimester or receiving no care at all climbed from 6.3% to 7.3%.
The trend appears to affect nearly all groups, but the decline is especially pronounced among minority mothers. For example, first trimester prenatal care among Black mothers dropped from 69.7% in 2021 to 65.1% in 2024.
Michelle Osterman, the lead author of the CDC report, said the findings represent a shift after several years of improvement between 2016 and 2021.
Separate research from the nonprofit March of Dimes reinforces the concern. Nearly 25% of pregnant women in the United States did not receive prenatal care in the first trimester in 2024, marking what experts describe as a four year decline.
Dr. Michael Warren of March of Dimes said the country is moving in the “wrong direction.”
What Prenatal Care Includes
Prenatal care involves a series of medical visits throughout pregnancy designed to monitor the health of both mother and baby and to detect problems early.
These visits can include blood pressure checks, blood tests, screenings, physical exams, ultrasound scans, and health guidance. Doctors also use early visits to identify chronic conditions such as diabetes or hypertension and to manage risk factors before complications develop.
Experts emphasize that the earliest weeks of pregnancy are particularly important. As one specialist explained, “A lot of critical fetal development happens in the earliest weeks of pregnancy, often before women know they’re pregnant.”
Missing that window means doctors are often reacting to problems rather than preventing them.
Why Early Care Matters
Doctors consistently warn that delayed prenatal care can increase the risk of serious complications.
Dr. Clayton Alfonso, an OB GYN at Duke University, said, “We know that early engagement in prenatal care is linked to better overall health outcomes.” He added that when patients delay care, “we’ve missed that window to optimize both fetal and maternal care.”
Early care allows physicians to detect conditions such as gestational diabetes, preeclampsia, infections, and nutritional deficiencies before they become dangerous.
One physician described treating a woman who came for her first prenatal visit at 37 weeks with dangerously high blood sugar levels near 300. The situation required immediate induction of labor because uncontrolled diabetes posed a major risk of stillbirth and maternal complications. The doctor noted that earlier treatment could have significantly reduced the risks.
Barriers Driving the Decline
The CDC report does not identify specific causes, but experts point to several likely factors.
One major concern is the growth of maternity care deserts. A 2024 March of Dimes report found that more than 35% of U.S. counties lack a birthing facility or obstetric provider. These areas are home to more than 2 million women of reproductive age and about 150,000 births annually.
Dr. Grace Ferguson, an OB GYN in Pittsburgh, said hospital closures play a role. “Many hospitals have shut down labor and delivery units and the prenatal care providers that work at those hospitals also have probably moved.”
Access problems may be especially severe in rural areas, where patients must travel long distances and may struggle to find providers who accept Medicaid.
Insurance barriers also contribute. Some patients delay care because they are unsure whether their visits will be covered or because they face high deductibles. Others encounter workforce shortages, long wait times for appointments, or lack of paid time off from work.
Social factors also matter. Housing instability, food insecurity, and difficulty obtaining Medicaid coverage are frequently cited reasons patients present late for care.
Some experts believe legal and policy changes following the Supreme Court’s 2022 decision overturning Roe v. Wade may also affect provider availability in certain states.
Why This Matters for Public Health
The decline in early prenatal care is occurring during a broader maternal health crisis in the United States.
The country already has one of the highest maternal death rates among high income nations. Each year, more than 600 mothers die during pregnancy, delivery, or the postpartum period, and more than 20,000 infants die before their first birthday.
Doctors warn that delayed prenatal care increases the risk of complications such as preterm birth, maternal illness, and infant mortality.
“If this trend continues,” Alfonso said, “I worry about kind of what that would mean for morbidity and mortality for our moms.”
March of Dimes data shows the U.S. preterm birth rate remains at 10.4%, among the highest in developed nations. Medicaid recipients face higher preterm birth rates than those with private insurance, highlighting disparities in access and outcomes.
Experts say improving prenatal care access could significantly reduce severe complications and deaths.
Dr. Baker emphasized that early care is one of the most effective opportunities to prevent tragedy. “It’s the one area where we could really make a plan to prevent severe morbidity and mortality.”
Health leaders are calling for expanded access, better insurance coverage, stronger public health infrastructure, and education about reproductive health.
Without intervention, specialists warn that declining prenatal care could worsen maternal and infant outcomes across the country.
As one expert bluntly stated, the current situation is unacceptable. “That is not acceptable in the United States… and unless we change our course, those numbers are not going to get better. They’re going to get worse.”
