In 2018, it was found that a million women in the United States did not receive adequate prenatal care, which was defined as attending 80 percent of the recommended prenatal care visits or beginning prenatal care during the first trimester.[25] Transportation is one of the biggest threats to prenatal care access, making it hard for pregnant people in rural communities to have access to proper prenatal care. Specifically, over half of the people in rural areas who are seeking prenatal care have to travel at least 30 minutes to receive care, and there are higher rates of clinic closures in rural areas. Because of Telemedicine, the gap in care due to transportation issues has been reduced.
Telemedicine
A new alternative for some of the routine prenatal care visits is Telemedicine, which is an online route of performing these prenatal appointments, and became more of a standardized practice due to the COVID pandemic.[26] Specifically, over half of pregnant women were afraid of stepping foot inside a hospital because of the risk of contracting the virus, so Telemedicine offered a way of communication that was not face to face, but would still get people the care they required.[26] In depth obstetric examinations and blood work are not possible through Telemedicine, but other appointment tasks are possible, such as using personal devices to detect fetal heart rate, conducting maternal mental health consults, and general sharing of information between provider and patient.[26] Overall, Telemedicine is seen as an improvement in prenatal care because it offers the potential for higher accessibility of care to marginalized groups.[25] However, it does tend to be younger, White patients who utilize Telemedicine because of their increased access to and familiarity with technology.[25]
Racial Health Disparities
Main article: Racial health disparities
Racial differences are also prevalent in prenatal care, especially because there is a trend of reduced funding for Black and Hispanic communities.[25] All racial minorities also experience higher levels of perinatal mortality, especially Black individuals.[27] Racial minorities are also more likely to have high-risk pregnancies and conditions such as preeclampsia, gestational diabetes, and gestational hypertension.[27] Because race and class are very heavily intertwined, there is a complex relationship between race and preterm birth risks that cannot be simplified into a specific cause.[28] However, pregnant Black women who encounter racism end up having physiological changes in their amniotic fluid and alterations in immune and endocrine mechanisms.[28] Women of color are less likely to access prenatal care within the first trimester than white women, along with Black women having the least amount of access to prenatal care out of all racial minorities.[29]
Class-based Health Disparities
The World Health Organization (WHO) reported that in 2015, around 830 women died every day from problems in pregnancy and childbirth.[30] Only 5 lived in high-income countries, and the rest lived in low-income countries.[30] A study examined the differences in early and low-weight birth deliveries between local and immigrant women and saw that the difference was caused by receiving prenatal care.[31] The study, between 1997 and 2008, looked at 21,708 women giving birth in a region of Spain. The results indicated that very preterm birth (VPTB) and very low birth weight (VLBW) were much more common for immigrants than locals.[31] The study showed the importance of prenatal care and how universal prenatal care would help people of all origins get proper care before pregnancy/birth.[31]
Increasing Access
There are many ways of changing health systems to help women access antenatal care, such as new health policies, educating health workers, and health service reorganization.[32] Community interventions to help people change their behavior can also play a part. Examples of interventions are media campaigns reaching many people, enabling communities to take control of their health, informative-education-communication interventions, and financial incentives.[32] A review looking at these interventions found that one intervention helps improve the number of women receiving antenatal care.[32] However, interventions used together may reduce baby deaths in pregnancy and early life, lower the number of low birth weight babies born, and improve the number of women receiving antenatal care.[32]
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