Prenatal care visits have declined significantly across the United States, with the percentage of pregnant women receiving first trimester care dropping from 78.3% in 2021 to 75.5% in 2024, according to new data from the Centers for Disease Control and Prevention (CDC). Meanwhile, the share of women receiving very late or no prenatal care at all rose from 6.3% to 7.3% during the same period. This reversal of nearly a decade of progress is happening at a moment when maternity wards are closing, healthcare providers are stretched thin, and the U.S. already has the highest maternal mortality rate among wealthy nations .

Why Are Pregnant Women Delaying or Skipping Prenatal Care?

The decline in prenatal care isn't driven by a single cause. Instead, a combination of cultural shifts, misinformation, and structural failures in the healthcare system are converging to keep women away from their doctors. Linda Hanna, a registered nurse with more than 40 years of experience in maternal health and co-founder of Mahmee, a wraparound maternal health care company, traces the problem to multiple overlapping forces .

Since around 2015, skepticism of hospital-based obstetric care has grown as midwifery gained mainstream popularity. The COVID-19 pandemic accelerated this trend when women labored alone in hospitals, leaving many feeling isolated and distrustful of the medical system. Some women have since moved toward fully unassisted home births or "gentle birthing" approaches that bypass medical providers entirely. At the same time, social media has become saturated with voices presenting themselves as pregnancy experts without clinical training, spreading alarming messages about hospital interventions .

"Women are scared, and have absorbed messaging that medical providers will do things to them they don't want or are not ready for," explained Linda Hanna, Director of Care at Mahmee.

Linda Hanna, Director of Care at Mahmee

Beyond cultural factors, structural problems make accessing prenatal care increasingly difficult. Maternity care deserts are expanding as clinics close due to financial pressures. More than 35% of U.S. counties now lack a single birthing facility or obstetric provider, according to the March of Dimes. Cost barriers, insurance gaps, and lack of transportation prevent early access. Rural women are being funneled into overcrowded urban hospitals already stretched by high-risk cases, meaning they may not receive the individualized care they need .

Who Is Most Affected by the Prenatal Care Decline?

The CDC data reveals stark racial disparities in prenatal care access. The declines were steepest among Black, Native Hawaiian and Pacific Islander, and American Indian and Alaska Native women. In five states, more than one in ten pregnant women delayed or skipped care entirely. These disparities reflect a tangle of access and trust issues rooted in historical inequities and experiences with institutional bias. When communities lack consistent access to providers, confidence in the system erodes. When patients receive conflicting guidance from their doctors and their families or communities, the entire relationship with their care team can fracture .

What Conditions Are Being Missed When Women Skip Prenatal Visits?

The quiet danger of skipping prenatal care lies in the conditions that show no early symptoms. Many of the conditions that kill pregnant and postpartum women, such as hypertensive disorders and gestational diabetes, develop silently in their early stages. Without routine prenatal checkups, these life-threatening conditions go undetected until they become emergencies .

"Women are dying from exactly this: conditions that should have been caught and weren't, because they never came in for initial checkups," stated Linda Hanna.

Linda Hanna, Director of Care at Mahmee

Skipping prenatal visits doesn't just mean missing a weigh-in. It means missing the window to catch something that could become fatal. Early prenatal care allows healthcare providers to screen for complications, monitor fetal development, and intervene before problems escalate .

How Can Pregnant Women Access Better Prenatal Care?

• Build a Support Team: Work with your OB alongside doulas and mental health providers to create a comprehensive care network that addresses your physical, emotional, and informational needs throughout pregnancy.
• Ask Questions and Advocate: Ask your healthcare provider about their approach to birth preferences, interventions, and shared decision-making. A good provider should partner with you, listen to your concerns, and respect your choices.
• Support Accessible Care Models: Advocate for policies that expand maternal health coverage, push back against maternity ward closures in your area, and support community-based models like pop-up clinics that bring basic diagnostics to underserved areas.
• Seek Integrated Care Services: Look for healthcare systems that offer wraparound care combining nurses, doulas, lactation consultants, and mental health professionals working together rather than in silos.
• Understand Your Provider's Philosophy: Find a provider who frames medical interventions as tools to protect you and your baby, not as threats to your autonomy or birth preferences.

Hanna emphasizes that the answer to imperfect care isn't no care. It's better care. She points out that a good provider should partner with patients, listen to their concerns, and respect their birth preferences. When all those services are bundled together, problems get identified earlier and interventions happen faster. When mothers have to coordinate that patchwork on their own, many simply never receive the support they need .

What Does Research Show About Integrated Prenatal Care Models?

The data backs up what experts like Hanna describe about the power of coordinated care. Through wraparound care models that integrate multiple services, her team has seen a 55% lower preterm birth rate than the national average and a 20% lower cesarean section rate. Those outcomes held across both Medicaid and commercial patient populations, which suggests that continuous, coordinated care works regardless of income level .

For millennial and Gen Z mothers, Hanna's advice is practical and actionable. Prenatal care isn't a box to check on some medical to-do list. It's the system that catches the thing you didn't know was wrong before it becomes the thing no one can fix. Right now, too many women are falling outside of it, and the consequences are serious .