Series 21

No. 54

Prenatal Care in the

United States, 1980–94

July 1996

Vital and

Health Statistics

From the CENTERS FOR DISEASE CONTROL AND PREVENTION / National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics
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All material appearing in this report is in the public domain and may be

reproduced or copied without permission; citation as to source, however, is

appreciated.

Suggested citation

Lewis CT, Mathews TJ, Heuser RL. Prenatal care in the United States,

1980–94. National Center for Health Statistics. Vital Health Stat 21(54). 1996.

Library of Congress Cataloging-in-Publication Data

Prenatal care in the United States, 1980–94.

p. cm. — (Vital and health statistics. Series 21, Data from the national vital

statistics system ; no. 54) (DHHS publication ; no. (PHS) 96-1932)

Includes bibliographical references.

ISBN 0-8406-0518-8

1. Prenatal care—United States. 2. Prenatal care—United States—Statistics.

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Prenatal Care in the

United States, 1980–94

Series 21

Data on Natality, Marriage, and

Divorce

No. 54

Hyattsville, Maryland

July 1996

DHHS Publication No. (PHS) 96-1932

Vital and

Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics
National Center for Health Statistics

Edward J. Sondik, Ph.D., Director

Jack R. Anderson, Deputy Director

Jacob J. Feldman, Ph.D., Associate Director for Analysis,

Epidemiology, and Health Promotion

Gail F. Fisher, Ph.D., Associate Director for Planning and

Extramural Programs

Jack R. Anderson, Acting Associate Director for

International Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Monroe G. Sirken, Ph.D., Associate Director for Research

and Methodology

Division of Vital Statistics

Mary Anne Freedman, Director

James A. Weed, Ph.D., Deputy Director

Robert L. Heuser, Chief, Natality, Marriage and Divorce

Statistics Branch

Nicholas F. Pace, Acting Chief, Systems and Programming

Branch

Robert Armstrong, Acting Chief, Statistical Resources

Branch
Abstract

Objectives. This report examines trends in timing of

prenatal care in the United States from 1980 to 1994.

Demographic characteristics examined include age, race,

Hispanic origin, marital status, place of birth of mother,

educational attainment of mother, and live-birth order.

Social characteristics discussed include barriers to care and

pregnancy wantedness.

Methods. The source of data for trends and demographic

analyses is the certificate of live birth filed for each child born

in the United States. Data for social characteristics are from

the 1988 National Maternal and Infant Health Survey (NMIHS).

Data from the NMIHS are based on 9,953 responses.

Results. Very few groups of women have yet to achieve

the goal of 90 percent initiating prenatal care in the first

trimester as set by Healthy People 2000. In 1994, 80 percent

of all mothers initiated care in the first trimester. Cuban

mothers were the only mothers to reach the objective of

90 percent with Japanese mothers close behind at 89 percent.

Mothers with the lowest percent initiating early prenatal care

were non-Hispanic black (68 percent), Puerto Rican (67 percent), and American Indian mothers (65 percent). Mothers

who have problems getting prenatal care due to financial,

scheduling, transportation, or other problems have lower rates

of initiating early care. Mothers who wanted to be pregnant

when they did were more inclined to initiate early care than

mothers who did not want to become pregnant or whose

pregnancies were mistimed.

Conclusions. Prenatal care use in the United States did not

improve in the 1980’s but has been improving since 1990.

Variations in use by demographic characteristics persist. There

are wide gaps between mothers with easier access to prenatal

care and those who encounter barriers to care. Mothers who

want to become pregnant also tend to seek help in understanding their pregnancy and its risks earlier than those who did not

intend to get pregnant or cared to become pregnant at another

time.

iii
Contents

Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Introduction ........................................................................................... 1

Background ......................................................................................... 1

Sources of data ...................................................................................... 2

Demographic characteristcs ............................................................................... 3

Race of mother ...................................................................................... 3

Hispanic origin of mother ............................................................................. 3

Place of birth of mother ............................................................................... 3

Age of mother ....................................................................................... 3

Live-birth order ...................................................................................... 3

Educational attainment of mother ....................................................................... 4

Marital status of mother ............................................................................... 4

Social characteristics .................................................................................... 5

Barriers to care ...................................................................................... 5

Wantedness status .................................................................................... 5

Summary ............................................................................................. 6

References ............................................................................................ 7

List of detailed tables.................................................................................... 8

Appendix

Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Computation of percents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Accuracy of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Tests of significance for the National Maternal and Infant Health Survey (NMIHS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Figures

1. Percent of live births where mothers received early prenatal care by race: Reporting States, 1970–78 and

United States, 1979–94.............................................................................. 1

2. Percent of live births where mothers received early prenatal care, by age and race of mother: United States, 1994.... 4

3. Percent of live births where mothers received early prenatal care, by live-birth order and race of mother:

United States, 1994................................................................................. 4

4. Percent of live births where mothers received late or no prenatal care, by educational attainment and race of mother:

United States, 1994................................................................................. 4

Keywords: Prenatal care v Birth certificate v National Maternal and Infant Health Survey v Year 2000 Health Objectives

v
Prenatal Care in the United

States, 1980–94

by Caroline T. Lewis, Bureau of Health Professions,

Health Resources and Service Administration; T. J.

Mathews, and Robert L. Heuser, Division of Vital

Statistics

Introduction

Background

During the 1980’s and early 1990’s at least three out of

every four infants in this country were born to women who

began prenatal care in the first trimester. A minimum of

4 percent were born to women who began care as late as the

third trimester or who received no care at all. Other studies

have found that early prenatal care is associated with a

decreased risk of low birthweight and preterm delivery (1,2),

birth outcomes that are major predictors of infant morbidity

and mortality (3,4,5). Improvement in the timing of prenatal

care is considered so crucial to our Nation’s health that it has

been included in the Year 2000 Health Objectives for the

Nation (6). Early care is critical to the health of the mother and

child because it allows for early detection and treatment of

existing medical and obstetric conditions. It also provides the

opportunity for encouraging healthy behaviors and prevents

disease by educating women early in their pregnancies about

proper nutrition, adequate weight gain, safe sexual practices,

dangers of smoking, alcohol, and drugs, environmental and

occupational hazards, and other factors that might affect

pregnancy outcome (7).

In this report national trends in the proportions of mothers

receiving early care and late or no care between 1980 and

1994, as reported on live-birth certificates, are examined.

Differential timing of prenatal care for various sociodemographic subgroups are reviewed. Data from the 1988 National

Maternal and Infant Health Survey (NMIHS) show how some

factors beyond those available on the birth certificate are

related to initiation of prenatal care.

The proportion of mothers receiving early prenatal care

remained at 76 percent from 1980 to 1991 and then increased

each year thereafter to 80 percent in 1994 (figure 1 and

table 1). A similar pattern is observed for white mothers, but

for black mothers there was a decrease in early care usage in

the 1980’s and a notable increase in the 1990’s. The proportion of mothers beginning care in the third trimester or

receiving no care at all increased from 5.1 to 6.4 percent

between 1980 and 1989 before declining to 4.4 percent in

1994.

Because increasing the proportion of women receiving

early care is a major health priority for the Nation, it is

important to identify the particular subgroups that are less

likely to receive early care. Birth registration data show that

timing of prenatal care varies by race, ethnicity, place of birth,

age, live-birth order, educational attainment, and marital status

of the mother. Mothers who are black, Hispanic, not born in

the United States, young, unmarried, or who have had little

schooling are more likely to delay initiating prenatal care to

the second or third trimester or to receive no prenatal care.

Data from the 1988 NMIHS show that initiation of

prenatal care also varies according to whether the mother

encounters financial, transportation, child care, or other problems. Mothers who encounter these types of problems are

more likely to delay care than are mothers who do not. The

1988 NMIHS also indicates that whether a woman wants to be

pregnant influences when she begins care. Women who do not

want to be pregnant are more likely to delay care.

This report was prepared in the Division of Vital Statistics (DVS). The

authors gratefully acknowledge the assistance of John L. Kiely, Chief of the

Infant and Child Health Studies Branch, Division of Health and Unit Analysis

and Michael D. Kogan of the Followback Survey Branch, DVS, who reviewed

the report and provided helpful comments; and Thomas Dunn of the Statistical

Resources Branch, DVS, who provided content review. This report was edited

by Thelma W. Sanders and typeset by Zung T. N. Le of the Publications

Branch, Division of Data Services.

NOTE: For 1970-79 data are by race of child and for 1980-94 by race of

mother.

1970 1975 1980 1985 1990 

Year

10

100

Percent

White

Black

All races

90

80

70

60

50

40

30

20

Figure 1. Percent of live births where mothers received early

prenatal care by race: Reporting States, 1970–78 and United

States 1979–94

1
Because the quality or content of prenatal care given to

pregnant women cannot be evaluated from the information on

the birth certificate, the measure used in this report is the

timing of the first prenatal visit. Timing of care is used as a

proxy measure for adequacy of care because it indicates when

care began and suggests the duration of that care.

In this report ‘‘early care’’ is defined as care initiated in

the first trimester, ‘‘delayed care’’ refers to care begun in the

second trimester, and ‘‘late care’’ refers to care started in the

third trimester.

Sources of data

Data shown in tables 1–7 for 1994 are based on 100 percent of the birth certificates in all States and the District of

Columbia except where otherwise noted. The data are provided to the National Center for Health Statistics through the

Vital Statistics Cooperative Program (VSCP). In 1984 and

earlier years, the VSCP included a varying number of States,

which provided data on 100 percent of their birth certificates.

Data for States not in the VSCP were based on a 50-percent

sample of birth certificates filed in those States. Information

on sampling procedures and sampling errors for 1984 and

earlier years is provided in the annual report Vital Statistics of

the United States, Volume I, Natality.

Data shown in tables 8–12 for 1988 are based on the

NMIHS, which was conducted by the National Center for

Health Statistics to examine factors concerning maternal health,

pregnancy outcome, and infant health. Data from the NMIHS

are based on 9,953 responses. The NMIHS was made nationally representative by the calculation of a sample weight for

each record that accounts for the survey’s sampling scheme

and for survey nonresponse.

2
Demographic characteristics

Race of mother

The Public Health Service included among the year 2000

infant health objectives a goal that 90 percent of pregnant

women in each racial and ethnic group receive prenatal care

within the first trimester of pregnancy (6). In 1994 only

Japanese mothers came close to achieving this goal with

89 percent receiving prenatal care in the first trimester (table 2).

Other Asian and Pacific Islander subgroups had a range of 76

to 86 percent, compared with 65 and 68 percent for American

Indian and black mothers and 83 percent for white mothers. In

1994 the proportion of women who delayed care until the third

trimester or who received no care ranged from 2 to 5 percent

for Asian and white mothers compared with 8 to 10 percent for

black and American Indian mothers.

Hispanic origin of mother

Sixty-nine percent of Hispanic mothers began prenatal

care in the first trimester of pregnancy in 1994, nearly the

same level as that for non-Hispanic black mothers but substantially below that for non-Hispanic white mothers (87 percent)

(table 3). Cuban mothers achieved the year 2000 infant health

goal of 90 percent starting care in the first trimester while

other Hispanic groups were much lower (67–72 percent).

Hispanic mothers are generally much more likely than

non-Hispanic white mothers to get care late or to receive no

care at all. However, Hispanic and non-Hispanic black mothers have similar proportions receiving late or no care. In 1994,

8 percent of Hispanic and non-Hispanic black mothers received

late or no care compared with 3 percent of non-Hispanic white

mothers. The proportions for specified Hispanic subgroups

varied between 2 percent for Cuban mothers and 7–8 percent

for Mexican, Puerto Rican, and Central and South American

mothers.

Such differences among these Hispanic subgroups indicate that the problem with timing of care among Hispanic

women is probably due to factors such as educational attainment and income. For example, in 1994, 85 percent of Cuban

mothers completed high school compared with only 41 percent of Mexican mothers (8).

Place of birth of mother

Timing of care also varies by the place of birth of the

mother. In 1994, 85 percent of white mothers born in the

United States began care in the first trimester as compared

with 71 percent of those born outside the United States (data

not shown). This sizable differential is due to the large

proportion of births to Mexican-born mothers among white

mothers who were not born in the United States. In 1994,

54 percent of these births were to Mexican-born mothers and

only 64 percent of the mothers born in Mexico began care in

the first trimester of pregnancy. These differences in timing of

prenatal care may be due, at least in part, to factors such as

language barriers or lack of familiarity with available health

care systems and social services (9).

In contrast, the differential in receipt of early care between

black mothers who were and were not born in the United

States was not as great and the relationship was reversed.

Sixty-eight percent of black mothers born in the United States

received early care as compared with 72 percent of black

mothers who were not born in the United States. This is

consistent with other reports that black mothers born outside

the United States are relatively better off than their U.S.-born

counterparts in terms of income, years of schooling completed, health status, and lifestyle characteristics such as diet

and alcohol and tobacco use (10) .

Age of mother

Figure 2 indicates that initiation of care also varies with

age of mother. Generally, older mothers are more likely to

start care in the first trimester. Teenage mothers are the least

likely of any age group of women to get early prenatal care

(table 4). In 1994, 50 percent of white mothers and 42 percent

of black mothers aged 15 years and younger began prenatal

care in the first trimester. For mothers under 35 years of age,

the percent starting care in the first trimester increased successively with age for white and black mothers. White and black

mothers 30–34 years of age were most likely to initiate care in

the first trimester (90 percent and 76 percent) and proportions

declined slightly for women in their late thirties and in their

forties for both racial groups. Although patterns are the same

for white and black mothers, for each age group black mothers

consistently have a lower proportion of mothers initiating care

in the first trimester.

Live-birth order

Table 5 indicates that timing of prenatal care is also

associated with live-birth order. Women giving birth to a first

or second order child were more likely to begin care in the

3
first trimester than were women having a third or higher order

birth (figure 3). After the second order birth, the proportion of

mothers starting care in the first trimester declined. In 1994,

84 percent of white mothers having their first live birth

received prenatal care in the first trimester while only 59 percent having a sixth or higher order birth got prenatal care in

the first trimester. Seventy-two percent of black mothers

having their first live birth began prenatal care in the first

trimester compared with 47 percent bearing a sixth or higher

order child. For each live-birth order, the proportion of black

mothers initiating care early is substantially lower than that for

the comparable group of white mothers.

Educational attainment of mother

Timing of prenatal care is associated with the years of

schooling completed by the mother, a measure of socioeconomic status. The more years of schooling completed by the

mother, the more likely she is to get early care. In 1994,

60 percent of mothers with 8 years of schooling or less began

care in the first trimester compared with 94 percent of mothers

with 16 years of schooling or more (table 6). The variation is

even more striking when receipt of late or no care is examined

(figure 4). In 1994, 11 percent of white mothers and 13 percent

of black mothers who had 8 years of education or less received

late or no care compared with 1 percent of white mothers and

2 percent of black mothers with 16 years of schooling or more.

Marital status of mother

Married women are much more likely to initiate early

prenatal care than unmarried women (table 7). In 1994, 88 percent of married white mothers compared with 68 percent of

unmarried white mothers began care in the first trimester.

Among black mothers, 81 percent of married mothers compared with 63 percent of unmarried mothers began care in the

first trimester. Unmarried mothers were more than three times

as likely as married mothers to obtain late care or no care at

all; large differences are seen for white and black mothers.

Racial differences in the timing of care were greater for

married mothers than for unmarried mothers.

Unmarried mothers are less likely to initiate early prenatal

care and also have higher levels of low-birthweight babies. In

1994 an unmarried white mother was 50 percent more likely

to bear a low-birthweight baby than a married white mother

(8.1 compared with 5.4 percent). Among black mothers the

risk was 32 percent higher for unmarried mothers compared

with married mothers (14.3 compared with 10.8 percent). This

higher risk of low birthweight translates into higher risk of

infant mortality and morbidity for babies born to unmarried

mothers.

Under

15

years

15 19 20 24 25 29 30 34 35 39 40

years

and

over

Age of mother

0

20

40

60

80

100

Percent

White Black

Figure 2. Percent of live births where mothers received early

prenatal care, by age and race of mother: United States, 1994

1st child 2d child 3d child 4th child 5th child 6th

child

or more Live birth order

0

20

40

60

80

100

Percent

White Black

Figure 3. Percent of live births where mothers received early

prenatal care, by live-birth order and race of mother: United

States, 1994

0 8

years

9 11

years

12 years 13 15

years

16 years

or more

Years of school completed

0

2

4

6

8

10

12

14

Percent

White Black

Figure 4. Percent of live births where mothers received late or no

prenatal care, by educational attainment and race of mother:

United States, 1994

4
Social characteristics

Barriers to care

Attitudinal surveys of women who receive inadequate

prenatal care show that these women often do not want to be

pregnant, have a low perceived value of prenatal care, or do

not realize that they are pregnant until after the first trimester

(11,12). These surveys also identify certain structural barriers

to prenatal care including lack of health insurance coverage,

transportation, and child care (12,13,14). The 1988 National

Maternal and Infant Health Survey (NMIHS) conducted by the

National Center for Health Statistics permits examination of

such structural and attitudinal factors that affect the timing of

prenatal care.

A sample of mothers who gave birth in 1988 was asked

whether it was hard to get prenatal care during pregnancy

because of problems with money or insurance; problems with

appointments, work, or transportation; problems with health

care providers; or any other problems. Fourteen percent of

respondents reported problems with getting prenatal care.

Table 8 shows that mothers reporting problems were more

likely to initiate care late or to receive no care at all than were

mothers who reported no problems in receiving care. In 1988,

66 percent of black mothers who did not report any problems

getting prenatal care began prenatal care in the first trimester

while only 49 percent of black mothers who did encounter

problems initiated care in the first trimester. Although the

levels are higher, the same pattern was observed for white

mothers. Even among women reporting no problems with

getting prenatal care, neither racial group reached the goal of

90 percent receiving early care.

Many studies have indicated that financial and insurance

problems are the most significant barriers to prenatal care (15).

Table 9 shows the percent distribution of births to mothers

who encountered problems with receiving care by trimester

prenatal care began and problem type. Only 54 percent of

mothers with money or insurance problems began care in the

first trimester. In comparison, a significantly higher proportion

(66 percent) of mothers who encountered problems with health

care providers began care in the first trimester. There was no

significant difference in proportions of mothers receiving early

care among mothers encountering financial problems (54 percent) and those encountering appointments, work, or transportation problems (61 percent). Mothers who encountered ‘‘other’’

problems were the least likely to initiate early care (42 percent). ‘‘Other’’ included not knowing that one was pregnant

and not wanting others to know about the pregnancy.

In order to determine whether more educated mothers

may be better equipped to overcome barriers to prenatal care,

timing of prenatal care was examined in light of educational

attainment for mothers who reported problems. As indicated in

table 10, white mothers experiencing barriers to care with no

more than a high school education were significantly less

likely to receive early care (55 percent) than white mothers

with 13 years of schooling or more (83 percent). The differences observed for black mothers were also significant (46 percent and 62 percent). This suggests that mothers who are more

educated are better able to cope with these barriers to prenatal

care than are their less-educated counterparts.

Wantedness status

As suggested earlier, timing of care is also associated with

wantedness status. Table 11 uses information reported by the

mother on whether she wanted to become pregnant with her

last child at the time she did or earlier (‘‘wanted at an earlier

time or wanted at that time’’), at a later time (‘‘wanted some

time in the future’’), or not at all (‘‘did not want’’). A

significantly higher proportion of white mothers who wanted

to be pregnant at that time or earlier began prenatal care in the

first trimester (88 percent) compared with white mothers who

had a mistimed pregnancy (72 percent) or an unwanted pregnancy (69 percent). Black mothers wanting a birth at that time

or earlier were also notably more likely to begin care early

(75 percent) compared with those bearing a mistimed or

unwanted baby (57 percent and 52 percent). There was no

significant difference between mothers who had a mistimed

pregnancy and those who had an unwanted pregnancy for

black or white mothers.

A significantly higher proportion of married mothers who

wanted to be pregnant at that time or earlier began care in the

first trimester (90 percent) compared with married mothers

who had a mistimed pregnancy (77 percent) or who had an

unwanted pregnancy (73 percent). For unmarried mothers

there were significant differences between all three categories

of wantedness (table 12).

5
Summary

Mothers who are the least likely to obtain early prenatal

care (that is, women who are black, Puerto Rican, American

Indian, teenaged, poorly educated, unmarried, or who have

problems with money, insurance, transportation, or child care)

are also the ones whose infants have higher levels of poor

outcomes. Early prenatal care is essential for these women at

increased medical and social risk because it provides the

opportunity for interventions and education necessary to prevent or reduce the risks. Prenatal care visits give the health

care provider the opportunity to counsel expectant mothers on

the benefits of proper nutrition, adequate weight gain, and

breastfeeding as well as the negative effects of stress, anxiety,

depression, extreme physical work and exercise, tobacco,

alcohol, illicit drug use, and exposure to environmental hazards (7).

The steady improvements in timing of care achieved in

the 1970’s did not continue in the 1980’s but improvements

have occurred in the early 1990’s. Black mothers, whose

overall prenatal care usage comes much later than white

mothers, experienced decreases in the proportions of mothers

receiving early care in the 1980’s and improvements in the

1990’s. The proportion of mothers who initiated care in the

first trimester is now at its highest point since 1969, the first

year that prenatal care data were collected on the birth

certificate. Continued improvements in the overall rate will

depend primarily upon the progress in obtaining early care by

the high-risk groups discussed in this report.

6
References

1. Institute of Medicine. Preventing low birth weight. Washington:

National Academy Press. 1985.

2. Singh S, Torres A, and Forrest JD. The need for prenatal care in

the United States: Evidence from the 1980 National Natality

Survey. Family Planning Perspectives 17(3): 118–124. 1985

3. McCormick MC. The contribution of low birth weight to infant

mortality and childhood morbidity. N Engl J Med 312:82–90.

1985.

4. Hogue CJR, Buehler JW, Strauss LT, Smith JC. Overview of the

National Infant Mortality Surveillance (NIMS) project-design,

method, results. Public Health Rep 102(2): 126–38. 1987.

5. Taffel SM. Trends in low birth weight: United States, 1978–85.

National Center for Health Statistics. Vital Health Stat 21(48).

1989.

6. U.S. Department of Health and Human Services. Healthy

people 2000: National health promotion and disease prevention

objectives for the nation. Washington: Public Health Service.

1991.

7. Public Health Service Expert Panel on the Content of Prenatal

Care. Caring for our future: The content of prenatal care.

Washington: 1989.

8. Ventura SJ, Martin JA, Mathews TJ, Clarke SC. Advance report

of final natality statistics, 1994. Monthly vital statistics report;

vol 44 no 11, suppl. Hyattsville, Maryland: National Center for

Health Statistics. 1996.

9. Institute of Medicine. Committee to Study Outreach for Prenatal Care. Prenatal care: Reaching mothers, reaching infants.

Washington: National Academy Press. 1988.

10. Cabral H, Fried LE, Levenson S, Amaro H, Zuckerman B.

Foreign-born and US-born black women: Differences in health

behaviors and birth outcomes. Am J Public Health 80:70–2.

1990.

11. Sable MR, Stockbauer JW, Schramm WF, Land GH. Differentiating the barriers to adequate prenatal care in Missouri,

1987–8. Public Health Reports 105(6): 549–55. 1990.

12. Poland ML, Ager JW, Olson, JM. Barriers to receiving adequate

prenatal care. Am J Obstet Gynecol 157(2): 297–303. 1987.

13. Fingerhut LA, Makuc D, Kleinman JC. Delayed prenatal care

and place of first visit: Differences by health insurance and

education. Family Planning Perspectives 19(5): 212–34. 1987.

14. Kalmuss D, Fennelly K. Barriers to prenatal care among

low-income women in New York City. Family Planning Perspectives 22(5): 215–31. 1990.

15. National Commission to Prevent Infant Mortality. Troubling

trends persist: Shortchanging America’s next generation. Washington: March 1992.

16. Schoendorf KC, Parker JD, Batkhan LZ, Kiely JL. Comparability of the birth certificate and the 1988 Maternal and Infant

Health Survey. National Center for Health Statistics. Vital

Health Stat 2(116). 1993.

7
List of detailed tables

1. Number and percent distribution of live births by trimester

of pregnancy prenatal care began, according to the race of

mother: United States, 1980–94 .................. 9

2. Number and percent distribution of live births by trimester

of pregnancy prenatal care began, according to the specified race of mother: United States, 1994 ............ 10

3. Number and percent distribution of live births by trimester

of pregnancy prenatal care began, according to Hispanic

origin of mother and by race of mother for mothers of

non-Hispanic origin: United States, 1994 ............ 10

4. Number and percent distribution of live births by trimester

of pregnancy prenatal care began, according to age and

race of mother: United States, 1994 ............... 11

5. Number and percent distribution of live births by trimester

of pregnancy prenatal care began, according to live-birth

order and race of mother: United States, 1994 ........ 12

6. Number and percent distribution of live births by trimester of

pregnancy prenatal care began, according to educational

attainment and race of mother: United States, 1994 ...... 12

7. Number and percent distribution of live births by

trimester of pregnancy prenatal care began, according to

marital status and race of mother: United States, 1980

and 1994 ................................... 13

8. Number and percent distribution of live births by trimester

of pregnancy prenatal care began, according to problem

status with receiving prenatal care and race of child:

United States, 1988 National Maternal and Infant Health

Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

9. Number of live births to mothers who reported a problem

receiving prenatal care and percent distribution by trimester of pregnancy prenatal care began, according to type of

problem and race of child: United States, 1988 National

Maternal and Infant Health Survey . . . . . . . . . . . . . . . . 14

10. Number and percent distribution of live births to mothers who reported a problem receiving prenatal care by

trimester of pregnancy prenatal care began, according

to educational attainment of mother and race of child:

United States, 1988 National Maternal and Infant Health

Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

11. Number and percent distribution of live births by trimester

of pregnancy prenatal care began, according to wantedness

status and race of child: United States, 1988 National

Maternal and Infant Health Survey . . . . . . . . . . . . . . . . 15

12. Number and percent distribution of live births by trimester

of pregnancy prenatal care began, according to wantedness and marital status: United States, 1988 National

Maternal and Infant Health Survey . . . . . . . . . . . . . . . . 16

8
Table 1. Number and percent distribution of live births by trimester of pregnancy prenatal care began, according to race of mother:

United States, 1980–94

Race of mother and year All births1 Total

Trimester of pregnancy prenatal care began

1st 2d

3d or no care

Total 3d No care

All races2 Number Percent distribution

1994 ..................................... 3,952,767 100.0 80.2 15.4 4.4 3.0 1.4

1993 ..................................... 4,000,240 100.0 78.9 16.3 4.8 3.2 1.6

1992 ..................................... 4,065,014 100.0 77.7 17.1 5.2 3.5 1.7

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,110,907 100.0 76.2 18.0 5.8 3.9 1.9

1990 ..................................... 4,158,212 100.0 75.8 18.1 6.1 4.1 2.0

1989 ..................................... 4,040,958 100.0 75.5 18.1 6.4 4.3 2.2

1988 ..................................... 3,909,510 100.0 75.9 18.0 6.1 4.2 1.9

1987 ..................................... 3,809,394 100.0 76.0 17.9 6.1 4.1 2.0

1986 ..................................... 3,756,547 100.0 75.9 18.1 6.0 4.1 1.9

1985 ..................................... 3,760,561 100.0 76.2 18.1 5.7 4.0 1.7

19843 .................................... 3,669,141 100.0 76.5 17.9 5.6 3.9 1.7

19833 .................................... 3,638,933 100.0 76.2 18.3 5.6 3.9 1.6

19823 .................................... 3,680,537 100.0 76.1 18.5 5.5 3.9 1.5

19813 .................................... 3,629,238 100.0 76.3 18.5 5.2 3.8 1.4

19803 .................................... 3,612,258 100.0 76.3 18.6 5.1 3.8 1.3

White

1994 ..................................... 3,121,004 100.0 82.8 13.6 3.6 2.6 1.0

1993 ..................................... 3,149,833 100.0 81.8 14.3 3.9 2.8 1.2

1992 ..................................... 3,201,678 100.0 80.8 15.0 4.2 2.9 1.2

1991 ..................................... 3,241,273 100.0 79.5 15.9 4.7 3.3 1.4

1990 ..................................... 3,290,273 100.0 79.2 15.9 4.9 3.5 1.4

1989 ..................................... 3,192,355 100.0 78.9 15.9 5.2 3.6 1.6

1988 ..................................... 3,102,083 100.0 79.3 15.7 5.0 3.6 1.5

1987 ..................................... 3,043,828 100.0 79.3 15.7 5.0 3.5 1.5

1986 ..................................... 3,019,175 100.0 79.1 16.0 5.0 3.5 1.5

1985 ..................................... 3,037,913 100.0 79.3 15.9 4.8 3.4 1.3

19843 .................................... 2,967,100 100.0 79.6 15.8 4.7 3.3 1.3

19833 .................................... 2,946,468 100.0 79.3 16.1 4.6 3.3 1.3

19823 .................................... 2,984,817 100.0 79.2 16.3 4.5 3.3 1.2

19813 .................................... 2,947,679 100.0 79.3 16.4 4.3 3.2 1.1

19803 .................................... 2,936,351 100.0 79.2 16.5 4.3 3.3 1.0

Black

1994 ..................................... 636,391 100.0 68.3 23.5 8.2 4.9 3.3

1993 ..................................... 658,875 100.0 66.0 25.0 9.0 5.2 3.8

1992 ..................................... 673,633 100.0 63.9 26.2 9.9 5.6 4.2

1991 ..................................... 682,602 100.0 61.9 27.4 10.7 6.1 4.6

1990 ..................................... 684,336 100.0 60.6 28.0 11.3 6.6 4.7

1989 ..................................... 673,124 100.0 60.0 28.1 11.9 6.8 5.1

1988 ..................................... 638,562 100.0 60.7 28.3 11.0 6.9 4.2

1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611,173 100.0 60.8 28.0 11.2 6.8 4.4

1986 ..................................... 592,910 100.0 61.2 28.1 10.7 6.6 4.1

1985 ..................................... 581,824 100.0 61.5 28.4 10.2 6.7 3.4

19843 .................................... 568,138 100.0 61.9 28.4 9.7 6.4 3.3

19833 .................................... 562,624 100.0 61.2 29.0 9.8 6.5 3.3

19823 .................................... 568,506 100.0 61.1 29.2 9.7 6.5 3.2

19813 .................................... 564,955 100.0 62.1 28.7 9.2 6.3 2.9

19803 .................................... 568,080 100.0 62.4 28.7 8.9 6.1 2.8

1Includes births with trimester of pregnancy prenatal care began not stated.

2Includes races other than white and black.

3Based on 100 percent of births in selected States and on a 50-percent sample of births in all other States.

9
Table 2. Number and percent distribution of live births by trimester of pregnancy prenatal care began, according to specified race of

mother: United States, 1994

Race of mother All births1 Total

Trimester of pregnancy prenatal care began

1st 2d 3d or no care

Number Percent distribution

All races .......................................... 3,952,767 100.0 80.2 15.4 4.4

White ........................................... 3,121,004 100.0 82.8 13.6 3.6

Black ............................................ 636,391 100.0 68.3 23.5 8.2

American Indian2 .................................... 37,740 100.0 65.2 25.0 9.8

Chinese .......................................... 26,578 100.0 86.2 11.1 2.7

Japanese ......................................... 9,230 100.0 89.2 8.9 1.9

Hawaiian ......................................... 5,955 100.0 77.0 18.3 4.7

Filipino ........................................... 30,495 100.0 81.3 15.1 3.6

Other Asian and Pacific Islander ........................... 85,374 100.0 76.2 19.0 4.8

1Includes births with trimester of pregnancy prenatal care began not stated.

2Includes births to Aleuts and Eskimos.

Table 3. Number and percent distribution of live births by trimester of pregnancy prenatal care began, according to Hispanic origin of

mother and by race of mother for mothers of non-Hispanic origin: United States, 1994

Origin of mother All births1

Trimester of pregnancy prenatal care began

Total 1st 2d 3d or no care

Number Percent distribution

All origins2 ................................. 3,952,767 100.0 80.2 15.4 4.4

Hispanic ................................... 665,026 100.0 68.9 23.5 7.6

Mexican ................................. 454,536 100.0 67.3 24.4 8.3

Puerto Rican .............................. 57,240 100.0 71.7 21.8 6.5

Cuban ................................... 11,889 100.0 90.1 8.3 1.6

Central and South American ..................... 93,485 100.0 71.2 22.3 6.5

Other and unknown Hispanic .................... 47,876 100.0 72.1 21.7 6.2

Non-Hispanic3 ............................... 3,287,741 100.0 82.5 13.8 3.7

White ................................... 2,474,162 100.0 86.5 11.0 2.5

Black ................................... 624,303 100.0 68.3 23.5 8.2

1Includes births with trimester of pregnancy prenatal care began not stated.

2Includes Hispanic origin not stated.

3Includes races other than white and black.

10
Table 4. Number and percent distribution of live births by trimester of pregnancy prenatal care began, according to age and race of

mother: United States, 1994

Age and race of mother All births1 Total

Trimester of pregnancy prenatal care began

1st 2d 3d or no care

Number Percent distribution

All races2 .................................. 3,952,767 100.0 80.2 15.4 4.4

Under 15 years .............................. 12,901 100.0 45.7 38.4 15.9

15–19 years ................................ 505,488 100.0 64.3 27.7 8.0

15 years ................................. 30,742 100.0 54.8 34.1 11.1

16 years ................................. 63,125 100.0 59.3 31.2 9.5

17 years ................................. 101,302 100.0 63.3 28.4 8.3

18 years ................................. 137,547 100.0 65.4 27.0 7.6

19 years ................................. 172,772 100.0 67.6 25.4 7.0

20–24 years ................................ 1,001,418 100.0 74.6 19.8 5.6

25–29 years ................................ 1,088,845 100.0 84.5 12.1 3.4

30–34 years ................................ 906,498 100.0 87.7 9.6 2.7

35–39 years ................................ 371,608 100.0 86.8 10.3 2.9

40 years and over ............................. 66,009 100.0 83.0 12.9 4.0

White .................................... 3,121,004 100.0 82.8 13.6 3.6

Under 15 years .............................. 5,978 100.0 49.9 34.9 15.2

15–19 years ................................ 348,081 100.0 66.9 25.9 7.2

15 years ................................. 17,443 100.0 58.3 31.2 10.4

16 years ................................. 40,198 100.0 62.1 29.0 9.0

17 years ................................. 68,747 100.0 65.6 26.8 7.6

18 years ................................. 96,605 100.0 67.7 25.5 6.8

19 years ................................. 125,088 100.0 69.7 24.1 6.2

20–24 years ................................ 764,085 100.0 76.9 18.3 4.9

25–29 years ................................ 889,581 100.0 86.5 10.8 2.8

30–34 years ................................ 754,871 100.0 89.6 8.4 2.1

35–39 years ................................ 305,291 100.0 88.7 9.0 2.3

40 years and over ............................. 53,117 100.0 85.1 11.5 3.4

Black ..................................... 636,391 100.0 68.3 23.5 8.2

Under 15 years .............................. 6,465 100.0 42.1 41.7 16.1

15–19 years ................................ 140,968 100.0 58.7 31.5 9.8

15 years ................................. 12,297 100.0 50.1 37.9 12.0

16 years ................................. 20,853 100.0 54.6 35.0 10.4

17 years ................................. 29,413 100.0 58.8 31.5 9.7

18 years ................................. 36,489 100.0 59.8 30.5 9.6

19 years ................................. 41,916 100.0 62.3 28.7 9.0

20–24 years ................................ 197,841 100.0 66.8 24.9 8.3

25–29 years ................................ 142,355 100.0 73.8 18.9 7.3

30–34 years ................................ 99,155 100.0 75.9 17.1 7.0

35–39 years ................................ 42,029 100.0 74.5 18.3 7.3

40 years and over ............................. 7,578 100.0 71.8 19.9 8.3

1Includes births with trimester of pregnancy prenatal care began not stated.

2Includes races other than white and black.

11
Table 5. Number and percent distribution of live births by trimester of pregnancy prenatal care began, according to live-birth order and

race of mother: United States, 1994

Live-birth order and race of mother All births1 Total

Trimester of pregnancy prenatal care began

1st 2d 3d or no care

Number Percent distribution

All races2,3 ................................. 3,952,767 100.0 80.2 15.4 4.4

First child .................................. 1,618,811 100.0 82.0 14.5 3.5

Second child ................................ 1,266,056 100.0 83.1 13.4 3.5

Third child .................................. 631,571 100.0 78.6 16.5 4.9

Fourth child ................................. 245,636 100.0 71.8 20.8 7.4

Fifth child .................................. 93,043 100.0 64.5 24.7 10.7

Sixth child and more ........................... 74,861 100.0 54.7 29.1 16.2

White3 .................................... 3,121,004 100.0 82.8 13.6 3.6

First child .................................. 1,290,315 100.0 84.0 12.9 3.1

Second child ................................ 1,022,360 100.0 85.3 11.9 2.9

Third child .................................. 496,852 100.0 81.4 14.7 3.9

Fourth child ................................. 182,812 100.0 75.5 18.7 5.8

Fifth child .................................. 64,042 100.0 68.8 22.7 8.4

Sixth child and more ........................... 47,148 100.0 58.7 27.8 13.5

Black3 .................................... 636,391 100.0 68.3 23.5 8.2

First child .................................. 245,196 100.0 71.8 22.5 5.7

Second child ................................ 182,499 100.0 71.3 21.8 6.9

Third child .................................. 107,572 100.0 66.5 24.5 9.1

Fourth child ................................. 51,665 100.0 59.8 27.3 12.9

Fifth child .................................. 23,832 100.0 53.9 29.2 16.9

Sixth child and more ........................... 21,345 100.0 47.3 29.8 22.9

1Includes births with trimester of pregnancy prenatal care began not stated.

2Includes races other than white and black.

3Includes births with live-birth order not stated.

Table 6. Number and percent distribution of live births by trimester of pregnancy prenatal care began, according to educational

attainment and race of mother: United States, 1994

Years of school completed by mother and race of mother All births1 Total

Trimester of pregnancy prenatal care began

1st 2d 3d or no care

Number Percent distribution

All races2,3 ................................. 3,952,767 100.0 80.2 15.4 4.4

0–8 years .................................. 247,285 100.0 60.1 28.8 11.1

9–11 years ................................. 644,894 100.0 65.0 26.2 8.7

12 years ................................... 1,364,436 100.0 79.4 16.4 4.2

13–15 years ................................ 845,172 100.0 86.6 11.0 2.4

16 or more years ............................. 793,827 100.0 93.8 5.2 1.0

White3 .................................... 3,121,004 100.0 82.8 13.6 3.6

0–8 years .................................. 209,550 100.0 60.8 28.0 11.2

9–11 years ................................. 460,295 100.0 67.9 24.7 7.4

12 years ................................... 1,052,684 100.0 82.4 14.4 3.2

13–15 years ................................ 673,546 100.0 88.7 9.4 1.9

16 or more years ............................. 685,328 100.0 94.7 4.6 0.8

Black3 .................................... 636,391 100.0 68.3 23.5 8.2

0–8 years .................................. 22,741 100.0 52.7 34.4 12.9

9–11 years ................................. 160,197 100.0 57.1 30.5 12.4

12 years ................................... 253,759 100.0 68.2 23.8 7.9

13–15 years ................................ 132,460 100.0 77.4 17.9 4.7

16 or more years ............................. 54,312 100.0 87.4 10.4 2.3

1Includes births with trimester of pregnancy prenatal care began not stated.

2Includes races other than white and black.

3Includes births with educational attainment of mother not stated.

12
Table 7. Number and percent distribution of live births by trimester of pregnancy prenatal care began, according to marital status and

race of mother: United States, 1980 and 1994

Marital status and race of mother and year All births1 Total

Trimester of pregnancy prenatal care began

1st 2d

3d or no care

Total 3d No care

All races2 Number Percent distribution

All births:

1994 ..................................... 3,952,767 100.0 80.2 15.4 4.4 3.0 1.4

19803 .................................... 3,612,258 100.0 76.3 18.6 5.1 3.8 1.3

Births to married women:

1994 ..................................... 2,663,175 100.0 87.0 10.7 2.4 1.8 0.6

19803 .................................... 2,946,511 100.0 81.3 15.2 3.5 2.7 0.8

Births to unmarried women:

1994 ..................................... 1,289,592 100.0 66.1 25.2 8.6 5.6 3.0

19803 .................................... 665,747 100.0 53.8 33.7 12.5 8.7 3.8

White

All births:

1994 ..................................... 3,121,004 100.0 82.8 13.6 3.6 2.6 1.0

19803 .................................... 2,936,351 100.0 79.2 16.5 4.3 3.3 1.0

Births to married women:

1994 ..................................... 2,326,743 100.0 87.7 10.1 2.2 1.7 0.5

19803 .................................... 2,599,440 100.0 82.5 14.4 3.1 2.5 0.6

Births to unmarried women:

1994 ..................................... 794,261 100.0 68.2 24.1 7.7 5.3 2.4

19803 .................................... 328,984 100.0 53.2 33.5 13.3 9.4 3.9

Black

All births:

1994 ..................................... 636,391 100.0 68.3 23.5 8.2 4.9 3.3

19803 .................................... 568,080 100.0 62.4 28.7 8.9 6.1 2.8

Births to married women:

1994 ..................................... 188,076 100.0 81.2 15.0 3.7 2.6 1.2

19803 .................................... 248,450 100.0 72.2 22.1 5.7 4.2 1.5

Births to unmarried women:

1994 ..................................... 448,315 100.0 62.8 27.1 10.1 5.9 4.2

19803 .................................... 318,799 100.0 54.7 33.9 11.4 7.6 3.7

1Includes births with trimester of pregnancy prenatal care began not stated.

2Includes races other than white and black.

3Based on 100 percent of births in selected States and on a 50-percent sample of births in all other States.

13
Table 8. Number and percent distribution of live births by trimester of pregnancy prenatal care began, according to problem status with

receiving prenatal care and race of child: United States, 1988 National Maternal and Infant Health Survey

Problem status and race of child

All births in

thousands Total

Trimester of pregnancy prenatal care began

1st 2d 3d or no care

Number Percent and standard error

All races1 .................... 3,899 100.0 78.3 (0.5) 16.6 (0.5) 5.1 (0.3)

Problems . . . . . . . . . . . . . . . . . . . . 539 100.0 59.2 (1.8) 26.6 (1.7) 14.3 (1.2)

No problems .................. 3,360 100.0 81.5 (0.5) 15.0 (0.5) 3.6 (0.3)

White ...................... 3,033 100.0 81.6 (0.6) 14.3 (0.6) 4.1 (0.3)

Problems . . . . . . . . . . . . . . . . . . . . 404 100.0 61.9 (2.3) 26.1 (2.1) 11.9 (1.6)

No problems .................. 2,629 100.0 84.7 (0.7) 12.5 (0.6) 2.8 (0.3)

Black . . . . . . . . . . . . . . . . . . . . . . . 667 100.0 62.7 (0.7) 27.5 (0.7) 9.8 (0.4)

Problems . . . . . . . . . . . . . . . . . . . . 113 100.0 48.9 (1.8) 27.3 (1.6) 23.9 (1.5)

No problems . . . . . . . . . . . . . . . . . . 555 100.0 65.5 (0.8) 27.6 (0.7) 6.9 (0.4)

1Includes races other than white and black.

Table 9. Number of live births to mothers who reported a problem receiving prenatal care and percent of distribution by trimester of

pregnancy prenatal care began, according to type of problem and race of child: United States, 1988 National Maternal and Infant Health

Survey

Problem type and race of child

All births

in thousands Total

Trimester of pregnancy prenatal care began

1st 2d 3d or no care

Number Percent and standard error

All races1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 539 100.0 59.2 (1.8) 26.6 (1.7) 14.3 (1.2)

Money or insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 100.0 53.8 (2.8) 29.0 (2.5) 17.2 (2.1)

Appointments, work, or transportation . . . . . . . . . . . . . . . . . 229 100.0 60.7 (2.8) 29.2 (2.6) 10.1 (1.5)

Health care providers . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 100.0 65.7 (3.3) 24.4 (3.0) 9.9 (1.9)

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 100.0 41.5 (4.3) 34.0 (4.3) 24.5 (3.6)

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404 100.0 61.9 (2.3) 26.1 (2.1) 11.9 (1.6)

Money or insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 100.0 55.3 (3.3) 28.9 (3.1) 15.9 (2.5)

Appointments, work, or transportation . . . . . . . . . . . . . . . . . 161 100.0 64.2 (3.6) 29.5 (3.4) *

Health care providers . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 100.0 68.1 (3.9) 23.3 (3.5) *

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 100.0 45.1 (6.0) 35.5 (6.0) *

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 100.0 48.9 (1.8) 27.3 (1.6) 23.9 (1.5)

Money or insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 100.0 46.9 (2.9) 28.4 (2.6) 24.7 (2.5)

Appointments, work, or transportation . . . . . . . . . . . . . . . . . 53 100.0 50.3 (2.8) 28.8 (2.5) 20.9 (2.2)

Health care providers . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 100.0 56.4 (3.7) 24.9 (3.3) 18.7 (2.9)

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 100.0 32.6 (3.5) 29.2 (3.4) 38.3 (3.6)

*Does not meet standards of precision and reliability; less than 30 sample cases.

1Includes races other than white and black.

14
Table 10. Number and percent distribution of live births to mothers who reported a problem receiving prenatal care by trimester of

pregnancy prenatal care began, according to educational attainment of mother and race of child: United States, 1988 National Maternal

and Infant Health Survey

Years of school completed by mother and race of child

All births

in thousands Total

Trimester of pregnancy prenatal care began

1st 2d 3d or no care

Number Percent and standard error

All races1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 539 100.0 59.2 (1.8) 26.6 (1.7) 14.3 (1.2)

0–12 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406 100.0 52.5 (2.2) 30.4 (2.0) 17.1 (1.5)

13 years or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 100.0 79.3 (3.0) 15.1 (2.7) 5.6 (1.7)

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404 100.0 61.9 (2.3) 26.1 (2.1) 11.9 (1.6)

0–12 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299 100.0 54.5 (2.8) 30.7 (2.6) 14.8 (2.0)

13 years or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 100.0 82.9 (3.5) * *

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 100.0 48.9 (1.8) 27.3 (1.6) 23.9 (1.5)

0–12 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 100.0 46.0 (2.0) 27.7 (1.8) 26.3 (1.8)

13 years or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 100.0 62.4 (4.2) 25.5 (3.8) *

*Does not meet standards of precision and reliability; less than 30 sample cases.

1Includes races other than white and black.

Table 11. Number and percent distribution of live births by trimester of pregnancy prenatal care began, according to wantedness status

and race of child: United States, 1988 National Maternal and Infant Health Survey

Wantedness status and race of child

All births

in thousands Total

Trimester of pregnancy prenatal care began

1st 2d 3d or no care

Number Percent and standard error

All races1 .................................. 3,899 100.0 78.3 (0.5) 16.6 (0.5) 5.1 (0.3)

Wanted then or earlier .......................... 2,213 100.0 86.8 (0.6) 10.3 (0.6) 2.9 (0.3)

Wanted later ................................ 1,413 100.0 68.1 (1.1) 24.8 (1.0) 7.1 (0.6)

Unwanted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272 100.0 62.6 (2.2) 25.2 (2.0) 12.2 (1.5)

White .................................... 3,033 100.0 81.6 (0.6) 14.3 (0.6) 4.1 (0.3)

Wanted then or earlier .......................... 1,854 100.0 88.2 (0.7) 9.3 (0.6) 2.5 (0.3)

Wanted later ................................ 1,021 100.0 71.5 (1.4) 22.6 (1.3) 6.0 (0.7)

Unwanted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 100.0 69.4 (3.5) 20.4 (3.1) *

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 667 100.0 62.7 (0.7) 27.5 (0.7) 9.8 (0.4)

Wanted then or earlier . . . . . . . . . . . . . . . . . . . . . . . . . . 231 100.0 75.2 (1.1) 18.9 (1.0) 5.9 (0.6)

Wanted later . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332 100.0 57.1 (1.1) 32.3 (1.0) 10.6 (0.7)

Unwanted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 100.0 52.2 (1.9) 31.6 (1.8) 16.2 (1.4)

*Does not meet standards of precision and reliability; less than 30 sample cases.

1Includes races other than white and black.

15
Table 12. Number and percent distribution of live births by trimester of pregnancy prenatal care began, according to wantedness and

marital status: United States, 1988 National Maternal and Infant Health Survey

Wantedness and marital status

All births

in thousands Total

Trimester of pregnancy prenatal care began

1st 2d 3d or no care

Number Percent and standard error

All births ................................... 3,899 100.0 78.3 (0.5) 16.6 (0.5) 5.1 (0.3)

Wanted then or earlier .......................... 2,213 100.0 86.8 (0.6) 10.3 (0.6) 2.9 (0.3)

Wanted later ................................ 1,413 100.0 68.1 (1.1) 24.8 (1.0) 7.1 (0.6)

Unwanted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272 100.0 62.6 (2.2) 25.2 (2.0) 12.2 (1.5)

Married ................................... 2,904 100.0 85.1 (0.6) 11.8 (0.5) 3.1 (0.3)

Wanted then or earlier .......................... 1,919 100.0 89.5 (0.6) 8.3 (0.6) 2.2 (0.3)

Wanted later . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 821 100.0 77.2 (1.3) 18.3 (1.2) 4.6 (0.6)

Unwanted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 100.0 72.7 (3.0) 20.5 (2.7) 6.8 (1.7)

Unmarried . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 995 100.0 58.4 (1.3) 30.9 (1.2) 10.8 (0.8)

Wanted then or earlier . . . . . . . . . . . . . . . . . . . . . . . . . . 295 100.0 68.6 (2.4) 24.1 (2.2) 7.3 (1.3)

Wanted later . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 591 100.0 55.3 (1.7) 34.0 (1.7) 10.7 (1.0)

Unwanted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 100.0 47.3 (3.1) 32.3 (2.9) 20.4 (2.6)

16
Appendix

Technical notes

Computation of percents

Percent distributions are computed using only events for

which the characteristic is reported. The number of events

with information not stated is subtracted from the total before

computation of these measures.

Accuracy of reporting

In 1994 month of pregnancy prenatal care began was not

reported for 2.3 percent of the births. Information on when

prenatal care is initiated is either self-reported by the mother

or derived from the medical record, both of which may have

inaccuracies (16).

Tests of significance for the National

Maternal and Infant Health Survey (NMIHS)

The standard error (SE) may be used to assess the

statistical signifance of the difference between two rates or

percents. If the difference between two rates (R1-R2) exceeds:

1.96 √SE2

R1 + SE2R2

it may be regarded as statistically significant at the 0.05 level.

17
Vital and Health Statistics

series descriptions

SERIES 1. Programs and Collection Procedures—These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the methods

used to collect and process the data, definitions, and other

material necessary for understanding the data.

SERIES 2. Data Evaluation and Methods Research—These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. These studies also

include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

SERIES 3. Analytical and Epidemiological Studies—These reports

present analytical or interpretive studies based on vital and

health statistics. These reports carry the analyses further than

the expository types of reports in the other series.

SERIES 4. Documents and Committee Reports—These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

SERIES 5. International Vital and Health Statistics Reports—These

reports are analytical or descriptive reports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

SERIES 6. Cognition and Survey Measurement—These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

SERIES 10. Data From the National Health Interview Survey—These

reports contain statistics on illness; unintentional injuries;

disability; use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

SERIES 11. Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributions of the population with respect to

physical, physiological, and psychological characteristics, and

(2) analyses of trends and relationships among various

measurements and between survey periods.

SERIES 12. Data From the Institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

included in Series 13.

SERIES 13. Data From the National Health Care Survey—These

reports contain statistics on health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14. Data on Health Resources: Manpower and Facilities—

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

SERIES 15. Data From Special Surveys—These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

SERIES 16. Compilations of Advance Data From Vital and Health

Statistics—Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reports in Series 10–13.

SERIES 20. Data on Mortality—These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

SERIES 21. Data on Natality, Marriage, and Divorce—These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

SERIES 22. Data From the National Mortality and Natality Surveys—

Discontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

SERIES 23. Data From the National Survey of Family Growth—

These reports contain statistics on factors that affect birth

rates, including contraception, infertility, cohabitation,

marriage, divorce, and remarriage; adoption; use of medical

care for family planning and infertility; and related maternal

and infant health topics. These statistics are based on

national surveys of childbearing age.

SERIES 24. Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

Monthly Vital Statistics Report (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact:

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and Prevention

Public Health Service

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782

(301) 436–8500

E-mail: nchsquery@nch10a.em.cdc.gov

Internet: http://www.cdc.gov/nchswww/nchshome.htm
DHHS Publication No. (PHS) 96-1932, Series 21, No. 54

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