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Why This Topic Is Important
High-quality health care before, during, and after pregnancy promotes the long-term health of both parent and child and reduces serious health risks including infant death (1, 2, 3). Experts increasingly are focused on promoting health before conception, as many pregnancies are unintended and a pregnant person may not realize they are pregnant during the critical first weeks of their baby's development (1, 2, 3). Preconception care should be part of routine health care and should cover reproductive planning, address medical conditions and pregnancy risk factors such as weight or heart problems, link patients to services for issues such as substance abuse or mental health problems, and provide guidance about important habits in case of pregnancy (2, 3, 4).

Once a person becomes pregnant, receiving prenatal care in the first trimester is critical as it lowers the risk of adverse birth outcomes (1). Through prenatal care, health professionals can identify and resolve medical problems, connect patients to services for non-medical issues, and provide general health education (2, 4). Prenatal care also helps to ensure that the pregnant person receives needed vaccinations, which can protect themselves and their baby from certain infections (1, 5).

Inequities in access to prenatal care by race/ethnicity and other demographic factors have persisted for decades, with the greatest burden of poor maternal and infant outcomes experienced by African American/black and American Indian/Alaska Native families (2, 6). Reducing these disparities and improving access to preconception, prenatal, and postpartum care for all people of reproductive age has long been a U.S. public health priority. The federal Healthy People 2030 initiative has set national objectives to improve access to prenatal care and improve health before, during, and after pregnancy (1).
Find more information on this topic in kidsdata.org’s Research & Links section.

Sources for this narrative:

1.  U.S. Department of Health and Human Services. (n.d.). Healthy People 2030: Pregnancy and childbirth. Retrieved from: https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth

2.  National Academies of Sciences, Engineering, and Medicine. (2020). Birth settings in America: Outcomes, quality, access, and choice. National Academies Press. Retrieved from: https://nap.nationalacademies.org/catalog/25636/birth-settings-in-america-outcomes-quality-access-and-choice

3.  Verbiest, S., et al. (2016). Advancing preconception health in the United States: Strategies for change. Upsala Journal of Medical Sciences, 121(4), 222-226. Retrieved from: https://www.tandfonline.com/doi/full/10.1080/03009734.2016.1204395

4.  Scott, K. A., et al. (2019). The ethics of perinatal care for black women: Dismantling the structural racism in “mother blame” narratives. Journal of Perinatal and Neonatal Nursing, 33(2), 108-115. Retrieved from: https://journals.lww.com/jpnnjournal/fulltext/2019/04000/.5.aspx

5.  March of Dimes. (2021). Vaccinations and pregnancy. Retrieved from: https://www.marchofdimes.org/pregnancy/vaccinations-and-pregnancy.aspx

6.  As cited on kidsdata.org, Births to mothers receiving first trimester prenatal care, by race/ethnicity. (2022). Centers for Disease Control and Prevention.
Policy Implications
Substantial evidence indicates that quality health care before, during, and after pregnancy can improve maternal and infant health outcomes (1, 2). While the U.S. has made progress in maternal and child health in recent years—through provisions for pregnant and reproductive-age people in the Affordable Care Act and other public health efforts—it still trails behind other high-resource countries in maternal and infant mortality rates (1). California fares better than the nation as a whole on many key measures of birth outcomes, e.g., infant and maternal mortality, preterm births, and low birthweight (3, 4, 5). However, much room for improvement exists in California, particularly in addressing inequities in health outcomes and access to care by race/ethnicity and other demographic factors (4, 5, 6). Statewide and nationally, African American/black and American Indian/Alaska Native mothers experience disproportionately high rates of adverse pregnancy and birth outcomes (1, 5, 6, 7).

Policymakers have a role in helping to ensure that all people of reproductive age have access to continuous, affordable, comprehensive, culturally-informed health care before conception and during and after pregnancy (1, 8). It is especially important to safeguard recent policy gains, while continuing to transform health care systems and practices to advance equitable access to high-quality care. In particular, leaders across multiple sectors—providers, administrators, educators, advocates, decisionmakers, and others—must target structural racism to improve pregnancy outcomes for families of color (1, 5, 6, 9).

Policy and program options that could improve timely access to quality prenatal care, as well as care before and after pregnancy, include:
  • Supporting public education campaigns to increase awareness of the importance of preconception health, life planning, and the need to receive regular health care before, during, and after pregnancies; such campaigns should include information on how to access health care and other resources, and should use a variety of methods to reach different age and racial/ethnic groups at all income levels (8)
  • Raising awareness among leaders and health care professionals about what preconception health care entails and how it can improve population health while reducing costs (8)
  • Supporting recruitment of health care professionals from diverse racial, cultural, and linguistic communities and expanding education and training for providers to adequately address social and structural determinants of preconception and prenatal health (1, 7, 8, 9)
  • Increasing awareness across sectors about maternal and child health inequities by race/ethnicity and other factors, the effects of practitioner bias, and how to improve health care delivery (1, 7, 9)
  • Promoting evidence-based prenatal care programs and initiatives—such as group care models and mental health service integration—to reduce racial/ethnic disparities in pregnancy outcomes (1, 7)
  • Maintaining and strengthening insurance coverage benefits for preconception care, maternity care, and support services such as home-visiting programs, especially for immigrants and lower-income groups; also, continuing efforts to improve insurance enrollment and renewal processes (1, 10)
  • Advancing efforts to incorporate preconception care into routine health care; also, supporting research to identify and apply best practices to reduce structural and cultural barriers to care (1, 8)
For more on this topic, see kidsdata.org’s Research & Links section or visit the American College of Obstetricians and Gynecologists and Before, Between and Beyond Pregnancy. Also see Policy Implications on kidsdata.org for Health Care, Low Birthweight and Preterm Births, and Infant Mortality.

Sources for this narrative:

1.  National Academies of Sciences, Engineering, and Medicine. (2020). Birth settings in America: Outcomes, quality, access, and choice. National Academies Press. Retrieved from: https://nap.nationalacademies.org/catalog/25636/birth-settings-in-america-outcomes-quality-access-and-choice

2.  U.S. Department of Health and Human Services. (n.d.). Healthy People 2030: Pregnancy and childbirth. Retrieved from: https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth

3.  As cited on kidsdata.org, (i) Infant mortality per year; (ii) Infants born at low birthweight; (iii) Preterm births. (2022). California Department of Public Health & Centers for Disease Control and Prevention.

4.  Joynt, J. (2020). Quality of care: Maternal health and childbirth. California Health Care Foundation. Retrieved from: https://www.chcf.org/publication/2020-edition-quality-of-care-maternal-health-and-childbirth

5.  California Department of Public Health, Maternal, Child and Adolescent Health Division. (2021). CA-PMSS surveillance report: Pregnancy-related deaths in California, 2008-2016. Retrieved from: https://www.cdph.ca.gov/Programs/CFH/DMCAH/Pages/CA-PMSS.aspx

6.  California Department of Public Health, Maternal, Child and Adolescent Health Division. (2019). California American Indian/Alaska Native maternal and infant health status report. Retrieved from: https://www.cdph.ca.gov/Programs/CFH/DMCAH/MIHA/CDPH%20Document%20Library/AIAN-MIH-Status-Report-2019.pdf

7.  Scott, K. A., et al. (2019). The ethics of perinatal care for black women: Dismantling the structural racism in “mother blame” narratives. Journal of Perinatal and Neonatal Nursing, 33(2), 108-115. Retrieved from: https://journals.lww.com/jpnnjournal/fulltext/2019/04000/.5.aspx

8.  Verbiest, S., et al. (2016). Advancing preconception health in the United States: Strategies for change. Upsala Journal of Medical Sciences, 121(4), 222-226. Retrieved from: https://www.tandfonline.com/doi/full/10.1080/03009734.2016.1204395

9.  Julian, Z., et al. (2020). Community-informed models of perinatal and reproductive health services provision: A justice-centered paradigm toward equity among black birthing communities. Seminars in Perinatology, 44(5), 151267. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0146000520300483

10.  Kaiser Family Foundation (2022). Medicaid/CHIP coverage of lawfully-residing immigrant children and pregnant women. Retrieved from: https://www.kff.org/health-reform/state-indicator/medicaid-chip-coverage-of-lawfully-residing-immigrant-children-and-pregnant-women
How Children Are Faring
Among California infants born in 2021, 87% had mothers who received prenatal care during the first three months of pregnancy—the highest rate recorded since the early 2000s. At the local level, the share of infants born to mothers receiving first trimester prenatal care varies widely; across counties with data for 2021, percentages ranged from less than 60% to more than 90%.

Statewide and nationally, infants born to Asian and white mothers have the highest rates of timely prenatal care among groups with data, whereas infants born to African American/black, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander mothers have the lowest. In 2020, fewer than 80% of infants born to California African American/black mothers and fewer than 70% born to American Indian/Alaska Native mothers received first trimester prenatal care; this compared with nearly 90% for their white and Asian counterparts.