Early prenatal care is important but not everyone is getting it. A recent report from infant and maternal health nonprofit March of Dimes shows nearly 25% of pregnant people did not get prenatal care in their first trimester in 2024, demonstrating the fourth year of decline. The report also shows the national preterm birth rate remains at 10.4%, putting the U.S. among the highest of developed nations.
“This statistic reflects both a maternity crisis and systemic failures that are deeply interconnected, starting with a significant education gap around reproductive health”, says Prati Sharma, MD, FACOG, a double-board certified OB-GYN and reproductive endocrinologist and infertility specialist (REI).
In her opinion, many people enter their reproductive years without understanding when they should start prepping for fertility, when prenatal care should begin, and why those early weeks of pregnancy matter so much.
Why first trimester care matters
Health care providers recommend people start taking prenatal vitamins three to four months before trying to conceive so that their bodies are prepped for pregnancy and filled with the nutrients needed to support foetal development. “If proper care is not taken leading up to pregnancy, this could be detrimental to both mom and baby”, says Dr. Sharma.
If pregnant people aren’t taking a prenatal because the pregnancy is a surprise or for other reasons, health care providers would have them start on supplements right away.
Once conception occurs, a first prenatal appointment is usually recommended between week six and eight.
“A lot of critical foetal development happens in the earliest weeks of pregnancy—often before women know they’re pregnant”, says Dr. Sharma. “Early prenatal care during the first trimester is when we can identify and address critical factors that directly impact both maternal and foetal health”.
Missing the first trimester window of care often means physicians are responding to complications as they arise rather than preventing them from developing in the first place. This frequently results in more intensive medical interventions and increased risks throughout the pregnancy.
“This is an important window where we can manage chronic conditions like hypertension or diabetes that significantly affect pregnancy outcomes, establish baselines for bloodwork to screen for infections or nutritional deficiencies, and begin important conversations about nutrition, lifestyle factors, and any medications that might need adjustment during pregnancy”, says Dr. Sharma.
Jasmine Johnson, MD, an assistant professor of obstetrics and gynaecology in the division of maternal-foetal medicine at Indiana University School of Medicine, adds that in the current reproductive policy landscape, not getting early prenatal care can limit reproductive choice options for those who may need to end a pregnancy for maternal health or foetal reasons.
Barriers to prenatal care
Access to care remains a significant barrier to people seeking care in the first trimester. Over 35% of counties in America are considered OB deserts, or maternal care deserts, meaning there aren’t any obstetric clinicians or hospitals or birth centres providing obstetric care. On top of that, there are only about 1,250 fertility specialists across the country.
“Those who do have access often face appointment wait times that stretch months into the future”, adds Dr. Sharma.
Navigating insurance policies and high deductibles that turn early prenatal visits into significant financial burdens can also be a barrier, and understandably so. The situation becomes even more challenging for those working hourly jobs without paid leave, where attending a daytime medical appointment means choosing between their health and their income.
Meanwhile, there are not enough care team members to cater to all of the patients in need, explains Dr. Johnson. “Hospitals are losing maternity services and labour and delivery units, so the entire system is stretched which means there are not enough OB appointments for everyone who needs them,” she adds. “Furthermore, we know that a lot of patients do not trust the medical team—and sometimes for the right reasons”.
Tackling the problem
Dr. Johnson says more unified public health information and recommendations for patients is needed, as well as better health care coverage policy for both patient access and physician reimbursement. “We need to improve the awful maternal morbidity and mortality statistics in our country which would improve trust in the system”, adds Dr. Johnson.
Dr. Sharma stresses the importance of education as a means of improving access to early prenatal care. “Preconception education plays a vital role because when people understand their reproductive health before they become pregnant, they’re more likely to recognize the importance of seeking care early once pregnancy occurs”, adds Dr. Sharma.
Beyond education, help needs to be more accessible. “We need systemic solutions like expanded telehealth options that reduce travel barriers, mobile clinics that bring care directly to underserved communities, and policy changes that ensure comprehensive prenatal care coverage without cost barriers or workplace penalties for attending appointments”, shares Dr. Sharma.
Racial disparities in maternal health
The March of Dimes report also mentions that racial disparities are worsening, with preterm birth rates among Black mothers climbing to 14.7%. More so, Black, American Indian/Alaska Native, and Pacific Islander moms and birthing people still die at two to three times the rate of White moms and birthing people. These are worrying statistics.
“This is a multifactorial issue but its roots are in continued systemic and structural racism that perpetuates the inequities that create a system where we, as Black women, are dismissed, ignored, and invalidated when it comes to our health”, highlights Dr. Johnson. “Research shows that in addition to medical racism, segregated neighbourhoods, police violence in the community, inadequate resources for education, housing, and jobs all contribute to Black-White preterm birth and infant mortality disparities”.
She acknowledges that even with insurance, adequate prenatal care, and resources to have the best outcomes, Black women continue to have worse outcomes compared to white women—she even published a study on this. A newer report supports this showing that insurance coverage and access to health care facilities alone don’t eliminate these disparities, which demonstrates that the problem extends beyond availability of care to how that care is delivered.
Dr. Sharma adds that the maternity care system is failing Black women through a combination of factors, including implicit bias among providers that affects how Black patients’ symptoms and concerns are perceived and prioritised, gaps in cultural competency training, and structural inequities that persist regardless of socioeconomic status.
“Addressing these disparities requires action that includes provider training on implicit bias, increased representation of Black clinicians in maternal care, and accountability measures that track and address these outcome disparities throughout the system”, she suggests.
Source: Parents.com – Hannah Nwoko
Image Credit: ShutterStock
