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United States
Early Prenatal Care
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Early Prenatal Care is the percentage of pregnant women who receive care within the first trimester of pregnancy and was revised in the 2010 Edition. Early prenatal care is derived directly from the birth certificate. In 2003, CDC’s National Center for Health Statistics (NCHS) introduced a revised live birth certificate, however implementation of the new certificate has not occurred across all 50 states. Because states are using different versions of the birth certificate, a state-to-state direct comparison of prenatal care measures cannot be made, and a national average cannot be calculated. Therefore, the prenatal care measure only compares one state to another state using the same birth certificate and their scores are calculated based upon their peer group. Early prenatal care is not adjusted for frequency of care, continuation of care, age or race. Ranks are based on the most recently available data from the National Center for Health Statistics, three years prior to the publication date. Prior to the 2010 Edition, a broader definition of prenatal care was used that included frequency and timeliness of prenatal care throughout the pregnancy. The 1990 through 2004 Editions of the report defined Prenatal Care using the Kessner Index and 2005 through 2009 Editions used the Kotelchuck (APCNU) index.

Prenatal care is a critical component of health care for pregnant women and a key step towards having a healthy pregnancy and baby. Early prenatal care is especially important because many important developments take place during the first trimester, screenings can identify babies or mothers at risk for complications and health care providers can educate and prepare mothers for pregnancy.  Women who receive prenatal care have consistently shown better outcomes than those who did not receive prenatal care[1]. Mothers who do not receive any prenatal care are three times more likely to deliver a low birth weight baby than mothers who received prenatal care, and infant mortality is five times higher[2].  Early prenatal care also allows health care providers to identify and address health conditions and behaviors that may reduce the likelihood of a healthy birth, such as smoking and drug and alcohol abuse.

[1] Berg CJ. Pregnancy-related mortality in the united states, 1998 to 2005. Obstet Gynecol. 2010;116(6):1302. 

[2] Berg CJ. Pregnancy-related mortality in the united states, 1998 to 2005. Obstet Gynecol. 2010;116(6):1302. 


USA Prenatal Care (1990-2011) see more
  • Percentage of pregnant women receiving adequate prenatal care, as defined by Kessner Index.
  • Percentage of pregnant women receiving adequate prenatal care, as defined by Kotelchuck’s Adequacy of Prenatal Care Utilization (APNCU) Index.
  • Percentage of pregnant women receiving prenatal care during the first trimester.

The measures tracked by America's Health Rankings are those actions that can affect the future health of the population. For a state to improve the health of its population, efforts must focus on these measures, these determinants of health.


State Changes
Over Time
Rank Value Take Action
Alabama graph 44 78.7 View Actions
Alaska graph 39 79.7 View Actions
Arizona graph 41 79.5 View Actions
Arkansas graph 43 78.9 View Actions
California graph 3 80.2 View Actions
Colorado graph 37 68.1 View Actions
Connecticut graph 4 87.6 View Actions
Delaware graph 46 78.3 View Actions
Florida graph 32 69.7 View Actions
Georgia graph 17 72.6 View Actions
Hawaii graph 21 82.9 View Actions
Idaho graph 33 69.3 View Actions
Illinois graph 8 86.3 View Actions
Indiana graph 40 67.4 View Actions
Iowa graph 19 72.5 View Actions
Kansas graph 15 73.3 View Actions
Kentucky graph 23 72.2 View Actions
Louisiana graph 7 86.7 View Actions
Maine graph 6 87.3 View Actions
Maryland graph 31 81.3 View Actions
Massachusetts graph 5 87.5 View Actions
Michigan graph 9 77.2 View Actions
Minnesota graph 11 85.7 View Actions
Mississippi graph 24 82.3 View Actions
Missouri graph 10 85.8 View Actions
Montana graph 14 73.4 View Actions
Nebraska graph 13 73.9 View Actions
Nevada graph 49 75.4 View Actions
New Hampshire graph 2 82.1 View Actions
New Jersey graph 45 78.5 View Actions
New Mexico graph 48 62.2 View Actions
New York graph 21 72.4 View Actions
North Carolina graph 18 83.0 View Actions
North Dakota graph 19 72.4 View Actions
Ohio graph 29 70.6 View Actions
Oklahoma graph 47 76.5 View Actions
Oregon graph 25 71.1 View Actions
Pennsylvania graph 28 70.8 View Actions
Rhode Island graph 27 81.9 View Actions
South Carolina graph 42 66.5 View Actions
South Dakota graph 33 69.3 View Actions
Tennessee graph 38 67.8 View Actions
Texas graph 50 59.3 View Actions
Utah graph 35 80.4 View Actions
Vermont graph 1 82.6 View Actions
Virginia graph 12 85.0 View Actions
Washington graph 36 68.5 View Actions
West Virginia graph 26 82.0 View Actions
Wisconsin graph 16 83.3 View Actions
Wyoming graph 30 70.1 View Actions
  • 1990 - 2013
    Annual Report
  • 2013
    Senior Report

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