Early pregnancy care declines despite Trump’s pro-birth agenda
The current Trump administration has previously said it’s focused on promoting a “pro-family” agenda. Trump has said that he wants to be the “fertilization president.” Yet infant mortality remains high compared to other wealthy nations, despite more than 80 percent of pregnancy-related deaths being preventable.
We can cut this death rate with early and consistent prenatal care, research has shown. Still, a new report published by the CDC shows that the U.S. is not trending in a positive direction to do so. After years of progress, fewer pregnant Americans are getting prenatal care in the first weeks of pregnancy — or getting access to care at all. The data highlights a bigger story in America: that timely reproductive care is getting harder to access, despite the current administration stating that it wants Americans to have “more babies.”
Per the CDC analysis, first-trimester prenatal care increased from 77.1 percent in 2016 to 78.3 percent in 2021. But from 2021 to 2024, prenatal care starting in the first trimester declined to 75.5 percent. The decline in early prenatal care was highest for Black mothers, where first-trimester care fell from 69.7 percent in 2021 to 65.1 percent in 2024. Overall, between 2021 and 2024, late or no care increased in 36 states and Washington, D.C.
Dr. Melissa Simon, an obstetrician-gynecologist at Northwestern Medicine, told Salon that women-related health policies over the past five years have not had a positive trend for “fostering good health and vitality” for women. For example, on June 24, 2022, the SCOTUS ruling in Dobbs v. Jackson Women’s Health Organization — a case that challenged a Mississippi ban on abortion at 15 weeks of pregnancy — overturned Roe v. Wade, which effectively ended the federal constitutional right to choose to have an abortion in the United States.
Since then, 13 states have completely banned access to abortion, and six more have implemented restrictive laws that make access nearly impossible. Restrictive abortion laws have led to provider shortages in states, resulting in subsidized clinic shutdowns, an increase in infant deaths, and pregnancies with complications, including death. Since the pandemic, Simon added, there has been “a tsunami of disinformation that has promulgated distrust in health care and science, which also makes people less likely to seek health care, let alone prenatal care,” she said.
Dr. David Hackney, a maternal fetal medicine specialist, told Salon that abortion bans may not be directly causing the trend, but they’re still part of a bigger story of an attack on access to health care for women.
“Unfortunately, it would be anticipated that this problem will worsen in the coming years under the current administration.”
“Although abortion restrictions may or may not be causative, the consequences of late prenatal care initiation in restrictive states are greater,” Hackney said. “For patients who may need to travel out of state for abortion care, early prenatal care initiation allows for earlier recognition of concerns which as maternal medical problems or fetal genetic or structural anomalies.”
Early prenatal care not only consistently improves obstetric outcomes, he said, but is also “a primary tool to mitigate the risks of abortion bans.”
Notably, nationwide, more than one-third of the U.S. is now considered to be a maternity care desert, leaving more than 5.6 million women in counties with no or limited access to maternity care. Hackney told Salon the rise in maternity deserts is most likely a factor to the decline in early prenatal care.
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“A county that is in a maternity care desert not only lacks a labor and delivery unit, but also has no outpatient prenatal care provider at all, such that for prenatal care, a patient must drive into a neighboring county,” Hackney said. “As such deserts have expanded, patients in the first trimester have had to drive further, and thus it is unsurprising that early initiation is decreasing.”
Loss of insurance coverage, specifically Medicaid, among young women could be a contributing factor. Between ages 25 and 34, women are 69 percent more likely than men of the same age to live in poverty and possibly not be employed, meaning no access to private health insurance and a provider if they’re pregnant.
“Unfortunately, it would be anticipated that this problem will worsen in the coming years under the current administration, as Medicaid coverage continues to be intentionally curtailed and decreasing hospital support leads to growing maternity care deserts,” Hackney said.
The Department of Health and Human Services did not respond to Salon’s request for a comment on how the administration plans to increase access to early prenatal care across the country to improve maternal mortality outcomes.
Simon noted that under the current administration, with restrictive immigration laws, there is “fear” to engage in health care “around immigration and refugee status.”
The current Trump administration rescinded an ICE policy that prohibited the agency’s activities in “protected areas” such as hospitals and medical facilities. Pregnant and breastfeeding women have commonly been detained in ICE facilities.
“Delayed prenatal care has serious consequences for both mothers and babies,” Dr. Kim Bruno, associate director at Sera Prognostics, told Salon. “Early visits are essential for identifying and managing conditions like hypertension, diabetes, infections and fetal growth restriction. When care begins late, or not at all, clinicians miss the window to manage these risks effectively.”
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