Early prenatal care is not optional; it is critical for the health and well-being of mother and baby.
Yet, in 2023, nearly 1 in 5 pregnant women in the U.S. began care after the second trimester or didn’t receive it at all, according to the CDC. These numbers are worse for Black and Indigenous mothers, reflecting the racial disparities embedded in our healthcare system. For many women, this isn’t a choice but a failure of our healthcare system–one that puts lives at risk.
The consequences of delayed prenatal care are severe. Maternal mortality remains the highest among developed nations, and nearly 80% of those deaths are preventable. Closing the prenatal care gap is crucial to addressing this crisis.
The first trimester of pregnancy is critical for assessing fetal development, screening for anomalies, and monitoring the mother’s health. Delaying care means missing critical diagnoses, leaving conditions untreated, and increasing the risk of preterm birth or complications during delivery. Conditions such as gestational diabetes, preeclampsia, and high blood pressure are detectable and treatable, but only with early care. As more women give birth later in life and rates of chronic conditions increase, early monitoring becomes essential. Yet, for thousands of pregnant individuals each year, this care is out of reach.
Navigating America’s healthcare system can be daunting, especially when seeking something as essential as prenatal care. Complex insurance systems, endless appointment waitlists, and provider shortages contribute to a system where timely care seems more like a privilege than a right.
Many barriers are structural and systemic. One major obstacle is Medicaid, which covers nearly half of U.S. births, but often delays coverage. In many states, prenatal care isn’t automatically covered and requires an application process that can take up to 60 days, delaying first-trimester care. Additionally, the inconsistent expansion of Medicaid coverage under the Affordable Care Act has left some states with disproportionate rates of delayed access.
The growing shortage of healthcare providers, including OB/GYNS and midwives, exacerbates the crisis, especially in low-income and rural communities. Even in areas with ample providers, patients may wait weeks for their first appointment. Widespread facility closures in rural and underserved regions have created maternity care deserts. According to the 2024 March of Dimes Report, nearly 35% of U.S. counties lack obstetric providers or facilities. For many, accessing prenatal care requires traveling long distances, finding transportation, and taking time off work, all significant barriers.
Further exacerbating the issue, cuts to the CDC and public health programs under the Trump administration threaten surveillance systems, maternal health interventions, and access to community-based care. These cuts have left public health departments under-resourced and unable to sufficiently address the growing maternal health crisis.
Tackling this problem requires systemic changes. Expanding Medicaid to guarantee immediate prenatal coverage upon pregnancy detection without any bureaucratic hurdles is a necessary first step. Addressing the healthcare provider shortage requires implementing more doulas and midwives, particularly by incentivizing them to work in rural areas. Public health officials play a crucial role in educating the public about the importance of prenatal care and the benefits of starting care early, so they must be at the forefront of advocating for change.
As individuals, we can urge policymakers and insurance companies to implement these changes and support maternal health organizations that provide essential services and advocacy for prenatal care.
In a nation that spends an exorbitant amount of money and resources on healthcare each year, it’s unacceptable that anyone should have to delay or forgo prenatal care. And delaying care isn’t just dangerous, it’s expensive. Treatable conditions like preeclampsia or gestational diabetes, when left undetected, can require emergency interventions and increase the risk of preterm birth, leading to costly hospitalizations.
Prenatal care should not be treated as a luxury. It is a fundamental aspect of health care that protects the health of both mothers and infants. Until we address the systemic failures that prevent access, we will continue to see disproportionately high rates of preventable complications and deaths.
The health outcomes of mom and baby reflect the health of our nation. It’s time for us to demand better, because a country that truly values life ensures every mother and infant receives the care they deserve.
Ava Holland is a program manager at Varda 5 and is a women’s health researcher. She is currently a senior at Boston College studying Global Public Health.