Early prenatal care improves the chances of having a healthy pregnancy and baby. But a new federal report shows it’s been on the decline.
The share of U.S. births to women who began prenatal care in the first trimester dropped from 78.3% in 2021 to 75.5% in 2024, according to data released by the Centers for Disease Control and Prevention on Thursday.
Meanwhile, starting care later in pregnancy or getting no care at all has been on the rise. Prenatal care beginning in the second trimester rose from 15.4% to 17.3%, and starting care in the third trimester or getting no care went from 6.3% to 7.3%.
“We know that early engagement in prenatal care is linked to better overall health outcomes,” said Dr. Clayton Alfonso, an OB-GYN at Duke University in North Carolina. When patients delay medical care during pregnancy, “we’ve missed that window to optimize both fetal and maternal care.”
While the trend identified in the report held for nearly all racial and ethnic groups, the decrease in early prenatal care was higher for moms in minority groups. For example, first-trimester care dropped from 69.7% in 2021 to 65.1% in 2024 for Black mothers. Getting late or no prenatal care raises the risk of maternal mortality, which is much higher among Black mothers.
Michelle Osterman, lead author of the report, said the overall findings represent a shift. Between 2016 and 2021, the timing of when U.S. women started prenatal care had been improving.
The earlier prenatal visits begin, doctors said, the earlier problems can be caught. Visits give doctors a chance to share health guidance, and can include blood pressure checks, screenings, blood tests, physical exams and ultrasound scans.
The report doesn't provide reasons why prenatal care is starting later. But the proliferation of maternity care deserts across the nation is a growing concern, said Dr. Grace Ferguson, an OB-GYN in Pittsburgh.
Many hospitals have shut down labor and delivery units “and the prenatal care providers that work at those hospitals also have probably moved,” said Ferguson, who was not involved with the report.
A 2024 March of Dimes report found that more than 35% of U.S. counties are maternity care deserts, meaning there’s no birthing facility or obstetric provider. Women living in these areas receive less prenatal care, the report showed.
Ferguson, who provides abortions as part of her OB-GYN care, said post-Roe v. Wade abortion restrictions may play a part because some obstetricians are choosing not to practice in states with more restrictive laws.
Alfonso, who was not involved in the CDC report, said he also suspects that access issues for patients are pushing prenatal care later, particularly in rural areas. Patients may have to travel farther to get to appointments and may struggle to find a practice that accepts their insurance, particularly if they have Medicaid.
Doctors fear that things could get worse.
“If this trend continues,” Alfonso said, “I worry about kind of what that would mean for morbidity and mortality for our moms.”
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
FILE - A doctor performs an ultrasound scan on a pregnant woman at a hospital in Chicago on Aug. 7, 2018. (AP Photo/Teresa Crawford, File)
PROVIDENCE, R.I. (AP) — Sitting in the stands at a hockey game, Michael Black heard what he thought was popping balloons before quickly realizing it was gunfire. As dozens of people rushed out of the Rhode Island arena, Black told his wife to “run, run” and then lunged toward the shooter's handgun.
Black managed to get his left hand caught in the chamber of Robert Dorgan's gun, jamming it and then briefly attempted to hold Dorgan down. But Dorgan, a former bodybuilder, hoisted Black into the air before at least two other bystanders rushed over to subdue the shooter. One of them could be seen on video putting Dorgan into a choke hold.
Dorgan fell to the ground, with Black on top of him. The shooter died from a self-inflicted gunshot after pulling out a second gun as the two locked eyes. Black never heard Dorgan say a word.
“The first thought was the safety of my wife. And the second thought was, because the bullets were coming out, was to focus in on the gun,” Black said. “Get the gun and then subdue the shooter.”
Pawtucket police have said the shooter behind the deadly ice rink tragedy on Monday was Robert Dorgan, who also went by Roberta Esposito and Roberta Dorgano.
Dorgan's ex-wife Rhonda Dorgan and adult son Aidan Dorgan were killed in the shooting, and three others were injured: Rhonda Dorgan’s parents, Linda and Gerald Dorgan; and a family friend, Thomas Geruso, all of whom remained in critical condition Wednesday.
Pawtucket police say the group of “courageous citizens” who rushed to intervene in the attack “undoubtedly prevented further injury and increased the chances of survival for the injured.” Along with Black, Robert Rattenni, and Ryan Cordeiro are being credited as subduing the suspect. Separately, Chris Librizzi and Glenn Narodowy, both retired Rhode Island firefighters and EMTs, and nurse Maryann Rattenni provided first aid in the immediate aftermath.
“I look at it as being fortunate, saddened tremendously in the loss, but fortunate that a small group of people could make a difference,” Black said in a Zoom interview Thursday from South Carolina where he was on a college visit with his son.
Authorities have not directly said that Dorgan was transgender and have said questions around Dorgan’s gender identity are not relevant to their investigation surrounding the case.
However, court records from Dorgan’s past show that gender identity was at least one of the contributing factors to Dorgan’s wife filing for divorce in 2020 after nearly 30 years of marriage. Dorgan's X account mentions being transgender and sharing far-right ideologies.
Black said Dorgan was walking down rows of seats determined to shoot more people. As he pinned the shooter's head with his knee, Black said he noticed Dorgan had additional magazines holding “quite a few bullets."
With Dorgan dead, other bystanders rushed to provide treatment for the five people who had been shot and were lying between the bleachers. Blood was everywhere. Police arrived within minutes and, Black with his injured hand, was escorted outside in the parking lot where he reunited with his wife.
“My wife saw me and she ran underneath the yellow tape, kind of grabbed me from behind, and we gave a big hug,” Black said. “She said, ‘I heard you helped with the shooter. And she says, what’s all the blood? I said, ’I got my hand caught in the gun.' And then she said, ‘Honey, I don’t know whether I should be proud of you, but I’m pissed off at you for putting yourself in that situation.’”
As he was sitting in the hospital getting treatment on his injured hand, Black recalled a nurse calling him a hero — a label that has repeatedly been applied to all three bystanders in recent days.
“I said I don’t feel like I’m a hero right now,” Black said. “I looked up and I was feeling for the family. So I started getting some tears in my eyes. And then she got tears in her eyes, too. It was just a moment of decompression at that point.”
Casey reported from Boston.
Police continue to tape off the Dennis M. Lynch arena a day after a deadly shooting during a youth hockey game on Tuesday, Feb. 17, 2026 in Pawtucket, R.I. (AP Photo/Rodrique Ngowi)
Police and ATF agents stand near the Lynch Arena in Pawtucket, R.I., after a shooting at the ice rink, Monday, Feb. 16, 2026. (AP Photo/Mark Stockwell)
Police congregate near the Lynch Arena in Pawtucket, R.I., after a shooting occurred at the ice rink, Monday, Feb. 16, 2026. (AP Photo/Mark Stockwell)
In this image taken from video, Michael Black, a Rhode Island man who helped stop a shooter at a high school hockey game on Monday, gestures during an interview with The Associated Press, Thursday, Feb. 19, 2026 in Spartanburg, S.C. (AP Photo)
In this image taken from video, Michael Black, a Rhode Island man who helped stop a shooter at a high school hockey game on Monday, holds up his injured hand during an interview with The Associated Press, Thursday, Feb. 19, 2026 in Spartanburg, S.C. (AP Photo)
