For years, the numbers in prenatal care showed encouraging trends. More pregnant women were consulting their doctors early, ensuring complications were identified before escalating into emergencies. The conversation surrounding maternal health finally gained the recognition it sorely needed.
However, that progress has taken a significant turn for the worse.
A recent report from the Centers for Disease Control and Prevention highlights a troubling decline in prenatal care across the nation. The percentage of pregnant women receiving first trimester prenatal care has fallen from 78.3% in 2021 to 75.5% in 2024. Simultaneously, the number of women who are either late to initiate care or forgo it entirely has increased from 6.3% to 7.3% over the same timeframe. The most affected groups include Black, Native Hawaiian and Pacific Islander, and American Indian and Alaska Native women, with more than one in ten pregnant women in five states delaying or skipping care altogether.
This isn’t just a minor fluctuation in statistics. It represents a reversal of nearly a decade’s worth of advancements, occurring at a time when maternity wards are closing, healthcare providers are overburdened, and the U.S. already has the highest maternal mortality rate among wealthy nations.
To help make sense of this alarming situation, we consulted Linda Hanna, RN, a seasoned registered nurse with over 40 years in maternal health. Linda has played a significant role in developing maternity and lactation programs at renowned institutions like Kaiser Permanente and Cedars-Sinai. Now, as the co-founder and Director of Care at Mahmee, a comprehensive maternal health care organization, she is deeply aware of the root causes driving these alarming trends.
Understanding the Decline in Prenatal Visits
“The growing number of women receiving no prenatal care or experiencing delays signifies a breakdown in the entire healthcare system,” Hanna tells Motherly. She’s not surprised by the trend’s direction, but the pace of change is startling. “I recognized that fear and misinformation were impacting care decisions,” she explains, “but the extent of this downward shift was unexpected.”
Hanna traces the issue to a mix of factors that have developed over the years. A cultural shift began around 2015, as midwifery gained popularity, and skepticism toward conventional hospital-based obstetric care began to rise. The pandemic intensified these sentiments; many women faced solitude during labor, creating lasting emotional impacts. Some have opted for entirely unassisted home births or “gentle birthing” methods, steering clear of the medical system altogether.
At the same time, social media has become a mixed bag of information, filled with individuals who present themselves as pregnancy authorities without clinical qualifications. Hanna describes this environment as a “perfect storm of fear and misinformation” that leads pregnant women to internalize troubling messages about hospital interventions. “Women are scared,” she notes, adding that they often perceive medical providers as a threat rather than allies.
The Maternity Care Crisis: Access and Availability
This situation is compounded by structural issues that exacerbate the crisis. Maternity care deserts are proliferating as clinics shut down due to economic strains. According to the March of Dimes, over 35% of U.S. counties lack a single birthing facility or obstetric provider. Cost barriers and gaps in insurance hinder early access to care. Rural women, in particular, are often routed to overcrowded urban hospitals that are already at capacity. “A healthy, low-risk mom from a rural area may end up in an overcrowded city hospital that can’t adequately support her needs,” Hanna warns. “This might prevent her from receiving crucial care.”
The racial disparities reflected in the CDC data illustrate a complex interplay of access and trust that is difficult to navigate. Hanna acknowledges that historical marginalization and experiences of bias have driven some patients to seek alternative information sources. When healthcare accessibility is inconsistent, trust in the system deteriorates. Conflicting guidance from healthcare providers and personal networks can fracture relationships between patients and their care teams.
What troubles Hanna most is the silent risk. Many dangerous conditions affecting pregnant and postpartum women, such as hypertension and gestational diabetes, often don’t present symptoms initially. “Women are dying from conditions that should have been detected,” she explains, “because they skipped those vital initial consultations.” Missing prenatal visits is more than just overlooking a routine checkup; it can mean missing the opportunity to identify potentially life-threatening issues.
Defining Wraparound Prenatal Care
Hanna’s message to expectant individuals who have yet to schedule that first appointment is clear: “Prenatal care is meant to safeguard you and your baby, not to control your choices or compromise your rights.” She emphasizes that a reputable provider should partner with patients, genuinely hear their concerns, and respect their birth choices. The solution to inadequate care is not to avoid it altogether, but to seek improved care.
Better care, Hanna argues, must look different than the traditional models many experienced during their pregnancies. It should involve integrated care teams made up of nurses, doulas, lactation specialists, and mental health professionals collaborating rather than working in isolation. Community-based initiatives, mobile clinics that deliver essential diagnostics to underserved areas, and virtual care opportunities can help keep expectant mothers connected with their providers between visits. When these services are bundled, problems can be identified earlier, allowing for timely interventions. Many mothers struggle to coordinate these services on their own, resulting in missed opportunities for support.
Data supports Hanna’s observations. In programs utilizing wraparound care, her team has achieved a 55% lower preterm birth rate compared to the national average, along with a 20% reduction in C-section rates. These outcomes remain consistent across both Medicaid and private patient populations, suggesting that continuous, coordinated care can be effective, regardless of financial status.
Taking Action: What Moms Can Do Now
For millennial and Gen Z moms who form a significant portion of this community, Hanna’s advice is straightforward: inquire and advocate. Build a support network that includes doulas and mental health professionals alongside your OB, advocate for accessible prenatal clinics in your area, and resist closures at local maternity wards. Support initiatives aimed at expanding maternal health coverage and improving provider access. These issues are not abstract; they are the foundational infrastructure for family safety and well-being.
This all boils down to a crucial truth. Prenatal care isn’t merely a task to check off a list. It’s the essential safety net that identifies issues before they become unmanageable. At this moment, far too many women are slipping through the cracks.
