Nearly 1 in 4 pregnant women are skipping early prenatal care. A veteran nurse explains why that should worry all of us.
For years, the numbers were moving in the right direction. More pregnant women were getting into a doctor’s office early, more complications were being caught before they became emergencies, and the conversation around maternal health was finally getting the attention it deserved.
That progress just reversed.
A new report from the Centers for Disease Control and Prevention reveals a sharp prenatal care decline across the country. The share of pregnant women receiving first trimester prenatal care dropped from 78.3% in 2021 to 75.5% in 2024. Meanwhile, the percentage of women receiving very late or no prenatal care at all rose from 6.3% to 7.3% during the same period. 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.
This is not a minor statistical wobble. It’s a reversal of nearly a decade of gains, and it comes at a moment when maternity wards are closing, providers are stretched thin, and the U.S. already has the highest maternal mortality rate among wealthy nations.
We reached out to Linda Hanna, RN, a registered nurse with more than 40 years of experience in maternal health, to help make sense of what’s going on. Linda helped build the maternity and lactation programs at Kaiser Permanente and Cedars-Sinai, and is now the co-founder and Director of Care at Mahmee, a wraparound maternal health care company. She has spent her career on the front lines of this exact crisis, and she did not sugarcoat what she’s seeing.
Why are pregnant women skipping prenatal care?
“The number of women receiving no prenatal care at all now, or delayed care, signals a breakdown in the entire system,” Hanna tells Motherly. She isn’t shocked by the direction of the trend. What caught her off guard is the speed. “I had known previously that fear and misinformation appeared to be influencing care decisions,” she says, “but I think no one expects that this would lead to such a drastic change.”
Hanna traces it to a confluence of forces that have been building for years. There’s been a cultural shift since roughly 2015, she explains, when midwifery gained mainstream popularity and skepticism of hospital-based obstetric care began to take root. COVID accelerated things. Women labored alone in hospitals during the pandemic, and the isolation left a mark. Some women have since moved toward fully unassisted home births or “gentle birthing” approaches that bypass the medical system entirely.
At the same time, social media has become saturated with voices who present themselves as pregnancy experts but lack clinical training. Linda describes a “perfect storm of fear and misinformation” in which pregnant women absorb alarming messaging about hospital interventions. “Women are scared,” she says, “and have absorbed messaging that medical providers will do things to them they don’t want or are not ready for.” She points out that even well-meaning birth workers can inadvertently stoke anxiety by framing interventions as threats rather than tools.
Maternity care deserts and the access crisis
And then there are the structural failures that make all of this worse. 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 and insurance gaps prevent early access. Rural women are being funneled into overcrowded urban hospitals already stretched by high-risk cases. “A healthy, low-risk mom from a rural area now gets funneled into an overcrowded city hospital that is already stretched to its limits,” Hanna says. “That could mean she doesn’t get the care she needs.”
The racial disparities in the CDC data point to a tangle of access and trust that’s nearly impossible to pull apart. Hanna acknowledges that historical inequities and experiences with institutional bias have pushed some patients toward alternative sources of information. When communities lack consistent access to providers, she says, confidence in the system erodes. And when patients receive conflicting guidance from their doctors and their families or communities, the entire relationship with their care team can fracture.
What keeps Linda up at night is the quiet danger. Many of the conditions that kill pregnant and postpartum women, like hypertensive disorders and gestational diabetes, show no symptoms in their early stages. “Women are dying from exactly this: conditions that should have been caught and weren’t, because they never came in for initial checkups,” she offers. Skipping prenatal visits doesn’t just mean missing a weigh-in. It means missing the window to catch something that could become fatal.
What wraparound prenatal care actually looks like
Hanna is direct in her message to any pregnant person who hasn’t yet made that first appointment: “Prenatal care is about protecting you and your baby, not controlling you or taking away your rights in any way.” She emphasizes that a good provider should partner with patients, listen to their concerns, and respect their birth preferences. The answer to imperfect care, she said, isn’t no care. It’s better care.
That better care, she argues, needs to look different than what most of us experienced during our own pregnancies. It means integrated teams of nurses, doulas, lactation consultants, and mental health professionals who work together rather than in silos. It means community-based models, pop-up clinics that bring basic diagnostics to underserved areas, and virtual options that keep women connected to their providers between visits. When all of those services are bundled, she explains, problems get identified earlier and interventions happen faster. When moms have to coordinate that patchwork on their own, many simply never receive the support they need.
The data backs up what Hanna describes. Through wraparound care models, her team has seen a 55% lower preterm birth rate than the national average and a 20% lower C-section rate. Those outcomes held across both Medicaid and commercial patient populations, which suggests that continuous, coordinated care works regardless of income level.
What moms can do right now
For the millennial and Gen Z moms who make up so much of this community, Hanna’s advice is practical: ask questions, build a support team that includes doulas and mental health providers alongside your OB, advocate for accessible prenatal clinics in your area, and push back when local maternity wards face closure. Support policies that expand maternal health coverage and provider access. These aren’t abstract fights. They’re the infrastructure that keeps families safe.
Because that’s really what this comes down to. 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. And right now, too many women are falling outside of it.
source https://www.mother.ly/health-wellness/prenatal-care-decline/
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