Disparities in Prenatal Care Utilization in the United States

This study examined disparities in prenatal care utilization by race/ethnicity and payer using three measures of inadequate prenatal care: (1) fewer than the recommended number of prenatal care visits, (2) late initiation of prenatal care (at or after 4 months gestation), or (3) no prenatal care.

Birth records data from the National Center for Health Statistics were used. The study population consisted of singleton live births in all 50 U.S. states and the District of Columbia between January 1, 2014, and December 31, 2022 (N = 33,107,382).

The average number of reported prenatal care visits was 11.2 (SD = 1.2), 36.8% reported fewer than the recommended number of prenatal care visits, 22.7% reported late initiation of prenatal care, and 1.8% reported no prenatal care. Women with a Medicaid-covered delivery were 1.06 times more likely to have fewer than the recommended number of visits, 1.36 times more likely to initiate prenatal care late, and 1.72 times more likely to have no prenatal visits (all p < 0.001). There were significant disparities in prenatal care utilization by race/ethnicity, particularly for NHPI and AIAN women, with all minoritized racial/ethnic groups having greater risk for multiple measures of inadequate prenatal care utilization relative to White populations.

Racial/ethnic and economic disparities in perinatal health in the U.S. are of national concern. Differences in prenatal care utilization between women with Medicaid and private/other insurance suggest modifications to Medicaid policies may improve prenatal care access among beneficiaries.