The shift threatens to reverse progress in maternal health outcomes and deepens existing health inequities. Experts cite maternity care deserts, barriers to access, and post-Roe abortion restrictions as likely contributing factors.
The share of U.S. births to women who began prenatal care in the first trimester dropped from 78.3 percent in 2021 to 75.5 percent in 2024, according to data released Thursday by the Centers for Disease Control and Prevention. The decline reverses steady improvements that had occurred between 2016 and 2021.
Meanwhile, prenatal care beginning in the second trimester rose from 15.4 percent to 17.3 percent. Starting care in the third trimester or receiving no prenatal care climbed from 6.3 percent to 7.3 percent.
The decline was steeper for Black mothers. First-trimester prenatal care for Black women fell from 69.7 percent in 2021 to 65.1 percent in 2024. The widening gap compounds existing health inequities: late or absent prenatal care raises the risk of maternal mortality, which is already significantly higher among Black mothers.
Why timing matters
Early prenatal visits allow doctors to check blood pressure, conduct screenings, perform blood tests, and order ultrasound scans — interventions that catch problems early. “We know that early engagement in prenatal care is linked to better overall health outcomes,” said Dr. Clayton Alfonso, an obstetrician-gynecologist at Duke University in North Carolina.
Delays in care have serious consequences. When patients postpone prenatal appointments, doctors have missed opportunities to intervene. “We’ve missed that window to optimize both fetal and maternal care,” Alfonso said.
A landscape of maternity care deserts
More than 35 percent of U.S. counties are maternity care deserts, meaning there are no birthing facilities or obstetric providers, according to a 2024 March of Dimes report. Women living in these areas consistently receive less prenatal care.
Many hospitals across the country have shut down labor and delivery units in recent years. “And the prenatal care providers that work at those hospitals also have probably moved,” said Dr. Grace Ferguson, an obstetrician-gynecologist in Pittsburgh.
The geographic barriers are substantial. Patients in rural areas may have to travel much farther to reach appointments and often struggle to find practices that accept their insurance — particularly if they have Medicaid coverage. These access obstacles are pushing prenatal care later, Alfonso said.
The abortion-restrictions factor
Some obstetricians are choosing not to practice in states with more restrictive abortion laws, Ferguson noted. This trend may further reduce the availability of prenatal care providers in affected regions, though experts cautioned that more research is needed to quantify the effect.
Warning signs ahead
The CDC report does not specify the reasons driving the decline, but experts have warned that the trend could have serious consequences. “If this trend continues,” Alfonso said, “I worry about kind of what that would mean for morbidity and mortality for our moms.”