Expectant parents faced prenatal care challenges over the last few years

Prenatal care is critical for reducing the complications for both babies and pregnant people. In 2019, the maternal mortality rate in the U.S. was higher than many other industrialized countries — in that year there was one death for every 5,000 live births. That rate rose during the COVID-19 pandemic, to almost one death for every 3,000 live births. The rate of babies who died before they turned a year old also rose in 2022 for the first time in 20 years.

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This fact sheet explores important drivers of these increases in deaths: obstacles in accessing prenatal care and education during the pandemic, as well as how pregnant people viewed their interactions with doctors.

It is important to acknowledge that there is extensive evidence of disparities based on race and ethnicity regarding experiences during pregnancy, delivery, and perinatal maternal and child outcomes. Moreover, research indicates that there are numerous social determinants of these differential experiences and outcomes. In upcoming fact sheets, RAPID will explore the experiences of Black and Latinx expectant parents during pregnancy, postpartum, and in accessing prenatal healthcare. Those experiences and parent voices merit their own fact sheet.

The pandemic created challenges to accessing prenatal care

Obtaining healthcare during the COVID-19 pandemic was challenging due to office closures, canceled appointments, difficulties accessing telehealth appointments, and concerns over being exposed to the virus.

Between May 2021 and June 2023, 39% of expectant parents reported that they had at least one canceled prenatal appointment, which could have been due to office closures/rescheduling, trouble finding care for other children, worries about COVID-19 exposure, or health insurance or transportation issues. Eighteen percent reported that the closure of a provider’s office was the reason for their disrupted prenatal care.

Reasons why pregnant people canceled or delayed prenatal care during the COVID-19 pandemic, all participants

During this time, it was common for offices to limit the people in the healthcare setting to just the patient, which created challenges for parents to find care for other children so that they can attend appointments. Sixteen percent of expectant parents reported that they were unable to attend their appointments because of difficulty finding care for other children.

We found that expectant parents living in lower-income (below 200% of the federal poverty level) and middle-income (between 200–400% of the federal poverty level) households were more likely to experience these challenges than those living in higher-income households.

Reasons why pregnant people canceled or delayed prenatal care during the COVID-19 pandemic, by income levels

Expectant parents also faced challenges in accessing education and support

Many services and supports aimed at preparing parents for birth and a new baby, such as childbirth classes, new parent support groups, prenatal yoga, and breastfeeding support, have traditionally been offered as in-person experiences. During the pandemic, many were either canceled or only offered virtually. Not only are these opportunities important educational experiences, but they can also play a part in supporting the mental health and well-being of expectant parents.

But concerns over the risks of contracting COVID-19 kept many expectant parents from attending in-person services and supports. Those concerns are warranted – pregnant people have an increased chance of experiencing severe illness from COVID-19. The risk of complications, such as preterm birth, also increases after contracting COVID.

Overall, 76% of expectant parents shared that they chose not to attend in-person educational and support opportunities during the pandemic because of concerns about the risks to their safety. Interestingly, in 2023, the proportion of parents who reported they chose not to attend these in-person experiences due to concern about illnesses and safety was greater than earlier in the pandemic in 2021–2022.

Types of in-person experiences pregnant people chose not to attend due to safety concerns

Most expectant parents felt respected by their doctor and informed about their care . But for many, more improvements in these services are needed

The vast majority of parents felt their doctor respected them and kept them
well-informed about their health and prenatal care.

But only 21% felt their doctor spent enough time listening to them and answering their questions. Similarly, only 30% reported that their doctor prepared them for labor and delivery and less than half (45%) reported that their doctor prepared them for breastfeeding. This suggests that, while doctors may provide relevant information to expectant parents, more could be done to listen and prepare parents for labor, delivery, and postpartum.

Types of support pregnant people reported their healthcare providers gave them

Conclusion

The pandemic created challenges to accessing prenatal healthcare, educational, and support opportunities. Although most expectant parents felt their doctor kept them informed about their care, they also felt that their providers underprepared them for childbirth and breastfeeding. Obstacles in access to prenatal care and not getting enough time with a doctor could have implications on the health of expectant parents and their babies.

RAPID previously reported on the ways in which the pandemic interrupted healthcare for families with young children. We will continue to keep an eye on these experiences after the pandemic, focusing on any trends or changes, and what parents of young children say they need the most.