More women are delaying or forgoing prenatal care

For the report, CDC reviewed birth certificate data and found that as of 2024, 75.5% of pregnant women in the United States received care during their first trimester, down from 78.3% in 2021.

Meanwhile, prenatal care starting in the second trimester rose from 15.4% in 2021 to 17.3% in 2024, and the percentage of women who received either very late prenatal care or no prenatal care at all increased from 6.3% in 2021 to 7.3% in 2024.

According to the report, these findings mark a significant shift from a decade ago when the percentage of women receiving prenatal care overall increased between 2016 and 2021.

While CDC found the trend held for virtually all racial and ethnic groups, it did find the decrease in early prenatal care was higher for moms in minority groups. For example, the percentage of Black mothers who received prenatal care in the first trimester dropped from 69.7% in 2021 to 65.1% in 2024.

The report also found that 36 states and Washington, D.C. saw increases in women either delaying their prenatal care or going without. More than one in 10 pregnant women fit that criteria in Florida, Georgia, Hawaii, New Mexico, and Texas.

However, six states saw access to prenatal care improve: Arkansas, New Hampshire, South Carolina, Tennessee, West Virginia, and Wisconsin.

The authors of the report noted that early provisional data from 2025 suggests there are some improvements in prenatal care access but added that could change once data is finalized this summer.

Why prenatal care rates are declining

While the report didn't offer a reason as to why early prenatal care is declining, experts suggested a variety of factors could be at play.

Grace Ferguson, an ob/gyn in Pittsburgh, said the proliferation of maternity care deserts — areas with no birthing facility or obstetric provider — across the United States is a growing concern. Several hospitals have shut down labor and delivery units, "and the prenatal care providers that work at those hospitals also have probably moved," Ferguson said.

Clayton Alfonso, an ob/gyn, said he suspects access issues for patients are pushing prenatal care later, especially in rural areas. Patients might have to travel farther to get to appointments and could struggle to find a practice that accepts their insurance, especially if they have Medicaid.

Mya Zapata, an ob/gyn at UCLA Health, said she wondered if mistrust in the medical establishment or the government also played a role.

"We have a large portion of patients in the Los Angeles area whose legal documentation is unclear," Zapata said. "They may be hesitant to get care."

The importance of prenatal care

Experts emphasized that early prenatal care is extremely important. Brenna Hughes, interim chair of the obstetrics and gynecology department at a U.S. medical school, said that there is "a host of reasons why prenatal care is important."

"The earlier we can get patients seen, the earlier we can start interventions that improve these longer-term outcomes," she said.

For example, urinary tract infections can lead to premature labor and even sepsis if left untreated. Ensuring that a woman is treated appropriately for diabetes is also essential, Zapata said, as pregnancy hormones make it more difficult to regulate blood sugar.

"In the first trimester, if a person's blood sugars are already not regulated, what that means is there's more sugar circulating in their blood all the time, and that is affecting how fetal organs are developing," she said.

Seeing a doctor early in pregnancy can also identify patients at risk for preeclampsia, a potentially fatal condition that causes high blood pressure during the later stages of pregnancy.

"If you don't even start your prenatal care until 14 weeks' gestation, you've already lost the opportunity to start that preventive measure early in the pregnancy, at a time when it's probably most important," Hughes said.

"If this trend continues," Alfonso said, "I worry about kind of what that would mean for morbidity and mortality for our moms."

Advisory Board's maternal health resources

To help you address issues related to maternity care, Advisory Board offers a library of resources on women's health, which includes:

Trends in women's health

We have several resources on the top drivers of change in the maternal and reproductive health market, as well as the outlook for the women's health service line.

These ready-to-use-slides can also help you understand the trends impacting maternal and reproductive care and how they will impact cross-industry stakeholders.

How to improve women's health

To learn more about ways to improve women's health in the United States, this report outlines six key factors to take into consideration, including the roles of various healthcare stakeholders and the importance of cross-industry collaboration.

For resources related specifically to maternity care, this expert insight explains how early recovery after surgery protocols for C-sections can reduce patient length of stay for obstetrics, which can help with capacity constraints. In this white paper, we offer key tactics for launching a successful midwifery program and explain how to overcome common implementation challenges.

This expert commentary also outlines ways healthcare stakeholders can reduce maternity care deserts and improve pregnancy outcomes. Some examples include expanding outreach with mobile units/satellite clinics and using digital health to close gaps in maternity care. In addition, this report details on how health plans are taking steps to drive better outcomes for pregnant people.