A new report from the Centers for Disease Control and Prevention (CDC) offers a look at concerning new trends in prenatal care access. From 2021-2024, prenatal care initiated during the first trimester of pregnancy declined, while those receiving care later or no prenatal care increased, as shown below. The share of pregnant women who received late or no prenatal care at all increased in every age and race and ethnicity group and in thirty-six states and Washington, D.C.
The Numbers Are Moving in the Wrong Direction
After several years of gradual improvement (from 77.1% in 2016 to 78.3% in 2021), the share of women receiving prenatal care in their first trimester began moving in the wrong direction, dropping to 75.5% in 2024. Mothers younger than age 20 (-8%) and Native Hawaiian or Other Pacific Islander (-8%), Black (-7%), and Hispanic (-6%) mothers experienced the greatest declines, but early prenatal care dropped among every maternal age group and every racial and ethnic group.
Additionally, stark racial disparities remain evident. More than 8 in 10 White and Asian mothers received care in their first trimester, compared to about 64-68% of American Indian and Alaska Native, Black, and Hispanic mothers and fewer than half of Native Hawaiian or Other Pacific Islander mothers.
From 2021-2024, the share of pregnant women receiving late or no prenatal care increased by 25% or more in 11 states (Colorado, Florida, Maine, New York, Illinois, District of Columbia, Vermont, Georgia, Missouri, Rhode Island, Massachusetts, and Utah). By 2024, at least 1 in 10 mothers in Florida, Georgia, Hawaii, New Mexico, Texas, and the District of Columbia received late or no prenatal care at all.
The CDC report does not break down these results by source of health insurance coverage, but recent data from the Centers for Medicare & Medicaid Services’ (CMS) Child and Adult Core Set show similar trends for pregnant women enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The median rate of timely prenatal care (in the first trimester, or on, before, or within 42 days of enrollment) declined from about 82% in 2021 to 80% in 2023. In 2024, a median rate of 64% of women under 21 and 72% of women 21 and over received timely care. (The “timely prenatal care” measure was voluntary in 2021-2023; 48 states reported data. In 2024, a new prenatal care measure was added that was mandatory for states to report in the Child Core Set for women under 21 but still voluntary to report as part of the Adult Core Set for women 21 and older.)
A Glance at Florida, Virginia and New Hampshire
While the U.S. has improved Medicaid coverage for pregnant women in recent years—especially through state Medicaid expansions—improving access to care requires a much more comprehensive look under the hood of Medicaid MCO contracts and provider access, as our CCF team detailed in a 12-state scan in 2023. Health coverage itself is essential, but not sufficient to ensure access to quality care. A look at three states illustrates the need for health system reforms across all insurance types.
Florida, a non-expansion state, is tied for the third-highest rate in the country of pregnant women receiving late or no prenatal care (11.4%), after rising 25% from 2021 to 2024. According to data from the March of Dimes, nearly 1 in 4 women (23.8%) do not receive adequate prenatal care in the state, and rates for Pacific Islander (36.7%) and (32.8%) Black women are substantially higher. Florida also scored a D+ on the March of Dimes report card for preterm birth. While the state’s overall preterm birth rate was 10.7% as of 2024, rates were much higher for Black women (14.9%).
Some may look at Florida and think the state’s decision not to expand Medicaid to cover more low-income women before they get pregnant is a major factor. We know expansion has been linked to improved maternal health and birth outcomes. But it’s only one piece of the story– coverage itself does not translate to immediate access. In 2023, Virginia’s Department of Medical Assistance Services launched a secret shopper survey to test whether people enrolled in Medicaid could actually get prenatal appointments through the state’s managed care organizations (MCOs) provider directories. Results were disappointing but illustrative: investigators found disconnected phone numbers, excessive hold times, providers listed in directories who didn’t actually offer prenatal care, and OB-GYNs who weren’t accepting new patients, and more than 95% of calls seeking prenatal care did not result in an available appointment. These kinds of surveys are key to understanding the extent to which MCOs are active in their provider outreach and communications to patients and offer states a way to identify where to make changes.
New Hampshire is one of the six states where the CDC report showed that the share of pregnant women accessing prenatal care late or not at all had decreased. New Hampshire has been a leader in prenatal care for many years. The state received an A- from the March of Dimes state report card and ranks first in the country for preterm birth (7.9%). The state’s External Quality Review Organization (EQRO) report from 2024 details the HEDIS performance measure for Timeliness of Prenatal Care by MCO, all of which exceeded the U.S. average of 75.5% of women accessing timely prenatal care – AmeriHealth Caritas (76.34%), NH Healthy Families (91.24%), and WellSense (86.19%). In New Hampshire, both certified nurse-midwives and certified professional midwives (non-nurse midwives) are allowed to bill Medicaid, offering another avenue for women to pursue prenatal care through midwifery. Despite New Hampshire’s progress, marketed racial disparities in the state remain: Black women experience preterm birth at a rate that is 38% higher than White women. Every state has much work to do.
Why Prenatal Care Matters
Prenatal care is critical, not optional. Early prenatal care allows health practitioners a chance to provide medical care, screenings, physical exams, and ultrasounds to make sure that both the fetus and mother are healthy. When prenatal care is delayed or not received, medical problems could go undetected or untreated and develop into emergencies during labor, delivery, or the postpartum period. Babies of mothers who do not get prenatal care are three times more likely to be born with a low birth weight and five times more likely to die. There is also a steep economic cost of delaying prenatal care or not receiving prenatal care at all. Pregnancy complications like preterm birth cost about $25 billion a year or $65,000 per preterm birth. Early prenatal care initiation can lead to better birth outcomes.
Florida and Virginia are illustrative examples—we know the system is failing pregnant people in every state, through a combination of hospital closures, provider shortages, insurance bureaucracy, and inadequate policy responses. The CDC data indicate that the period from 2016 to 2021 had been one of genuine improvement — proof that progress is possible. But for every percentage point that late or no prenatal care rises, real families face higher risks of preterm birth, maternal mortality, and infant death. Reversing this trend will require more than awareness — it will require meaningful investment in access, accountability from insurers, and policies that treat prenatal care as the essential, life-saving service it is.