Why do we measure prenatal care?
Starting prenatal care in the first trimester helps prevent complications throughout pregnancy, is linked to a longer gestation period, and reduces the likelihood that a child will be born at a low birthweight.(1-3) Up to half of pregnancy-related deaths could be prevented with recommended prenatal care services that range from screening for birth defects to advice on pregnancy.(4,5)
Unfortunately, those who are at the highest risk of experiencing problems related to childbirth are often the least likely to receive adequate prenatal care.(6) These women are often younger, less educated, and/or are unintentionally pregnant.(2) Black women are less likely to receive adequate prenatal care compared to non-Black women due to systemic factors.(4)
How do we measure prenatal care?
This metric includes births for which prenatal care began in the first trimester of pregnancy.
Strengths of Metric
Limitations of Metric
Prenatal care helps determine if pregnant people are able to access care early during their pregnancies. Early initiation of care allows clinicians to identify risk factors for poor birth outcomes and facilitates intervention as needed.
The prenatal care metric does not take into consideration different cultural perceptions and expectations of pregnancy and prenatal care.(7)
The prenatal care metric evaluates when care was initiated, not the quality or frequency of care during pregnancy.
Prenatal care is calculated by the following formula:
Prenatal care = [Births receiving care within the first trimester]/Total live births x 100%
Prenatal care represents one component of the Kotelchuck Index.(8) This metric was calculated by aggregating estimates from smaller geographies to the congressional district level. For more information on the calculation, please refer to the Congressional District Health Dashboard Technical Document.
Estimates for this metric are from Natality Data from the National Vital Statistics System of the National Center for Health Statistics.
Stringer M, Ratcliffe SJ, Evans EC, Brown LP. The cost of prenatal care attendance and pregnancy outcomes in low-income working women. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN. 2005;34(5):551-560.
Wally MK, Huber LRB, Issel LM, Thompson ME. The Association Between Preconception Care Receipt and the Timeliness and Adequacy of Prenatal Care: An Examination of Multistate Data from Pregnancy Risk Assessment Monitoring System (PRAMS) 2009-2011. Maternal and child health journal. 2017.
National Institute of Child Health and Human Development. What is prenatal care and why is it important? https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care. Accessed January 12, 2018.
Gadson A, Akpovi E, Mehta PK. Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome. Seminars in Perinatology. 2017;41(5):308-317.
Centers for Disease Control and Prevention. Gateway to Health Communication & Social Marketing Practice: Pregnancy and Prenatal Care. https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/PregnancyPrenatalCare.html. Updated September 15, 2017. Accessed January 12, 2018.
Till SR, Everetts D, Haas DM. Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes. The Cochrane database of systematic reviews. 2015(12):Cd009916.
Higginbottom GM, Hadziabdic E, Yohani S, Paton P. Immigrant women's experience of maternity services in Canada: a meta-ethnography. Midwifery. 2014;30(5):544-559.
Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health. 1994;84(9):1414-1420.
Last updated: January 24, 2023