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Organized prenatal care in the United States was introduced largely by social reformers and nurses. In 1901, Mrs. William Lowell Putnam of the Boston Infant Social Service Department began a program of nurse visits to women enrolled in the home delivery service of the Boston Lying-in Hospital (Merkatz and colleagues, 1990). It was so successful that a prenatal clinic was established in 1911. In 1915, J. Whitridge Williams reviewed 10,000 consecutive deliveries at Johns Hopkins Hospital and concluded that 40 percent of 705 perinatal deaths could have been prevented by prenatal care. In 1954, Nicholas J. Eastman credited organized prenatal care with having “done more to save mothers' lives in our time than any other single factor” (Speert, 1980). In the 1960s, Dr. Jack Pritchard established a network of university-operated prenatal clinics located in the most underserved communities in Dallas County. In large part because of increased accessibility, currently more than 95 percent of medically indigent women delivering at Parkland Hospital receive prenatal care. Importantly and related, the perinatal mortality rate of women in this system is less than that of the United States overall.


Almost a century after its introduction, prenatal care has become one of the most frequently used health services in the United States. In 2006, more than 4.2 million births were registered in the United States (Martin and associates, 2009). In 2001, there were approximately 50 million prenatal visits—the median was 12.3 visits per pregnancy—and as shown in Figure 8-1, many women had 17 or more visits.

Figure 8-1
Graphic Jump Location

Frequency distribution of the number of prenatal visits for the United States in 2001. (Adapted from Martin and associates, 2002b.)


A new birth certificate form was introduced in 2003 and is now used by 19 states, with the remaining 31 states continuing to use the 1989 form. Unfortunately, data regarding the timing of prenatal care from these two systems are not comparable. For example, with the 1989 version that represents 2.2 million births, nearly 83 percent of women received first-trimester prenatal care in 2006. Conversely, those states using the 2003 version reported that only 69 percent of women received first-trimester care (Martin and associates, 2009). Although the difference is striking, it merely represents a change in reporting and is not a harbinger of diminished of prenatal care. Indeed, according to the Centers for Disease Control and Prevention (2008a), birth certificate data using the 1989 version show that more than 99 percent of women received some prenatal care in the third trimester.


Since the early 1990s, the largest gains in timely prenatal care have been among minority groups. As shown in Figure 8-2, however, disparity continues. In 2006, African American and Hispanic women were more than twice as likely as non-Hispanic white women to begin prenatal care after the first trimester ...

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