Trends in the Well-Being of America's Children and Youth, 2000. HC 3.2 Prenatal Care

01/01/2000

Early Prenatal Care

Early prenatal care (i.e., care in the first trimester of a pregnancy) allows women and their health care providers to identify and, when possible, treat or correct health problems and health-compromising behaviors that can be particularly damaging during the initial stages of fetal development. Increasing the percentage of women who receive prenatal care, and who do so early in their pregnancies, can improve birth outcomes and lower health care costs by reducing the likelihood of complications during pregnancy and childbirth.53

The percentage of women receiving prenatal care in the first trimester has increased from 68.0 percent in 1970 to 83.2 percent in 1999 (see Table HC 3.2.A).54 Following a decade of essentially no change, the proportion of women receiving early prenatal care has improved incrementally throughout the 1990s.

Differences by Race and Ethnicity. The percentage of women receiving prenatal care during the first 3 months of pregnancy has increased over the past two decades for women of all races and those of Hispanic origin. While the gains have been greatest for women with lower levels of timely care, white, Chinese, Japanese, and Cuban women are most likely to receive prenatal care in their first trimester (see Table HC 3.2.A).

  • American Indian/Alaska Native and Mexican women have consistently had the lowest percentage of women receiving early prenatal care; however, this percentage has increased to 68.8 for American Indian women and 72.8 percent for Mexican women in 1998.
  • The percentage of black women receiving prenatal care in the first trimester increased from 44.2 percent in 1970 to 62.4 percent in 1980. Rates declined slightly during the 1980s but then increased in subsequent years, reaching 74 percent by 1999.
  • The percentage of all Hispanic women who receive early prenatal care has increased from 60.2 percent in 1980 to 74.3 percent by 1998. Among Hispanics, there are important subgroup disparities. In 1998, 91.8 percent of Cuban women received early prenatal care, compared with 72.8 percent of Mexican American women.
  • Since 1980, early prenatal care receipt has improved among Asian/Pacific Islander women as a group—from 73.7 percent in 1980 to 83.1 percent in 1998. Chinese, Japanese, and Filipino women tend to have higher rates of prenatal care than Hawaiian and other Asian women.
  • The percentage of white women receiving early prenatal care increased from 72.3 percent to 79.2 percent between 1970 and 1980, was stable through the 1980s, then increased during the 1990s to 88.4 percent by 1999.

Late or No Prenatal Care

Receiving prenatal care late in a pregnancy, or receiving no prenatal care at all, can lead to negative health outcomes for mother and child. Women who receive care late in their pregnancy, or who do not receive care at all, are at increased risk of bearing infants who are of low birthweight, who are stillborn, or who die within the first year of life.55 Between 1970 and 1999, the percentage of women receiving late or no prenatal care declined from 7.9 percent to 3.8 percent (see Table HC 3.2.B).

Differences by Race and Ethnicity. The percentage of women who receive late or no prenatal care has declined substantially for women in all racial and ethnic groups (see Table HC 3.2.B).

  • American Indian/Alaska Native women and black women have seen the most dramatic improvements, with the percentages receiving late or no prenatal care dropping by more than two-thirds for American Indian women and by more than half for black women since 1970. In 1998, 8.5 percent of American Indian/Alaska Native women received late or no prenatal care, and 7.0 percent of black women received late or no prenatal care.
  • The percentage of Hispanic women receiving late or no prenatal care has decreased every year during the 1990s and at 6.3 percent in 1998 was lower than the rate for black women at 7.0.
  • White women and Asian women as a group have consistently been least likely to receive late or no prenatal care. In 1998, 2.4 percent of white women received late or no prenatal care, compared to 3.6 percent of Asian women.

Adequacy of Prenatal Care

Receiving early and consistent prenatal care increases the likelihood of a healthy birth outcome. Adequate prenatal care is determined by both the early receipt of prenatal care (within the first trimester) and the receipt of an appropriate number of prenatal care visits for each stage of a pregnancy. Women whose prenatal care fails to meet these standards are at a greater risk for pregnancy complications and negative birth outcomes.

There has been a sharp decline in the percentage of women receiving inadequate prenatal care from 18 percent in 1989 to 11.9 percent in 1998 (see Table HC 3.2.C). According to the Adequacy of Prenatal Care Utilization Index, the proportion of women with at least adequate care rose from 66.1 percent to 74.3 percent between 1989 and 1998. The proportion of women with intensive use of care (women for whom the number of visits exceeded the American College of Obstetricians and Gynecologists’ recommendations by a ratio of observed to expected visits of at least 110 percent) rose from 24.1 to 31 percent during the same time period.

Table HC 3.2.A Percentage of womena in the United States receiving prenatal care in the first trimester, by race/ethnicity of mother: Selected years, 1970-1999

  1970 1980 1985 1990b 1991 1992 1993 1994 1995 1996 1997 1998 1999
Total 68.0 76.3 76.2 75.8 76.2 77.7 78.9 80.2 81.3 81.9 82.5 82.8 83.2
Race/ethnicity
Whiteb 72.3 79.2 79.3 83.3 83.7 84.9 85.6 86.5 87.1 87.4 87.9 87.9 88.4
Blackb 44.2 62.4 61.5 60.7 61.9 64.0 66.1 68.3 70.4 71.5 72.3 73.3 74.0
American Indian/Alaska Native 38.2 55.8 57.5 57.9 59.9 62.1 63.4 65.2 66.7 67.7 68.1 68.8
Asian/Pacific Islander 67.3 73.7 74.1 75.1 75.3 76.6 77.6 79.7 79.9 81.2 82.1 83.1
Chinese 71.8 82.6 82.0 81.3 82.3 83.8 84.6 86.2 85.7 86.8 87.4 88.5
Japanese 78.1 86.1 84.7 87.0 87.7 88.2 87.2 89.2 89.7 89.3 89.3 90.2
Filipino 60.6 77.3 76.5 77.1 77.1 78.7 79.3 81.3 80.9 82.5 83.3 84.2
Hawaiian 65.8 68.1 69.9 70.6 77.0 75.9 78.5 78.0 78.8
Other Asian or Pacific Islander 54.9 67.6 69.7 71.9 71.9 72.8 74.4 76.2 77.0 78.4 79.7 80.9
Hispanic originc,d 60.2 61.2 60.2 61.0 64.2 66.6 68.9 70.8 72.2 73.7 74.3 74.5
Mexican American 59.6 60.0 57.8 58.7 62.1 64.8 67.3 69.1 70.7 72.1 72.8
Puerto Rican 55.1 58.3 63.5 65.0 67.8 70.0 71.7 74.0 75.0 76.5 76.9
Cuban 82.7 82.5 84.8 85.4 86.8 88.9 90.1 89.2 89.2 90.4 91.8
Central and South 58.8 60.6 61.5 63.4 66.8 68.7 71.2 73.2 75.0 76.9 78.0
American Unknown Hispanic 66.4 65.8 66.4 65.6 68.0 70.0 72.1 74.3 74.6 76.0 74.8

a The data refer to those women who had live births.

b Includes persons of Hispanic origin until 1990. After 1990 persons of Hispanic origin are not included.

c Persons of Hispanic origin may be of any race.

d Figures for Hispanic women are based on data from 22 states that reported Hispanic origin on the birth certificate in 1980; 23 states and the District of Columbia in 1985, 48 states and the District of Columbia in 1990, 49 states and the District of Columbia in 1992, and 50 states and the District of Columbia since 1993.

Sources: Curtin & Martin, 2000; Data computed by the Division of Health and Utilization Analysis from data compiled by the Division of Vital Statistics; National Center for Health Statistics, 1998, Table 6; Ventura, et al., 2000, Births, Tables 24, 25 and 33; Ventura, et al., 1999, Births, Tables 24, 25, and 33.


Table HC 3.2.B Percentage of womena in the United States receiving late or no prenatal care,b by race/ethnicity of mother and by age: selected years, 1970-1999

  1970 1980 1985 1990 1991 1992 1993c 1994 1995 1996 1997 1998 1999
Total 7.9 5.1 5.7 6.1 5.8 5.2 4.8 4.4 4.2 4.0 3.9 3.9 3.8
Race/ethnicity
Whitec 6.3 4.3 4.8 4.9 4.7 4.2 2.7 2.5 2.5 2.4 2.4 2.4 2.3
Blackc 16.6 8.9 10.2 11.3 10.7 9.9 9.0 8.2 7.6 7.3 7.3 7.0 6.7
American Indian/Alaska Native 28.9 15.2 12.9 12.9 12.2 11.0 10.3 9.8 9.5 8.6 8.6 8.5
Asian/Pacific Islander  6.8 6.5 6.5 5.8 5.7 4.9 4.6 4.1 4.3 3.9 3.8 3.6
Chinese 6.5 3.7 4.4 3.4 3.4 2.9 2.9 2.7 3.0 2.5 2.4 2.2
Japanese 4.1 2.1 3.1 2.9 2.5 2.4 2.8 1.9 2.3 2.2 2.7 2.1
Filipino 7.2 4.0 4.8 4.5 5.0 4.3 4.0 3.6 4.1 3.3 3.3 3.1
Hawaiian 8.7 7.5 7.0 6.7 4.7 5.1 5.0 5.4 4.7
Other Asian or Pacific Islander 9.0 8.1 7.1 6.8 5.9 5.4 4.8 5.0 4.6 4.4 4.2
Hispanic originc, d 12.0 12.4 12.0 11.0 9.5 8.8 7.6 7.4 6.7 6.2 6.3 6.3
Mexican American 11.8 12.9 13.2 12.2 10.5 9.7 8.3 8.1 7.2 6.7 6.8
Puerto Rican 16.2 15.5 10.6 9.1 8.0 7.1 6.5 5.5 5.7 5.4 5.1
Cuban 3.9 3.7 2.8 2.4 2.1 1.8 1.6 2.1 1.6 1.5 1.2
Central and South American 13.1 12.5 10.9 9.5 7.9 7.3 6.5 6.1 5.5 5.0 4.9
Unknown Hispanic 9.2 9.4 8.5 8.2 7.5 7.0 6.2 6.0 5.9 5.3 6.0

 a The data refer to those women who had live births.

b Late prenatal care is defined as seventh month or later.

c Includes persons of Hispanic origin until 1993. After 1993, persons of Hispanic origin are not included. Persons of Hispanic origin may be of any race.

d Figures for Hispanic women are based on data from 22 states that reported Hispanic origin on the birth certificate in 1980; 23 states and the District of Columbia in 1985, 48 states and the District of Columbia in 1990, 49 states and the District of Columbia in 1992, and 50 states and the District of Columbia since 1993.

Sources: Curtin, & Mathews, 2000, Table 6; Ventura, et al.,2000, Births, Tables 24, 25, and 33.


Table HC 3.2.C Adequacy of Prenatal Care Utilization Indexa: United States, 1989, 1990, and 1995-1998

  1989 1990a 1995a 1996 1997 1998
Intensive use 24.1 24.6 28.8 29.3 30.7 31.0
Adequate 42.0 42.3 43.7 43.6 43.3 43.3
Intermediate 15.9 15.7 14.7 14.7 14.0 13.8
Inadequate 18.0 17.4 12.8 12.4 12.0 11.9

 a Kotelchuck M. An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. Am J Public Health 84(9):1414–20. 1994 Kogan MD, Martin JA, Alexander GR, et al. The changing pattern of prenatal care utilization in the United States, 1981–1985, using different prenatal care indices. JAMA 279(20):1623–28. 1998.

Sources: Ventura, et al., 2000, Births, Table F.


53 U.S. Public Health Service. 1989. Caring for Our Future: The Content of Prenatal Care. Washington, D.C.: U.S. Department of Health and Human Services.

54 These data include only those women who gave birth, not all women who were pregnant.

55 U.S. Public Health Service, 1989.

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