Pregnancy should be a time of joy, of anticipation.
Yet recent statistics reveal a troubling trend that shakes the very foundation of maternal health.
In a worrisome report from the Centers for Disease Control and Prevention, we see a notable decline in prenatal care across the nation.
The percentage of pregnant women receiving first trimester care dropped from 78.3% in 2021 to 75.5% in 2024.
Meanwhile, the number of women who receive little to no prenatal care increased from 6.3% to 7.3%. This decline is especially pronounced among Black, Native Hawaiian, Pacific Islander, American Indian, and Alaska Native communities. In five states, over ten percent of pregnant women are now missing care altogether.
This shift is not a mere statistical anomaly; it marks the unraveling of nearly a decade’s worth of progress.
As maternity wards close and healthcare providers become increasingly overwhelmed, the U.S. continues holding the unfortunate title of having the highest maternal mortality rate among wealthy nations.
To better understand this alarming situation, we spoke with Linda Hanna, RN, a nurse with over four decades of experience in maternal health. Linda has significantly contributed to maternity and lactation programs at Kaiser Permanente and Cedars-Sinai. Currently, she is the co-founder and Director of Care at Mahmee, a company dedicated to holistic maternal health care. Throughout her career, she has witnessed firsthand this escalating crisis and offered candid insights on its underlying issues.
Reasons for Skipping Prenatal Care
Linda observes, “The rise in the number of women who delay or skip prenatal care indicates a breakdown of the entire health system.” What surprises her the most isn’t the trend itself, but its rapid escalation.
“Fear and misinformation have always played a role in care decisions,” she explains. “But I don’t think anyone anticipated it would spiral so quickly.”
She attributes this phenomenon to a mix of long-standing cultural shifts and recent events. Since around 2015, midwifery gained traction, resulting in skepticism toward traditional hospital-based obstetric care. Then, the pandemic intensified these sentiments.
During COVID, many women faced laboring alone in hospitals, an experience that undoubtedly left lingering anxiety. Consequently, some mothers are opting for home births or “gentle birthing” practices that entirely sidestep the medical system.
On top of this, social media platforms are overflowing with self-proclaimed pregnancy experts who lack professional qualifications.
Linda notes a “perfect storm of fear and misinformation” as pregnant women absorb alarming messages regarding medical interventions.
“Women are scared,” she states. “They’ve internalized messages suggesting that medical providers may impose unwanted interventions.”
Even well-meaning birth workers can unintentionally heighten anxiety by framing necessary interventions as threats instead of supportive options.
Access Barriers and Maternity Care Deserts
Compounding these fears are the structural issues amplifying the crisis. Maternity care deserts are expanding as financial pressures force clinics to close.
More than 35% of U.S. counties now lack any birthing facility or obstetric provider, according to reports from the March of Dimes.
Cost barriers and insurance gaps further restrict access to timely care. Consequently, rural women often find themselves referred to overcrowded urban hospitals already struggling with high-risk cases.
Linda elaborates, “A healthy, low-risk mother from a rural area now faces influx into a city hospital overwhelmed with challenges. This often means she doesn’t get the support she needs.”
The racial disparities depicted in the CDC data reveal a complex web of access issues and trust, incredibly challenging to unravel.
Historical inequities and instances of institutional bias drive some patients to seek alternative information sources. When communities lack regular access to qualified providers, confidence in the healthcare system declines.
Conflicting guidance from healthcare professionals and the surrounding community often fractures the patient-provider relationship.
What worries Linda the most is the quiet peril.
Many conditions that jeopardize the lives of pregnant and postpartum women, such as hypertensive disorders and gestational diabetes, often start symptom-free.
“Women are indeed dying from preventable conditions that should have been identified early,” she explains, “because they haven’t made it to their initial checkups.”
Neglecting prenatal visits can lead to missed opportunities for critical interventions, potentially resulting in devastating outcomes.
Envisioning Comprehensive Prenatal Care
Linda’s message is clear for anyone who has yet to schedule prenatal care: “Prenatal appointments are designed to safeguard your health and that of your baby, not to restrict your autonomy in any manner.”
She stresses that a good provider will partner with patients, actively listen to their concerns, and honor their birth preferences.
Her approach to the difficulties in the system isn’t about avoiding care altogether. Instead, it advocates for improved quality of care.
She envisions a model that integrates teams of nurses, doulas, lactation consultants, and mental health professionals collaborating efficiently.
It should encompass community-based models, pop-up clinics delivering essential services to underserved regions, complemented by virtual care options. This bundled approach enables the identification of issues earlier, allowing for timely interventions.
When mothers are left to navigate this intricate web independently, many simply won’t receive the necessary support.
Evidence supports Linda’s view. Through their comprehensive care models, her team has observed a 55% reduction in preterm birth rates, along with a 20% drop in C-section rates. These positive outcomes span Medicaid and commercial patient populations, suggesting effective care delivery regardless of income circumstances.
Empowering Moms Today
For the millennial and Gen Z moms who constitute a significant portion of this community, Linda has practical advice: ask questions, establish a support network that includes doulas and mental health professionals alongside your OB, and advocate for accessible prenatal clinics in your area.
Push back against local maternity ward closures and support policies promoting maternal health coverage and provider accessibility.
These struggles aren’t abstract; they represent the very framework that ensures family well-being.
Ultimately, prenatal care transcends being just another item on a medical checklist.
It serves as the crucial safety net that detects problems before they reach a point of no return.
Right now, too many women are falling through the cracks.
