Data from the

NATIONAL VITAL STATISTICS SYSTEM

Prenatal Care

United States, 1969-1975

An analysis of recent trends and differentials in prenatal care, based

upon data reported on birth certificates. Discusses variations in care

received by different groups of mothers and the outcome of pregnancy as related to month of pregmmcy prenatal care began and

number of prenatal visits.

DHEW Publication No. (PHS) 78-1911

Series 21

Number 33

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

National Center for Health Statistics

Hyattsville, Md. September 1978
Library of Congress Cataloging in Publication Data

Taffel, Selma.

Prenatal care, United States, 1969-1975.

(Vital and health statistics: Series 21, Data from the National Vital Statistics System;

no. 33) (DHEW publication; no. (PHS) 78-1911)

Bibliography: p. 26

1. Prenatal care–United States–Statistics. 2. Childbirth–United States–Statistics. 3.

Birth weight, Low–United States–Statistics. I. Title. II. Series: United States. National

Center for Health Statistics. Vital and health statistics: Series 21, Data from the National

Vital Statistics System, Data on natality, marriage, and divorce; no. 33. III. Series: United

States. Dept. of Health, Education, and Welfare. DHEW publication. no. (PHS) 78-1911.

[DNLM: 1. Prenatal care. W2 A N148vu no. 33]

HA211.A3 no. 33 [RG960] 312’.1’73s

[618.2’4’0973] 78-11489
NATIONAL CENTER FOR HEALTH

DOROTHY P. RICE, Director

ROBERT A. 1SR4EL, Deputy Director

JACOB J. FELDMAN, Ph.D., Associate Director for Analysis

GAIL F. FISHER, Ph. D., Associate Director for the Cooperative Health Statistics System

ELIJAH L. WHITE, Associate Director for Data Systems

JAMES T. BAIRD, JR., Ph.D., Associate Director for International Statistics

ROBERT C. HUBER, Associate Director for Management

MONROE G. SIRKEN, Ph. D., Associate Director for Mathematical Statistics

PETER L. HURLEY, Associate Director for Operations

JAMES M. ROBEY, Ph.D., Associate Director for Program Development

PAUL E. LEAVERTON, Ph. D., Associate Director for Research

.4LICE HAYWOOD, Information Officer

DIVISION OF VITAL STATISTICS

JOHN E. PATTERSON, Director

ALICE M. HETZEL, Deputy Director

ROBERT L. HEUSER, M.A., Chiej Natality Statistics Branch

RITA U. HOFFMAN, Chief Programming Branch

MABEL G. SMITH, Chiej Statistical Resources Branch

Vital and Health Statistics-Series 21-No. 33

DHEW Publication No. (PHS) 78-1911

Library of Congress Catalog Card Number 78-11489
CONTENTS

Introduction ...........................................................................................................................................

Criterion for Measuring Care .............................................................................................................

Prenatal Care and Outcome of Pregnancy .........................................................................................

Summary of Findings .............................................................................................................................

Trends in Prenatrd Care ..........................................................................................................................

Month of Pregnancy Prenatal Care Began ..........................................................................................

Number of Prenatal Visits .................................................................................................................

Demographic and Socird Characteristics .................................................................................................

Age of Mother ...................................................................................................................................

Birth Order .......................................................................................................................................

Marital Status of Mother ...................................................................................................................

Educational Attainment of Mother ...................................................................................................

Place of Residence ............................................................................................................................

Prenatrd Care and Low Birth Weight .......................................................................................................

Educational Attainment of Mother ...................................................................................................

Effect of Premature Delivery ............................................................................................................

Age of Mother .............................................................................................................. ....................

Number of Prenatal Visits .................................................................................................................

Marital Status of Mother ...................................................................................................................

Area of Residence .............................................................................................................................

References ..............................................................................................................................................

List of Detailed Tables ...........................................................................................................................

Technical Appendix ...............................................................................................................................

1.

2.

3.

4.

A.

LIST OF FIGURES

Percent of births where mother had late or no prenatal care, by race: Reporting areas, 1969-

75 ................................................................................................................................................

Percent of births where mother had late or no prenatsl care, by age of mother and race: Reporting areas, 1975 ......................................................................................................................

Percent of births where mother received late or no prenatal care, by legitimacy status and race:

Reporting areas, 1969 and 1975 ..................................................................................................

Percent of births where mother had late or no care, by educational attainment of mother and

race: 39 reporting States and the District of Columbia, 1975 ......................................................

LIST OF TEXT TABLES

Percent distribution of live births by month of pregnancy prenatrd care began, according to

race: Reporting areas, 1969-75 ....................................................................................................

1

1

2

2

3

3

5

7

7

9

13

14

15

19

19

20

20

21

22

25

26

27

36

4

10

14

17

4

...

Ill
B. Percent distribution of live births by number of prenatal visits, according to race: Reporting

areas, 1972-75 .............................................................................................................................

C. Percent of births where mother made nine prenatal visits or more, by period of gestation and

race: Reporting areas, 1972 and 1975 .........................................................................................

D. Median number of prenatal visits, by period of gestation and race: Reporting areas, 1972 and

1975 ............................................................................................................................................

E. Median number of prenatal visits, by trimester of pregnancy prenatal care began and race: Reporting areas, 1972 and 1975 ......................................................................................................

F. Percent distribution of live births by month of pregnancy prenatal care began, accordkg to age

of mother and race of child: TotaI of 42 reporting States and the District of Columbia, 1975 ....

G. Percent of live births where mother received Iate or no prenatal care, by age of mother and race

of chiid: Reporting areas, 1969 and 1975 ....................................................................................

H. Percent distribution of live births by month of pregnancy prenataf care began, according to livebirth order and race: Reporting areas, 1969 and 1975 .................................................................

J. Percent of live births where prenatal care was initiated in the first trimester of pregnancy, by age

of mother, live-birth order, and race of child: Totaf of 42 reporting States and the District of

Columbia, 1975 ...........................................................................................................................

K. Observed and standardized percent distribution of live births, by month of pregnancy prenatal

care began and race: Reporting areas, 1969 and 1975 .................................................................

L. Median number of prenatal visits, by live-birth order and race: Reporting areas, 1972 and 1975 ...

M. Percent distribution of live births by month of pregnancy prenatal care began, according to

Legitimacy status and race: Totaf of 33 reporting States and the District of Columbia, 1975 .......

N. Percent distribution of live births by month of pregnancy prenatal care began, according to

educational attainment of mother and race of child: Reporting areas, 1969 and 1975 ................

0. Percent of mothers starting care in first trimester of pregnancy and percent of mothers with

late or no care, by educational attainment of mother and race: Total of 42 reporting States

and the District of Columbia, 1975 .............................................................................................

P. Percent of live births where mother received late or no care, by race: Reporting areas, 1969

and 1975 .....................................................................................................................................

Q. Median number of prenatrd visits in metropolitan and nonmetropofitan areas and in urban places

of 50,000 population or more, by educational attainment of mother and race of child: Total

of 37 reporting States and the District of CoIumbia, 1975 ..........................................................

R. Percent of infants of low birth weight, by educational attainment of mother, month of pregnancy prenatal care began, and race of child: Total of 39 reporting States and the District of

Columbia, 1975 ...........................................................................................................................

S. Percent of infants of low birth weight, by time of initiation of prenatal care, period of gestation,

and race: Total of 39 reporting States and the District of Columbia, 1975 ..................................

T. Percent of infants of low birth weight, by age of mother, month of pregnancy prenatal care

began, and race of child: Total of 39 reporting States and the District of Columbia, 1975 ..........

U. Percent of infants of low birth weight, by month of pregnancy prenatal care began, number of

prenatal visits, and race: Total of 37 reporting States and the District of Columbia, 1975 ..........

V. Percent of full-term infants of low birth weight by month of pregnancy prenatal care began

and number of prenatal visits: Total of 35 reporting States and the District of Columbia,

1975 ............................................................................................................................................

W. Percent of infants of low birth weight, by educational attainment of mother, number of prenatal

visits, and race of child: Total of 35 reporting States and the District of Columbia, 1975 ...........

5

6

6

7

8

9

11

12

12

13

14

16

17

18

19

20

21

22

23

23

24

iv
X. Percent of infants of low birth weight, by month of pregnancy prenatal CMCbegan, legitimacy

status, and race : Total of 33 reporting States and the District of Columbia, 1975 ....................... 24

Y. Percent of infants of low birth weight, by month of pregnancy prenatal care began, area of residence, and race: Total of 42 reporting States and the District of Columbia, 1975 ...................... 25
SYMBOLS

Data not available--------------------------—--- ---

Category not applicable ------------------------- . . .

Quantity zero–--------------— ------------- -

Quantity more than Obut less than 0.05---- 0.0

Figure does not meet standards of

reliabilityy or precision-----—-—--------—-- *

vi
PRENATAL CARE IN THE UNITED STATES, 1969-1975

Selma Taffel, Division of VitaI Statistics

INTRODUCTION

Concern about reproductive wastage and the

physical and mental impairment of the newborn

has given impetus in recent years to the study of

the role of prenatal care in the prevention of low

birth weight and shortened gestational periods.

It has become increasingly evident that low

birth weight and prematurity are highly associated with elevated levels of infant morbidity

and mortality and an increased incidence of

congenital anomalies.1’6

In order to explore further the relationship

between prenatal care and the outcome of pregnancy, and to assess the care received by different groups of mothers, two items were added

to the 1968 revision of the U.S. Standard Certificate of Live Birth. The first–month of pregnancy prenatal care began-provides an indication of the duration of prenatal care. The

second—total number of prenatal visits—gives

an indication of the amount of care received.

This report presents information on recent

trends in prenatal care derived from these two

items and from other information entered on

birth certificates. Data on month of pregnancy

prenatal care began are shown for the period

1969-75, and for number of prenatal visits, for

the years 1972-75.

Since not all State birth certificates include

items on prenatzd care, the data in this report refer only to mothers residing in those areas where

such questions are included. During 1975, 42

States and the District of Columbia reported on

the item “month of pregnancy prenatal care began,” and 38 States and the District of Columbia

reported on the item “number of prenatal visits”;

this represented 86.5 and 57.5 percent of zdl

births, respectively. (See table I of the Technical

Appendix for the composition of the reporting

areas in each year.) The data presented are

drawn from individual birth certificates; hence

the figures shown technically refer to numbers of

births rather than to numbers of mothers. However, since very few women have more than one

child in a given year, for ease and clarity in writing, the terms “women” and “mothers” rather

than “births,” are sometimes used in the ensuing

discussion.

Criterion for MeasuringCare

One of the basic aims of this report is to

identify those groups of women who are receiving late or no prenatzd care. To accomplish this,

demographic and socioeconomic information

available from birth certificates is related to the

timing of the initiation of prenatal care and the

number of prenatal visits. Because it is not possible to evaluate the excellence of medical supervision from information entered on birth certificates, the principal criterion used in this report

for measuring prenatal care is the time of the

first prenatal visit. The early initiation of prenatal care is deemed criticaI to the health of the

mother and child because it affords the opportunity to identify and treat existing medical and

obstetric problems and to educate the mother

in regard to proper nutrition and other aspects

of the hygiene of pregnancy.T The early termination of pregnancy may preclude the start of prenatal

have

care for those women who would ordinarily

begun care late in pregnancy. It seems

1
reasonable therefore to combine the number of

mothers who had no care with those starting

care in the third trimester of pregnancy. Mothers

in these two categories combined are referred to

in this report as having received late or no prenatal care.

Prenatal Care and Outcome of Pregnancy

Another objective of this study is to explore

the relationship between prenatal care and pregnancy outcome. Birth weight was chosen as the

measure of pregnancy outcome to be studied

since this item is more completely and accurately reported on birth certificates than

length of gestation. A major problem in performing such an assessment is that the women

who are most likely to seek early and continuous

prenatal care are also likely to have an inherently

lower risk of an adverse outcome because of

their favored socioeconomic or demographic

status. Where possible, therefore, such factors

as age and education of mother have been held

constant in order to evaluate more meaningfully the interaction between the time of the

initiation of prenatal care and birth weight.

SUMMARY OF FINDINGS

According to information entered on birth

certificates, there were large variations in the

prenatal care received by mothers of different

social and demographic backgrounds. Differences in the month of pregnancy prenatal care

began were observed for women of various ages,

educational levels, marital status, and areas of

residence. Moreover, within each of these

groups, there was a consistent pattern of less

care for black mothers.

For the period covered by this report,

1969-75, there was a gradual increase in the

proportion of both white and black mothers

who initiated care during the first trimester of

pregnancy, concomitant with a decrease in the

proportion of mothers who received late care

(care starting in the third trimester of pregnancy) or no care. Although there were greater

gains in the utilization of care among black than

among white mothers, in 1975 there remained

very substantial differences in the care received

by these two racial groups. Approximately twice

the proportion of black as of white mothers received late or no care (10.5 percent compared

with 5.0 percent); care started in the first trimester of pregnancy for 75.9 percent of white

mothers compared with only 55.8 percent of

black mothers.

Similarly, there was a greater decline between 1972 and 1975 in the proportion of black

mothers making few prenatal visits, but still as

of 1975, more than three times the proportion

of black as of white mothers limited tlheir care

to less than five visits or had no care (1.7.5 percent compared with 5.5 percent, respectively).

Three-quarters of the white mothers, but only

slightly more than half of the black mothers

made nine or more prenatal visits for births of

36 weeks of gestation or longer during 1975.

Teenage girls and women aged 45 years or

more were least likely to start care early in pregnancy, and these age groups were also the most

likely to receive late or no prenatal care,, Women

aged 25-29 years were most apt to skart care

early and least likely to receive late or no care.

Women bearing their first child were not as

likely to start” care in the first trimester of pregnancy as were women bearing their seccmd child

(72.3 percent compared with 76.5 percent, respectively, in 1975). The proportion of mothers

starting care early decreased with successive

births after the second birth for all age groups of

mothers.

In 1975, less than half (43.5 percent) of the

unmarried mothers started care as early as the

first trimester of pregnancy in contrast to

slightly more than three-quarters (76.7 percent)

of the married mothers. The proportion of unwed mothers who received late or no care was

nearly four times that of married mothers (16.2

percent compared with 4.3 percent). Care was

generally started earlier, and there were proportionately fewer unmarried black than white

mothers who had late or no care. Between 1969

and 1975 the proportion of black mothers (both

married and unmarried) receiving late or no care

dropped by about half; for married white

mothers the decline was 26 percent and for unmarried white mothers, 30 percent.

Mothers who did not complete high school

were far less likely to start care early and were

more likely to have late or no care than were

mothers with at least 12 years of schooling. In

1975, about half (50.7 percent) of the mothers

2
who had completed 8 years of schooling or less

started care in the first trimester of pregnancy

compared with about three-quarters (76.0 percent) of the mothers who had 12 years of

schooling and 85.4 percent of the mothers with

13 years of schooling or more. Racial differences

in the timing of care were not as noticeable for

women with very limited educational attainment

as for those with 9 years of schooling or more.

Although there were large variations in care

received by mothers according to State of residence, there was a generally consistent pattern

within each State of higher levels of late or no

care for black mothers. For most States there

were marked declines between 1969 and 1975 in

the proportion of mothers having late or no

care. Women living in metropolitan areas averaged 11.1 prenatal visits compared with 10.3

visits for women living in nonmetropolitan areas.

For both types of areas, higher leveIs of education were associated with a greater average

number of prenatal visits.

The relationship between the extent of care

received and the outcome of pregnancy as measured by birth weight is equivocal. For mothers

receiving care, the likelihood of a Iow-birthweight outcome (2,500 grams or Iess—5 pounds

8 ounces or less) was found to be more dependent on the mother’s educational attainment

than on when care was initiated. As years of

schooling increased, the incidence of low birth

weight decreased, regardless of when care began.

However, at all educational levels, the percent

Iow birth weight was far higher when mothers

had no care at alI than when some care was received. This difference, however, is to some

extent a reflection of the relatively high proportion of women in the “no-care” group delivering

prematurely before they may have had the opportunity to receive care.

The proportion of low-birth-weight babies

generally decreased as the frequency of prenatal

visits increased, but for each IeveI of visits, there

was a higher proportion of black than white

babies of low birth weight. The largest racial

disparity was seen for mothers making 13-16

prenatal visits, where the percent low birth

weight was nearly 2Y2 times as great for black as

for white babies.

Out-of-wedlock births were far more likely

than other births were to be of low birth weight

when care was started at similar points in pregnancy. The incidence of low birth weight was

about twice as high among out-of-wedIock as

among other births when care started in the first

trimester of pregnancy (12.3 percent compared

with 6.0 percent in 1975). The percent low birth

weight increased for legitimate births with each

delay in initiation of care (from 6.0 percent in

the first trimester of pregnancy to 7.4 percent in

the last trimester). However, for out-of-wedlock

births, there was a decrease in percent low birth

weight when care was delayed (from 12.3 percent in the first trimester to 10.8 percent in the

last trimester).

TRENDS IN

Month of Pregnancy

.

PRENATAL CARE

Prenatal Care Began

During the period 1969-75, there was a

steady increase in the proportion of mothers

starting care in the first few months of pregnancy. Concomitantly, the proportion of

mothers initiating care in late pregnancy or having no prenatal care declined (table A and figure

1). For both white and black mothers, the most

usual time for the first prenatal visit was during

the first 3 months of pregnancy. In 1969, 72.4

percent of all white mothers started care in the

first trimester of pregnancy; by 1975 this proportion had risen to 75.9 percent. The proportion of bIack mothers starting care in the first

3 months was far lower during this entire period,

despite substantial year-to-year gains (42.7 percent in 1969 compared with 55.8 percent in

1975). The proportion of white mothers receiving late care (care starting in the third trimester

of pregnancy) or no care declined from 6.4 percent in 1969 to 5.0 percent in 1975; for black

mothers, the comparable decline was from 18.2

percent in 1969 to 10.5 percent in 1975. Thus

in 1975, there stilI remained a very substantial

gap between these racial groups in utilization

of prenatal care services.

Deterrents to care. –A wide variety of factors have been identified as being influential in

the delay in seeking cares Foremost among

these is the attitude that childbearing is a natural

function that does not require medical intervention until the time of deIivery. This assumption

appears to be related to the cultural and socioeconomic background of the mother, and is

3
Table A. Percent distribution of live births by month of pregnancy prenatal care began, according to race: Reporting areas, 1!>69-75

Race

All racesl

White

1975 ............................................................... ..................

1974 .................................................................................

1973 .................................................................................

1972 ...................... ...... .......................................... ...........

1971 .................................................................................

1970 .................................................................................

1969 .................................................................................

Black

1975 .................................................................................

1974 .................................................................................

1973 ..... .. .............. ................................................ ............

1972 .................................................................................

1971 ..................................................... ............................

1970 .................................................................................

1969 ............................... ........ ...... ....................................

1Includes races other than white and black.

Total 1St

and

2d

100.0 45.5

100.0 44.9

100.0 43.8

100.0 42.4

100.0 41.4

100.0 41.2

100.0 41.5

100.0 48.5

100.0 48.0

100.0 47.1

100.0 45.7

100.0 44.7

100.0 44.5

100.0 44.7

100.0 31.6

100.0 30.1

100.0 28.2

100.0 26.4

100.0 24.8

100.0 23.7

100.0 22.8

Month of pregnancy prenatal care began

3d

26.8

27.2

27.0

27.0

27.2

26.7

26.5

27.4

27.9

27.8

27.9

28.3

27.9

27.7

24.2

23.8

23.2

22.6

21.8

20.6

19.9

4th

11.4

11.4

11.6

12.0

12.2

12.1

11.9

10.5

10.4

10.6

11.1

11.3

11.3

11.2

16.0

16.1

16.3

16.7

16.5

16.2

15.8

5th

6.3

6.4

6.8

7.1

7.2

7.3

7.2

5.4

5.4

5.7

6.0

6.1

6.2

6.2

10.8

11.3

11.9

‘f2.5

13,0

13.1

13.0

6th

3.9

3.9

4.2

4.5

4.7

4.8

4.8

3.2

3.2

3.4

3.7

3.8

3.9

3.9

6.9

7.3

7.9

8.5

9.2

9.8

10.3

7th

2.6

2.6

2.8

3.0

3.1

3.4

3.4

2.2

2.2

2.3

2.4

2.6

2.7

2.7

4.4

4.7

5.0

5.5

6.1

6.9

7.3

—

8th

—

1.5

1.6

1.7

1.7

1.8

2.0

2.0

1.3

1.3

1.4

1.4

1.5

1.6

1.6

2.4

2.6

2.8

3.0

3.3

3.8

4.2

—

9th

0.6

0.6

0.7

0.7

0.7

0.8

0.8

0.5

0.5

0.6

0.6

0.6

0.7

0.7

1.0

1.1

1.2

1.1

1.2

1.5

1.6

No

prenatal

care

1.3

1.4

1.5

1.6

1.6

1.7

1.9

1.0

1.0

1.1

1.1

1.1

1.2

1.3

2.7

3.0

3.4

3.6

4.0

4.4

5.1

1s,2

16,6

14.6

13.3

ILI! .:. ,.,+: White

.,, +

Black

12,4

10.5

1969 1970 1971 1972 1973 1974 197[)

NOTk k,, ,,,, M defined ascarebeginningin the th,,d ,nrm,,m of p,,smn,y

Figure 1. Percent of births where mother had late or no prenatal care, by race: Reporting areas, 1969-75
Table B. Percent distribution of live births by number of prenatal visits, according to race: Reporting areas, 1972-75

Race

All racesl

1975 ............................................

1974 ............................................

1973 ............................................

1972 ............................................

White

1975 ............................................

1974 ............................................

1973 ............................................

1972 ............................................

Black

1975 ............................................

1974 ............................................

1973 ............................................

1972 ............................................

Total

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

lIncl~des racm other than white and black.

None

1.0

1.1

1.2

1.3

0.7

0.7

0.7

0.8

2.3

2.8

3.2

3.5

—

1-2

—

2.2

2.3

2.6

2.8

1.5

1.6

1.7

1.9

5.2

5.6

6.1

6.8

—

34

4.6

4.8

5.1

5.6

3.3

3.5

3.7

4.1

10.0

10.4

11.3

12.3

educated groups. Ine&ibility for and th; inaccessibility of free medical care for women who

do not have enough money to pay for private

care are also major deterrents. Another obstacle

for many pregnant women is the difficulty in

arranging for medical visits, which often requires

making provisions for child care or arranging to

take time away from work. Additional deterrents for many are the forbidding settings and

brusqueness that may be encountered in maternity clinics. For the unmarried mother, a potent

factor causing delay in the initiation of care is

the desire to conceal pregnancy as long as possible.

Number of Prenatal Visits

According to standards recommended by the

American College of Obstetricians and Gynecologists, pregnant women should ideally be

seen at least once every 4 weeks for the first 28

weeks of pregnancy, every 2 weeks until the

36th week, and weekly thereafter. This amounts

to about 13 visits for a normal 38-week pregnancy. Women with health problems should of

necessity be seen more frequently.T The major

factors that determine the total number of

5-8

8.7

9.0

9.5

10.0

7.2

7.4

7.8

8.3

15.3

15.9

17.1

17.7

Number of prenatal visits

7-8

13.7

13.9

14.3

14.7

13.0

13.2

13.6

14.0

17.1

17.2

17.6

17.9

9-10

22.6

22.8

22.9

22.8

23.3

23.4

23.6

23.8

20.0

20.1

19.7

18.6

11-12

26.9

25.7

24.8

24.1

29.0

28.0

27.3

26.5

17.5

16.0

14.0

13.5

13-14

11.2

11.2

10.7

10.2

12.4

12.4

12.0

11.4

5.9

5.6

5.2

4.6

15-16

6.3

6.3

6.2

5.9

6.7

6.8

6.8

6.5

4.4

4.2

3.8

3.3

17-1 B

1.3

1.2

1.2

1.2

1.4

1.4

1.3

1.3

0.9

0.7

0.7

0.7

190r

more

1.5

1.7

1.4

1.4

1.5

1.7

1.5

1.4

1.4

1.6

1.2

1.1

more prevalent among low income and poorly prenatal visits are the time of the initiation of

care, the Ien@h of the gestationaI period, and

how frequently visits are made. These elements,

in turn, are often correlated with the health or

socioeconomic status of the mother. In 1975

only one-quarter of the variation in the total

number of prenatal visits made by white and

black mothers could be expktined in terms of

the timing of the first visit.a Thus length of gestation and frequency of visits were major determinants in the total care received.

Data on number of prenatal care visits have

been available since 1972. Since that year, the

proportion of black mothers making very few or

no prenatal visits has been consistently higher

than the comparable proportion of white

mothers. In 1975, 17.5 percent of all black

mothers limited their care to fewer than five

visits, in contrast to only 5.5 percent of white

mothers (table B). In 1972, the comparable proportions of women making fewer than five visits

were 22.6 percent for black mothers and 6.8

aThe relative explained variance (Y-2) between the

number of prenatal visits and month of pregnancy care

began was 0.25 in 1975 for white mothers and 0.26 for

black mothers.

5
percent for white mothers. Thus, the racial disparity in amount of care received remained quite

large, despite the proportionately greater gains

during this period for black mothers.

Gestational period. –Nine or more prenatal

visits has been defined as a minimum standard

for births of 36 weeks of gestation or longer,2

and is, therefore, used as a reference point in

this discussion. On the average, three-quarters of

all white mothers but only slightly more than

half of the black mothers met this minimum

criterion in 1975, despite greater gains for black

mothers since 1972, as shown in table C.

Table D presents the median number of

visits made for varying periods of gestation. For

mothers seeing a doctor at least once before

birth, the median number of visits made by

white mothers was 11.0 in 1975, relatively unchanged from the median of 10.8 in 1972. For

black mothers, the median number of visits increased from 8.2 in 1972 to 9.0 in 1975. As

would be expected, the longer the gestational

interval, the greater the median number of

visits. However, there was only a minimal increase in the median number of visits after the

40th week of gestation. In 1975, the median

number of visits made by white mothers still

remained between 16 and 20 percent greater

Table C. Percent of births where mother made nine prenatal

visits or more, by period of qestetion and race: Re~orting

areas, 1972 and 1975

Period of gestation

Total, 36 weeks and

over ........................

36 weeks ...................... .........

37-39 weeks ..........................

40 weeks ...............................

41-42 weeks ..........................

43 weeks and over ................

White I Black

1975 I 1972 I 1975 I 1972

Ill 75.9 72.9 52.9 45.4

56.4 52.2 37.8 31.4

72.0 68.9 50.0 42.5

78.1 75.4 55.7 49.0

80.2 77.8 58.5 51.4

78.4 76.6 57.1 51.0

than for black mothers for similar gestational

periods.

Trimester of prepancy prenatal care began. –There were only small increases between

1972 and 1975 in the median number of prenatal care visits made when care was started in

the same trimester of pregnancy (table E)I. The

increases were slightly greater, generally, for

black mothers than for white mothers. By 1975,

relative racial differences were most noticeable

when care began in the second trimester of pregnancy (8.8 visits for white mothers compared

Table D. Median number of prenatal visits, by period of gestation and race: Reporting areas, 1972 and 1975

[ ExcIudes births to mothers with no prenatal care]

All races2

1975 ...........................................................

1972 ...........................................................

White

1975 ..................................................... ......

1972 ...........................................................

Black

1975 ...................................................... .....

1972 ..................................................... ......

Total 1

10.7

10.4

11.0

10.8

9.0

8.2

Jnder 28

weeks

5.1

4.8

5.4

5.2

4.6

4.3

28-31

wee ks

6.4

6.1

6.7

6.4

5.7

5.5

32-35

weeks

8.1

7.8

8.5

8.2

7.1

6.6

Period of gestation

36

weeks

9.1

8.7

9.5

9.2

7.9

7.3

37-39

wee ks

10.4

10.1

10.6

10.4

9.1

8.4

40

weeks

11.1

10.8

11.2

11.0

9.6

9.0

41-42

weeks

11.4

11.2

11.6

11.4

9.9

9.2

43 weeks

and over

11.5

11.3

11.8

11.6

9.8

9.2

l~nclude5 not ~tated periodof gestation which is not shown Separately.

Z[ncludes races other than white and black.

6
Table E. Madian numbar of prenatal visits, by trimaster of pregnancy prenatal care began and rata: Reporting areas, 1972

and 1975

[Excludes births to mothers with no premtal care]

Race

All racesl

1975 .......................

1972 .......................

White

1975 .......................

1972 .......................

Black

7975 .......................

1972 .......................

All mothers

receiving

prenatal

care

10.8

10.4

11.1

10.8

9.1

8.2

Trimester of pregnancy

prenatal care began

First

11.5

11.4

11.6

11.5

10.6

10.1

Sacond

8.4

8.1

8.8

8.5

7.5

7.1

Third

4.6

4.4

4.9

4.6

4.2

4.0

lIncl”des races other than white and black

with 7.5 visits for bIack mothers) and least when

care started in the first trimester (11.6 visits for

white mothers compared with 10.6 visits for

bIack mothers). Detailed information for the year

1975 on the number of prenatal visits made according to the month of pregnancy care began is

presented in table 1.

The data shown in tables D and E suggest

that the overall increase between 1972 and 1975

in median number of prenatal visits made by

bIack mothers can be ascribed to an increase in

the average length of gestation and to the trend

to earlier initiation of care as well as to a greater

frequency of visits. Table D shows that for each

period-of-gestation category the increase in

median number of visits from 1972 to 1975 was

less than the increase for all gestational periods

combined. This seeming anomaly is explained by

the fact that during this time the distribution of

black births by gestational period shifted to

slightly longer gestations. For example, the percent born at 37 weeks or more increased from

82.3 to 83.9 percent. The overall increment in

median number of visits for all gestational

periods combined reflects this increase in proportion of full-term births, where the average

number of visits is greater. Similarly, when comparing the median number of visits made in

1972 and 1975 by black mothers who started

care in like trimesters of pregnancy (table E),

the gain is greater for all trimesters combined

than for any individual trimester, a reflection of

the trend toward earlier care. In 1972, 49.0 percent of black mothers started care in the first

trimester of pregnancy compared with 55.8

percent in 1975.

The small overall increase in the average

number of visits made by white mothers, however, can be attributed mainly to an increased

frequency of visits, since this increment is generalIy equal to or is less than the increases seen

for individual periods of gestation or trimesters

of pregnancy.

DEMOGRAPHIC AND SOCIAL

CHARACTERISTICS

Age of Mother

Teenage mothers. –Teenage girls were less

likely to start prenatal care early in pregnancy

than any other age group of women, with the

exception of mothers aged 45 years or more

(table F). In 1975, only 30.5 percent of very

young white mothers (those under 15 years of

age) and 31.4 percent of black mothers in this

age group started care in the first trimester of

pregnancy. The situation was more favorable for

older teenagers, with 56.7 percent of the white

mothers and 45.2 percent of the black mothers

aged 15-19 years starting care this early. Among

these oIder teenagers, there was a greater likelihood of care starting early with each successively higher year of age.

In 1975, 23 percent of all white births to

teenage mothers and 78 percent of all black

births to teenagers were out of wedlock. The

low percentage of teenage mothers initiating

care early may thus be a consequence of the

very large proportions of such mothers who

were unmarried. (A further discussion of patterns of care for unwed mothers is presented in

the section, “Marital Status of Mother.”)

A major biological problem of pregnancy for

young mothers is that the demands of the growing fetus are superimposed on the nutritional

needs of teenagers who are often themselves still

7
Table F. Percent distribution of live births by month of pregnancy prenatal care began, according to aga of mother and race of child:

Total of 42 reportinq States and tha District of Columbia. 1975

Total

Month of pregnancy

prenatal care began

Age of mother and race of child No

pre1St

and

2d

4th6th

7th9th 3d

natal

care

All racesl .................................... .................................... .................. ............ 100.0 45.5 26.8 21.6 4.7 1.3

Under 15 years ................................................................... .... .......................................

15-19 years ................................................................................. .. .................................

15 yeara ............................................................................................................... ....

16 years ................................................................................. .......... ........................

17 years ...................................................................................................................

18 years ...................................... .................................... .........................................

19 years ...................................................... .............................................................

20-24 years ...................... .......................... ............................ ................ ................ ........

25-29 years ................. ...................................................................................................

30-34 years ............................................................................ ................................ ........

35-39 years ................................. .................................... .................7.............................

4044 years ........................ ........................ ................ ....................................................

45-49 years ......................... ...... ........ .......... .................................................... ...... .........

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

14.5

27.8

18.5

20.9

24.5

28.1

33.9

46.1

54.3

51.7

43.3

34.9

26.4

48.5

16.4

25.5

21.2

23.4

25.2

25.9

26.8

27.3

27.1

27.2

27.0

26.1

23.1

27.4

48.0

35.8

44.3

42.5

38.7

35.5

30.4

20,8

15.0

16.9

23.0

28.6

37.1

19.1

16.2

8.5

12.6

10.4

9.2

8.3

7.0

4,5

2.8

3.3

5.0

7.8

8.4

3.9

4.9

2.3

3.4

2.8

2.4

2.2

1.9

1.3

0.8

1.0

1.7

2.7

5.0

White ............... ................ .............. .................................................................... . 1.0

Under 15 yaan .. .......... .............................................................. ............ ........................

15-19 yaars ................................ ................ ....................................................................

15 years ................ ................................ ...... ...................................................... .......

16 years ................................ ................ ...................................................................

17 years ................................................ .................................... ........................ .......

18 years ...................................................................................................................

19 years ................................................ ................ .............................. .............. .......

20-24 yaars ............ ............ ...................................... .............................. ................ ........

25-29 years ............................................................................................................. .......

30-34 years ........................ .............................................................. ..............................

35-39 years ................. ........ ...........................................................................................

40-44 years ........................ ........................ ...................................................... ..............

4549 years ........... .........................................................................................................

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

15.2

30.0

19.4

22.1

25.9

29.9

36.4

48.8

56.3

53.7

45.1

36.8

28.1

31.6

15.3

26.7

21.9

24.6

26.4

27.1

27.8

27.9

27.3

27.5

27.7

26.5

24.6

24.2

46.4

33.5

42.6

40.8

37.0

33.7

28.0

18.5

13.4

15.2

21.3

26.9

33.3

33.7

17.7

7.9

12.9

10.1

8.7

7.6

6.3

3.8

2.3

2.8

4.5

::;

7.8

5.5

1.9

3.2

2.5

2.0

1.8

1.5

1.0

0.6

0.8

1.4

2.5

5.5

Black ............... .. ........ ...................................... ............................ ....................... 2.7

Under 15 years ..............................................................................................................

15-19 yearn ................................................ .. ...... .. ...... ...................... .. ........ ....................

15 yeara ................................ .. .............. .............................................................. .....

16 years .......................................... ...... .. .................................................................

17 years .......................................................... .................................................. .......

1B years ............................................................................................................... ....

19 years .................. ........ ............................................................ .............................

20-24 years ............................................................ ........................................................

25-29 years ................................................... ........................................ .........................

30-34 years .................... .. ............................................ .......... ............ ............................

35-39 years ............. ................................ ............................ ........................ ........ ...........

40-44 years ................ ............................................ ................ ........................................

4549 years ..................... ...................................... .. ......................................................o

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

14.1

22.5

17.6

18.8

21.2

23.4

26.3

33.5

40.7

39.0

33.1

27.6

21.2

17.3

22.7

20.3

21.6

22.9

23.0

23.8

24.6

25.7

25.2

24.5

24.1

18.4

49.3

41.6

46.4

45.7

42.7

40.5

37.9

31.8

26.2

27.8

32.3

36.1

50.6

14.9

9.9

11.9

10.7

9.8

9.7

9.1

7.4

5.4

5.8

7.0

9.1

7.1

4.4

3.2

3.7

3.3

3.3

3.3

3.0

$:

2.3

3.1

3.1

2.7

lIncludes races Other than white and black.

in the growth stage. The resulting competition nancy and iron deficiency anemia appear to be

for nutrients–all too often obtained from an in- special hazards for very young mothers. 1‘0 Yet

adequate dietg —may result in low-birth-weight i; is evident that this age &oup-is less likely than

babies who are more likely to suffer injury, sick- most others to receive the early medical attenness, and death.4 In addition, toxemia of preg- tion that would provide the opportunity fc)r cor8
rective medical and nutritional measures to be

initiated.

Other age groups. –Mothers in the later years

of childbearing (40 years and over) were also less

likely to start prenatal care early (table F). As

with teenagers, the racial differential is quite

large. In 1975, between 53 and 63 percent of all

white mothers past age 39 initiated prenatal care

in the first trimester compared with 40-52 percent of black mothers. In contrast, in the age

groups 20-39 years, between 73 and 84 percent

of the white mothers and 58-66 percent of the

black mothers started care this early.

Late or no care. –Table G presents the percent of mothers starting care as late as the third

trimester or receiving no care in 1969 and 1975,

by the age of the mother. The proportion of

white mothers with late or no care declined for

all age groups except for women aged 40 years

and over. The relative drop in this proportion

was greatest for mothers aged 25-29 and 30-34

years and least for teenage girls and for women

aged 35-39 years. For black mothers, the decline

in late or no care was substantial for all ages, and

in aU instances, these declines far exceeded those

for white mothers. Despite these greater declines

for black mothers, by 1975 the overall percent

of black mothers receiving late or no care was

twice that of white mothers (10.5 percent compared with 5.0 percent).

In 1975, women aged 25-29 years were least

likely to start care late or have no care (3.0 percent of white mothers and 7.4 percent of black

mothers). The proportion of mothers who had

late or no care increased from these lows as the

age of the mother increased or decreased (table

G and figure 2). For women aged 45-49 years,

the percent with late or no care was 14.0 for

white mothers and 9.8 for black mothers; for

girls under 15 years of age the comparable

figures were 23.1 percent and 19.3 percent, respectively. The only two age groups where white

mothers were more apt than black mothers were

to receive late or no care were very young

mothers (less than 15 years old) and women in

the oldest years of childbearing (ages 45 years or

more).

Birth Order

Women bearing their first child were not as

likely to start care in the first trimester of pregnancy as were women bearing their second child

(table H). This is probably due to the fact that a

higher proportion of first than of second births

are to teenage mothers or are out of wedlock. As

already noted, these two characteristics are

closely associated with delay in seeking care.

The proportion of mothers starting care early

decreased with successive births after the second

birth. In 1975, 72.3 percent of the women bearing their first child had early care compared with

76.5 percent of women having their second

child. Only 55.5 percent of the mothers having a

fifth or higher order birth started care early.

Table G. Parcent of live births where mother received latel or no prenatal care,by age of mother and race of child: Reporting areas,

1969 and 1975

All races2 White Black

Age of mother

1975 1969 1975 1969 1975 1969

All ages...................................................................................................... 6.0 8.2 5.0 6-4 10.5 18.2

Under 15 years........................................................................................................... 21.1 26.9 23.1 25.2 19.3 27.8

15-19 years ................................................................................................................ 10.8 13.9 9.8 11.1 13.2 21.7

20-24 years ................................................................................................................ 5.8 7.7 4.8 6.1 10.0 17.4

25-29 years ................................................................................................................ 3.6 5.5 3.0 4.3 7.4 15.0

30-34 years ................................................................................................................ 4.2 6.7 3.6 5-3 8-0 15.5

35-39 years ................................................................................................................ 6.7 8.7 5.9 7.2 10.1 16.7

40-44 years ................................................................................................................ 10.5 10.4 9.8 8.8 12.2 18.8

45-49 years ................................................................................................................ 13.4 12.8 14.0 11.2 9.8 20.7

lcare initiated in the third trimester Of pregnancY.

21ncludes races other than white and black.
25

20

15

10

5

0

:

23.1

13,2

10,0

Under 15.19 20.24

15 yam yews years

NOTE Me care 1,d,fimd ,, care bc~nning m !hc third mmmter .f WW,”CY

•iBsl White

Black

12,2

10.1

2529 30.34 3539

years years yews

AGE OF MOTHER

40.44

years

14,0

45.49

years

Figure 2. Percent of births where mother had late or no prenatal care, by age of mother and race: Reporting areas, 1975

Between 1969 and 1975, there was only a

small increase (3 percentage points) in the proportion of white mothers havirw their first or

second child who initiated care in the first trimester of pregnancy. For white mothers of

higher order births, the gain was even less. Concomitzmtly, the proportion of white mothers

with late or no care dropped slightly for all

orders, except fifth and higher, where this proportion rose slightly. Regardless of the birth

order of the child, black mothers showed substantial improvement in the proportion starting

care early (increases ranging between 11 and 14

percentage points) and reduction in proportion

receiving late or no care. For both races, the improvement in early care was due primarily to the

increase in the proportion of mothers who

started care in the first 2 months of pregnancy.

Age and birth order. –The interrelationship

of the time of initiation of care, the age of the

mother, and birth order of the child is presented

in table J. Within each age group, the general

pattern is that care is less likely to start early

with each successive birth. For exampl q 78.9

percent of the mothers aged 20-24 years bearing

their first child started care in the first trimester

of pregnancy compared with 60.6 percent of the

mothers in this age group bearing their third

child. A study of women who had given birth to

one or more” children revealed that though the

great majority knew it was desirable that care be

initiated during the first trimester of pregnancy,

the proportion actually following this regimen

was considerably less. The gap bet ween performance and belief widened with increasing numbers of children.11 Regardless of age of mother,

the presence of other children in the home, particularly preschool children, may thus be a critical factor causing a delay in seeking care.

Since age of the mother and birth order of

the child are such imporant determinants in the

utilization of care, an effort was made to see

how much of the changing pattern of care described earlier can be ascribed to changes in age

of motherhood and in the proportion of loworder births that have taken place since 1969.

The increase in low-order births since 1969

would tend to enhance any trend towards earlier

initiation of care, while the small increase in proportion of teenage mothers would have the opposite effect.

To determine how much of the modification

in distribution of care between 1969 and 1975

was a result of the net effect of these changes,

10
Table H. Percent distribution of live births by month of pregnancy prenatal care began, according to live-bi~h order and race: Reporting

areas. 1969 and 1975

Live-birth order and month of pregnancy prenatal care began

All birth orders ........... .................................. ........ .................... ...........

Ist and 2d month .................................................................................................

3d month ...................................................... ........ ...............................................

4th-6th month ........................................................................................ .............

7th-9th month .......... ................ ............ ................ ...............................................

No prenatal care .... ...... .......................... ................................................ ............. .

First child .......................................................................................... ........

Ist and 2d month .............. .............. .......................... .............. .................... .........

3d month ..................................................................................................... ........

4th-6th month ............................... ...... ...................... ............ .............. ................

7th-9th month ....................... ................................................ ..............................

No prenatal mre ......................................................................................... ..........

Second child .............................. .................................. ...... ........................

1st and 2d month ... ..............................................................................................

3d month ................... .. .................................... ............................ .............. ..........

4th-6th month ................................................................... ........................ ..........

7th4Mh month ... .......................................................... .............. ..........................

No prenatal care . .............................. ...... ............................................ ..................

Third child .......................................... ...................... ................................

Ist and 2d month .................. ........................................................... ....................

3d month ....................... .. ...................... ........................................ ......................

4th-6th month .....................................................................................................

7th-9th month ....... ........ ...................... ........ ........................................................

No prenatal care ......................................... ............................ ..............................

Fourth child ............... .......................... .......... .................... .................... ...

Ist and 2d month ................................. .................................. ...... ........................

3d month .......... .............. ...... ...............................................................................

4th-6th month ...................................................................................... .... ...........

7th-9th month ...................... .................... .. .............. ............................ ...............

No prenatal care ...................................................................... .............................

Fifth child and over ............................................. ................ ......................

Ist and 2d month .................................................................................. .............. .

3d month ..................................... ........................................................................

4th-8th month ............. ................ ...... .. ...................................................... ..........

7th-9th month ....... .................... ...................................... ....................................

No prenatal care ......................................... ...... .......................................... ..........

Ail racesl

+

1975 1969

100.0 100.0

45.5 41.5

26.8 26.5

21.6 23.9

4.7 6.3

1.3 1.9

100.0 100.0

45.7 42.8

26.5 25.8

22.1 23.8

4.5 6.1

1.1 1.4

100.0 100.0

49.3 45.4

27.3 27.4

18.6 20.5

3.8 5.1

1.1 1.6

100.0 100.0

45.1 42.3

27.5 27.9

21.5 22.5

4.6 5.5

1.4 1.8

100.0 100.0

39.6 37.8

27.1 27.2

25.2 26.1

6.0 6.6

2.1 2.3

100.0 100.0

30.8 28.7

24.7 24.1

31.3 32.3

9.4 10.8

3.8 4.1

White Black

1975 1969 1975 1969

100.0 100.0 100.0 100.0

48.5 44.7 31.6 22.8

27.4 27.7 24.2 19.9

19.1 21.2 33.7 39.1

3.9 5.0 7.8 13.1

1.0 1.3 2.7 5.1

100.0 100.0 100.0 100.0

48.7 46.1 31.0 23.5

27.0 26.7 24.5 20.6

19.6 21.1 34.8 40.2

3.9 5.0 7.4 12.0

0.9 1.0 2.2 3.7

100.0 100.0 100.0 100.0

52.0 46.4 34.1 24.3

27.8 28.5 24.2 20.2

16.3 18.2 31.5 37.0

3.1 3.9 7.5 13.1

0.8 1.0 2.7 5.3

100.0 100.0 100.0 100.0

47.9 45.2 32.3 23.1

28.2 29.1 24.3 19.8

19.1 20.2 32.7 38.1

3.8 4.2 7.7 13.3

1.1 1.2 2.9 5.7

100.0 100.0 100.0 100.0

42.1 40.6 30.7 22.0

28.1 28.6 23.8 19.9

22.9 23.7 33.8 39.2

5.3 5.4 8.2 13.1

1.7 1.7 3.5 5.8

100.0 100.0 100.0 100.0

32.6 31.7 26.6 19.5

25.7 26.0 22.6 18.1

29.3 29.9 36.9 40.5

9.1 9.3 9.6 15.1

3.5 3.1 4.3 6.9

lIn~l~des races other than white and black

the direct method of standardization was used. tion of black births since 1969 accounted for

The results are shown in table K. only a very smalI part of the increase in proporFor white mothers, slightly more than half tion of mothers receiving early care. Nearly 90

of the modest gain in early care (care beginning percent of the substantial gain in early care for

in the first trimester) between 1969 and 1975 black mothers can thus be attributed to other

can be attributed to the net effect of age and factors.

birth-order changes during this period. By con- Ab-nber of visits. –For those mothers who

trast, the changes in age and birth-order distribu- made at Ieast one visit for prenatal care, there

11
Table J. Percent of live births where prenatal care was initiated in the first trimester of pregnancy, by age of mother, live-birth order,

and race of child: Total of 42 reporting States and tha District of Columbia, 1975

Age of mother

All Live-birth order and race of child T

20-24 25-29

years years

73.4 81.5

years

ages Under

20 years

72.4 52.9 76.9 I 60.3

78.9 87.3

73.1 85.4

60.6 77.7

49.1 66.8

41.1 52.2

76.7 83.7

81.2 88.7

76.0 86.9

64.2 79.9

51.2 69.6

40.7 53.8

58.1 66.4

64.7 76.1

58.8 72.4

50.9 65.0

46.2 57.2

42.3 49.8

84.3 71.8

85.6 73.9

81.2 71.3

74.7 68.6

58.7 53.2

79.3 62.7

72.3

76.5

72.6

66.7

55.5

75.9

54.3

48.6

40.3

37.4

33.6

56.4

75.7

79.8

76.0

70.2

58.2

55.8

57.4

52.9

42.4

41.0

41.3

44.6

46.3

40.6

38.2

35.3

28.4 4

85.6 72.9

87.2 75.1

83.1 73.3

76.9 69.6

61.4 55.7

62.3 51.0

74.8 63.4

73.2 64.8

67.7 61.4

62.7 61.2

50.9 46.6

First child ........................................ .................. ............................................

Second child .............................................................. ....................................

Third child .....................................................................................................

Fourth child ..................................... ........ .. ...................................................

Fifth child and over ........................................................................... ............

55.6

58.3

56.7

54.5

49.2

lInclude~ ~aceSother than white and black.

Table K. Observed and standardized parcent distribution of live

births, by month of pregnancy prenatal care began and

race: Reporting araas, 1969 and 1975

was little change between 1972 and 1975 in the

totzd number ;f prenatal visits, regardless of the

birth order of the child (table L). For each birth

order, the median number of visits made by

white mothers increased by only 2-3 percent

during this period. Increases in the median number of visits for each order were far hi~her for

black mothers, ranging from 8 percent for first

births to 11 percent for second and fihh and

higher order births. Because of this greater increase in utilization of care by black mothers,

the racial differential for each order narrowed

somewhat. By 1975, however, white mothers

still averaged between 17 and 22 percent more

visits than black mothers did for each order.

For both races, the highest median numbers

of visits in 1975 were for first and second order

births (an average of 11.2 visits for white first

and second order births compared with 9,,2visits

for black first order births and 9.3 visits for

black second order births). The median number

of visits declined thereafter with each successive

birth to a low of 9.8 and 8.4 visits for white and

black fifth and higher order births, respectively.

Month of pregnancy prenatal

care began and race

White

Total ..,......,.,,.......,,.....,,,

lst-3d month,,, .............. ...........

4th-6th month ..........................

7th-9th month ..........................

No prenatal cara ....... .......... ......

Black

Total ., ............................

lst-3d month,, ..........................

4th-6th month,,, ...................... .

7th-9th month ..........................

No prenatal care ...................... .

1975

1969 Standardized 1

Observed

100.0 100.0

75.9

19,1

3.9

1.0

100.0

100.0

73.9

20,4

4.5

1.3

100.0

72.4

21.2

5.0

1.3

100,0

42.7

39.1

13.1

5.1

55.8

33.7

7.8

2.7

54.2

34.6

8.2

3.0

lstandardi~ed by the direct method on the basis of the age

of mother and birth-order distribution of births in 1969; see

Technical Appendix.

12
Table L. Median number of prenatal visits, by live-birth order and race: Reporting areas, 1972 and 1975

[Excludes births to mothers with no prenatal care]

Race

All racesl

1975 ........................................................................ .................................

1972 ................................... ............................................ ..........................

White

1975 ............. ............................................ ........ ............ .......................... ..

1972 ........................................................ .................................................

Black

1975 .........................................................................................................

1972 ......................................... .................... ............................................

1lnclude~ races other than white and black.

Marital Status of Mother

The number of out-of-wedlockb births has

risen steadily in the last few decades. Moreover,

the proportion of all births that are out of wedlock has also shown a long-term rise. In 1969,

there were an estimated 360,800 out-of-wedlock

births, representing 10 percent of all live births.

By 1975, the estimated number of out-ofwedlock births had risen to 447,900 despite a

general decline in the total number of births

during this period. As a result, the proportion of

all births that were out of wedlock increased to

14 percent in 1976.

The risk of a low-birth-weight outcome in

1975 was 67 percent higher for illegitimate than

for legitimate white births (10.0 percent compared with 6.0 percent) and 30 percent higher

for illegitimate than for legitimate black births

(15.0 percent compared with 11.5 percent).

Low birth weight in turn has been shown to be

associated with an increased risk of both physical and mental impairment, and a higher rate of

infant mortality, as noted earlier. The critical

need for adequate prenatal care for unmarried

pregnant women is thus clearly evident.

bThe term “illegitimate “ is used occasionally for

convenience in writing.

All mothers

receiving

prenatal

care

10.8

10.4

11.1

10.8

9.1

8.3

First

:hild

10.9

10.6

11.2

10.9

9.2

8.5

Live-birth ordar

Sacond

ch iId

11.0

10.7

11.2

11.0

9.3

8.4

Third

child

10.7

10.4

11.0

10.8

9.1

8.3

Fourth

child

10.3

10.0

10.6

10.3

8.9

8.1

Fifth

child

and

over

9.4

9.0

9.8

9.5

8.4

7.6

Unmarried women encounter the whole

range of deterrents to prenatal care that married

women do. In addition, some deterrents, such as

the desire to conceal pregnancy or to deny the

existence of the pregnancy, are uniquely associated with unmarried status ‘—tid are potenf factors in delaying prenatal care.8 In 1975, 16.2

percent of all unwed mothers had no care or

started care as late as the third trimester of pregnancy. The comparable figure for married

mothers was 4.3 percent. Less than half (43.5

percent) of the unmarried mothers had care

starting as early as the first trimester of pregnancy compared with over three-quarters (76.7

percent) of the married mothers (table M).

Racial differences in the timing of care were

far less pronounced among unmarried than

among married mothers. Indeed, care was generally started earlier and there were proportionately fewer unmarried black than white

mothers having late or no care. The proportion

of unmarried black mothers starting care in the

first trimester of pregnancy was 45.4 percent

compared with 41.4 percent of white unmarried

mothers. The proportion of unmarried black

mothers with late or no care was 13.6 percent

compared with 18.9 percent of unmarried white

mothers. Among married women, however, the

13
Table M. Percent distribution of live births by month of pregnancy prenatal care began, according to legitimacy status and race: Total of

33 reporting Statesand the District of Columbia, 1975

Legitimacy status and race

All racesl ................. .....................................................................................

White. .................................................................................................................

Black ... .................................... .. .............. .. ........ ............ ................................ .....

Legitimate births ...........................................................................................................

Illegitimate births .............................. ........................................ ....................................

lIncl~des races other than white and black.

situation was more favorable for white than for

black mothers. Care was initiated in the first

trimester for 78.4 percent of the white married

mothers compared with 63.9 percent of the

black married mothers; the proportion of black

married mothers starting care late or having no

care was nearly double that of white married

mothers (7.5 percent compared with 3.9 percent).

Figure 3 presents the changes that have

taken place since 1969 in the proportion of

mothers with late or no care by race and legitimacy status of the child. Although a reduction

can be seen for each group, the greatest declines

were for black mothers, both married and unmarried. Between 1969 and 1975, the proportion of black mothers receiving late or no care

dropped by about half (from 14.9 to 7.5 percent

for married women and from 26.0 to 13.6 percent for unmarried women). For white mothers,

the comparable declines were 26 percent for

married women (from 5.3 to 3.9 percent) and

30 percent for unmarried women (from 26.9 to

18.9 percent).

Educational Attainment of Mother

Items on educational attainment of parents

have been included on birth certificates in recent

Total

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Month of pregnancy

prenatal care began

T

1St 4thand 3d

2d

6th

Tr 44.7 27,3 22.0

48.4 28.3 19.0

21.9 21.6 40.3

47.7 28.0 19.3

4+49.8 28.6 17.8

20.3 21.1 39.7

30.7 24.1 34.7

37.9 26.0 28.7

23.2 22.2 41.0

No

7th- pre9th natal

care

4.7 1.4

3.5 0.9

11.9 4.3

3.9 1.0

3.1 0.8

14.2 4.7

7.7 2.7

5.8 1.7

9.8 3.8

30 r

I

I

la 1969

❑ 1975

26.0

—

Whine Black White alack

Iegmmate Iegit, mare illegmmate

bmhs

dlegitimate

births brths births

NOTk. MC ..re u defined .s wc bcgmnmgm the flurd mnm$!cr of prqmm.y

Firwre 3. Percent of births where mother received late or no

prenatal care, by legitimacy status and race: Fleporting

areas, 1969 and 1975

14
years to provide a measure of the socioeconomic

status of the family. Data on education of the

mother are particularly useful in measuring

socioeconomic differences since information

about the father is often missing for out-of-wedlock births.

The point in pregnancy at which a mother

seeks prenatal care is directly related to the

years of schooling she has completed. Mothers

with low educational attainment are less apt to

start care early in pregnancy than are mothers

with more adequate schooling.c In 1975, only

50.7 percent of the mothers who had completed

8 years of schooling or less started care in the

first trimester of pregnancy, compared with 76.0

percent of the mothers who had 12 years of

schooliig only, and 85.4 percent of the mothers

with 13 years of schooling or more (table N).

Differences in the proportion of mothers with

late or no care in relation to educational attainment are even more striking. Only 4.2 percent

of the mothers who had completed high school

only and 2.1 percent of the mothers with more

than 12 years of schooling delayed care until the

third trimester of pregnancy or received no care,

compared with 14.4 percent of the mothers who

had completed 8 years of schooling or less.

Similarly, large differences in care received according to educational attainment were seen for

each racial group (figure 4).

Since 1969, there has been an increase in the

proportion of mothers at all educational levels

starting care early, with a concomitant decrease

in proportion having late or no care. However,

at each educational level, the gains have been

relatively greater for black than for white

mothers.

Racial differences in the timing of care were

not as noticeable for women with low educational attainment (O-8 years of schooling) as for

women with higher levels of schooling, as shown

in table O, which is based on data for the year

1975.

Place of Residence

There are extremely large variations in the

prenatal care pregnant women receive according

cMany of these mothers are, of course, young

teenagers who have not had the opportunity to complete

their schooling. In 1975, teenagers comprised 31 percent

of all mothers having 8 years of schooling or less and 46

percent of the mothers with 9-11 years of schooling.

to State of residence (table P and tables 2 and

3). Moreover, within each State there is a generally consistent pattern of higher levels of late

or no care for black than for white mothers. In

1975, the proportion of white mothers with late

or no care varied from a low of 1.6 percent

(Utah) to a high of 11.0 percent (Arizona); for

black mothers the proportion with late or no

care ranged from 1.6 percent (Maine) to 18.3

percent (West Viginia). There was an even wider

variation among States in the care received by

women of other races. However, when interpreting these data, it should be borne in mind that

the category “other races” includes a wide diversity of racial and ethnic groups (see Technical

Appendix) with varying representation from

State to State. Additionally, for both the

‘black” and “other races” categories, the percents shown are frequently based on relatively

small numbers that may cause Iarge year-to-year

fluctuations.

For many reporting States, there was a

noticeable reduction between 1969 and 1975 in

the proportion of mothers with late or no care.

The decreases were generaUy far more substantial for black than for white mothers. However,

as noted eaxlier, the level of late or no care within each State generally remained substantially

higher for black mothers at the end of this

period.

Women living in metropolitan areas tended

to make more prenatal visits than did women living in nonmetropolitan areas (table Q). In 1975,

white mothers living in metropolitan areas averaged 11.4 prenatal visits, about 8 percent more

than did their counterparts living in nonmetropolitan areas, who averaged 10.6 visits. Black

mothers averaged fewer visits for prenatal care

than white mothers did in both metropolitan

areas and nonmetropolitan areas. Additionally,

the difference in number of visits between these

two types of areas was nearly twice as great for

black as for white mothers. In metropolitan

areas, black mothers averaged 9.5 prenatal

visits, 14 percent more than did black mothers

in nonrnetropolitan areas who averaged 8.3

visits. Both white and black mothers living in

—large urban places within metropolitan areas.——

averaged slightly fewe~pren=id vi;its th&” did

their counterparts res~g in less - urbanized

portions of metropolitan areas.

15
Table N. Percent distribution of live births by month of pregnancy prenatal care began, according to educational attainment of mother

and race of child: Reporting areas, 1969 and 1975

Yaars of school completed by mothar and race of child

Al I racesl

All levels of schooling:

1975 ........................................................................................................................

1969 .................................................................................................. ......................

O-8 years:

1975 .......................................................... ..............................................................

1969 ..... ...... .. ...... .......... ...... .......... ...... .....................................................................

9-11 yaars:

1975 ................................................................ ........................................ ................

1969 ........................................................................................................................

12 years:

1975 ........... .............. .. ...... .. ................ ............................................ ........ .................

1969 ........................................................ ........................................ ........................

13 years or more:

1975. ........................................................ .................................................... ...........

1969 ........................ .......... ............................ ................................................ ..........

White

All levels of schooling:

1975 ......................................... ...............................................................................

1969 ........................................ ................................................................................

O-B years:

1975 .............. ................! ..................... ....................................................................

1969 ............................................. .......... .................................................................

9-11 years:

1975 ............................................................................................................ ............

1969 ........................................................................................................................

13 years or more:

1975 !........ ...............................................................................................................

1969 ........................................................................................................................

Black

All levels of schooling:

1975 ....................................... .. ........ ...... .. ............................................................$..

1969 ................ ........ ...... .......... ...... .... ...... .............. .. ...... .......... ................ .............. ..

O-S vears:

i975 ............................................. ...........................................................................

1969 ........................................................................................................................

See footnote at end of table.

Total

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

1St

and

2d

45.4

41.5

27.5

24.4

31.0

30.0

47.6

44.6

58.3

53.4

48.8

44.9

29.3

27.1

34.0

34.5

50.5

47.2

60.0

54.7

30.7

22.6

21.9

16.0

Month of pregnancy

prenatal care began

3d

27.1

26,7

23.3

21.0

25.6

23.9

28.4

28.5

27.2

27.8

27.9

28.0

24.0

22.4

26.9

26.1

29.1

29.5

27.4

28.1

23.8

19.4

20.9

16.9

4th6th

21.8

24.0

34.9

35.8

33.2

32.9

19.8

21.5

12.4

15.6

18.9

21.2

33.0

33.8

30.4

29.4

17.2

19.3

11.0

14.6

34.6

39.6

41.4

43.0

7th9th

4.6

6.3

11.2

14.0

8.1

10.3

3.5

4.5

1.8

2.8

3.7

4.9

10.8

12.8

7.2

8.2

2.7

3.5

1.4

2.4

8.2

73.7

11.8

17.3

No

prenatal

care

1.1

1,6

3.2

4.8

2.1

2.9

0.7

0.9

0.3

0.4

0.7

1.0

2.8

3.8

1.4

1.9

0.5

0.5

0.2

0.2

2.7

4.7

4.0

6.8

16
Table N. Percent distribution of live births by month of pregnancy prenatal care began, according to educational attainment of mother

and race of child: Reporting areas, 1969 and 1975–Con.

Years of school completed by mother and race of child

Black–Con.

9-11 years:

1975 ............................................................. ...........................................................

1969 ........................................ ............ .. ...... ............ ...... .......................... ................

12 years:

1975 .... .................................... .... ................ ............ ................................................

1969 ......... .. ........................................ ...... .............. ............ ..................... ........... O....

13 years or more:

1975 ....... .............. .. .............. ...... .. ...... ...... ...... .. ...... ...... ...... ........ ........................ .....

1869 .............. .. ............................ ............ ................................................................

Total

100.0

100.0

100.0

100.0

100.0

100.0

1St

and

2d

24.1

17.3

33.2

26.1

46.1

38.9

Month of pregnancy

prenatal care began

3d

22.6

17.6

25.0

21.0

25.3

23.8

4th6th

40.0

43.3

32.6

37.7

22.8

28.0

T

No

7th- pra9th natal

care

9.8 3.5

15.9 5.8

7.2 2.1

11.7 3.5

4.8 1.0

7.3 1.9

lIncludes races other then white end black.

Table O. Percant of mothers starting care in first trimester of

I 15.7

13.3

•I Whke

H

Bl=k

9,2

0.s 9-11 12 13 or

mors

YEARS OF SCHOOL cOMPLETED

NOTS: lateme h dalnedM art beslnnhvInthethird!rhnmlerofprqnmcy.

Figure 4. Percent of births whera mother had late or no care, by

educational attainment of mother and race: 39 reporting

States and the District of Columbia, 1975

For mothers living in both metropolitan and

nonrnetropolitan areq irzc=sing education~

attainment is associated with a greater number

of prenatal visits. Women residing in metropolitan areas who had completed 16 years of

schooling or more averaged 31 percent more

pregnancy and percent of mothers with late or no care, by

educational attainment of mother and race: Total of 42

reporting States and the District of Columbia, 1975

Reca

White ........................................

Black .........................................

White .................................. ......

81ack ....... ............................ ......

Years of school completed

by mother

Percent of mothers starting

care in first trimaster

of pregnancy

53.4 I

78.1

42.8 55.6

Percent of mothers with

late or no care

13.6

I

3.8

15.7 10.3

prenatal care visits than did women with only

8 years of schooling or Iess living in these areas;

the comparable difference for residents of nonmetropolitan areaswas 37 percent.

Differences in the average number of visits

by area of residence are reduced as the educational attainment of the mother increases (table

Q). For example, mothers with 8 years of

17
Table Q. Madian number of prenatal visits in metropolitan and nonmetropolitan areas and in urban places of 50,000 population or

more, by educational attainment of mother and race of child: Total of 37 reporting States and the District of Columbia, 1975

[Excludes births to mothers with no prenatal care]

Metropolitan areas I

Years of school completed by mother and race of child AH

areas

All racesl ........ ...... ........ .. .... ...... ........ .. .... ...... ............................ ...... ............ .. ...

O-8 years ................... ................ ................ .... ............................................................ .......

9-11 years ......... ........ ................ ...... .............. ...... ...... .................... ...... .. .... .. .... .............. ...

12years ..... .................... .......... ...... ............ .............. ...... .................... ............ .. ................

13-15 years .................... ........ ............................ .... ..........................................................

16 years or more .... ...................... ............ ............ .. .............................................. ...... ......

White .............. .................... ...... .............. ...... .. .... ..................................................

o-8 years .. ........ .............. ........ .................. ...................... .......................... ........................

9-11 years ...... ...... ...... .. ........ ............ .. ...... ...... ...... .................... ................................ ...... ..

12 years ........................... .............................. ..................................................................

13-15 years .............................. ...... .................... ...... .. .................. .................. ..................

16 years or more .... .. ...................... ...... ............ .. ...... ............ .................... .................. ......

Bl=k ............................... .............. ............ .. .................. ........................................

O-B years ... ...... .. .... .............................. .. ...... ...... ........ ...... .............. ...... ...... .................... ...

9-11 years ............. .............. .......... ...... ................................ ...... .............. .............. ...........

12 years ... .......................................... .................. .. ............ ...... ........................................

13-15 years ............... ...... ................ ........ ...... ...... ...... .. .... ................ .................................

16 years or more ..... .. ............ ........ ...... .. ........ .... .. ...... ........ .... .. ...... ...... .............................

10.8

8,6

9.5

11.0

11.5

11.7

11.1

9.1

10.0

11.2

11.6

11.8

9.1

7.5

8.2

9.5

10,4

11.4

l~ncludes races other than white and black.

PRENATAL CARE AND

LOW BIRTH WEIGHT

Reduction in number of low-birth-weight

babies has been “one of the prime objectives of

all programs of prenatal care. As noted earlier,

Iow birth weight is associated with a greatly increased frequency of infant mortality and morbidity. Weight at birth is known to be correlated

with such factors as gestational age, race, age of

mother (data from the National Center for Health

Statistics), weight gain during pregnancy,lz cigarette smoking, 13 and socioeconomic status.14

Whether or not there is an association between

prenatal care and birth weight is difficult to

establish, since access to care and the quality

of prenatal care are, in turn, related to many

other variables. Thus if an association between

prenatal care and birth weight is observed, it is

Total

11.1

9.0

9.7

11.2

11.7

11.8

11!4

9.2

10,2

11.5

11.B

11,9

9.5

8.1

8.5

9.8

1006

11.5

11Urban Nonplaces Bal- metroOf ante politan

50,000 ‘f areas

or more

area

10.8 11.3 10.3

8.8 9,4 8.3

9.5 10,1 9.3

11.1 11.4 10,6

11.6 11.7 11,1

11.8 11.8 11,4

11.3 11.4 10.6

9.0 9.6 8.7

10.1 10.4 9.7

11.4 11.5 10.8

11.8 11,8 11.2

11.9 11.9 11.5

9.4 9.7 8.3

8.2 7.8 6.9

8.4 7,6

;:! 10.0 8.9

10.5 10.8 9.8

11.5 11.7 11.1

necessary to ascertain whether care itself is the

critical factor.

Educational Attainment of Mother

As shown in table R, the likelihood of a lowbirth-weight outcome is far more dependent on

the mother’s educational attainment than on

when prenatal care is initiated. For mothers of

the same race with similar educational backgrounds, starting care Iate rather than earIy in

pregnancy generally resulted in only a small increase or in an actual decline in the proportion

of babies of low birth weight. As years of schooling increased, the incidence of low birth weight

decreased, regardless of when care began. For

white births, the decline in proportion of

birth weight was from 8.8 percent for mothers

with O-8 years of schooling, to 4.7 percent for

mothers who had completed college; for black

19
Table R. Percent of infants of low birth weight, by educational attainment of mothar, month of pregnancy prenatal cara began, and race

of child: Total of 39 reporting States and the District of Columbia, 1975

Month of pregnancy prenatal cara bagan and race of child

All racesl ......... .. ...... .. ............ .. ...... ................ .................... ................ .....

Ist and 2d month ................ .... .. ........ ...... .. ........ ........ .... .......... ............ ........ .. ...... ...

3d month ....... ...... ........ ........ ...... ........ .. ........ .. .... ........ .............. ........ ........ ...... ...... ...

4th-6th month ..... .......... ...... ...... .......... ...... .......... .......................................... ...... ...

7th-9th month ........................................................................................................

No prenatal care .... ........ ........ .. ...... ...... .. ........ ............ ........ .......... ............ ...............

White .............. ...... ........ .. ........ ............ .. .............. .........................................

Ist and 2d month ........ ...... .. ................ .... .. ...... .. ...... ...................... .......... ...... ...... .. .

3d month ........................................... .....................................................................

4th-6th month ..... .......... ...... .. ........ ............ ........ ...................... ...................... ........ .

7th-9th month ............................... ...... .............................................. ...... ...............

No prenatal care .... .. ...... ........ .. .............. ........ .................................................... .....

Black ................................................... .........................................................

Ist and 2d month ......... ...... ........ .. ............ .. ...... ........ ...... ...................... ........ ..........

3d month ................................................................................................. ...............

4th-6th month ...... .. ............ ........ .. ...... ........ .. ...... ...... .. ........ ...................... ........ ......

7th-9th month ....................... ................ ........ ...... ...... ........ ...................... ...............

No prenatal cara ................... ........ ........ .. ...... ...... ...... .. .. ...... .. .... ................ ..............

lrnclude~ races other than white and black.

births, the comparable decline was from 15.0

percent to 9.5 ~ercent. At alI educational levels, however, the percent of low birth weight was

far lower when mothers received some care than

when no care at all was received. Some of this

differential is expkiined by the large numbers of

premature births included in the “no-care”

category (see next section, “Effect of Premature

Delivery”).

Effect of Premature Delivery

Several researchers have postulated that the

large difference in the percent low birth weight

between births to mothers who had received no

care and births for which mothers had late care

is not due to any benefits derived from the provision of care, but because when mothers deliver early they do not have the opportunity to

receive care.15~16 Mothers delivering before the

ninth month of gestation who had delayed initiating care to that point would be classified

in the “no-care” category. Such premature

births (less than 37 weeks of gestation) would

Total

7.5

6.5

6.9

8.9

8.7

22.6

6.3

!5.7

5.9

7.2

7.3

19.4

13.2

12.1

12.4

13.2

12.0

27.7

Years of school completed by mother

o-8

10.2

9.1

9.5

10.3

9.6

21.3

9-11

10.3

9.3

9.5

10.5

9.9

24.1

12 I

13-15 I

16 or

more

6.9

6,2

6.3

8.0

7.8

22.0

5.9 I 5.1

5.5 5.1

5,6 4,8

6.8 5.4

6.6 4.9

18.0 15.8

8.8 I 8.5 I 5.9 I 5.2 I 4.7

8.1

8.4

8.8

8.3

19.1

15.0

7.9

8.1

8.7

8.4

20.8

14.8

5.6

5.5

6.6

6.5

18.8

12,1

5.0

4.9

5.7

5,3

14.7

11.0

4.7

4.4

4.7

3.8

13.7

9,5

14.0

13.9

14,8

13.9

27.7

14.3

13.8

14.2

13.0

28.3

11.3 10.6 9.3

11.6 10.6 9.5

12.2 11.1 9.8

10,8 9.8 7.4

26.8 23.7 22.3

be far more likely to be of low birth weiszhtthan

would full-term ‘births. The “no-care” category

is thus heavily weighted with premature births

of low birth weight. In 1975, 26 percent of the

births to mothers with no care were premature

compared with only 8 percent of the births to

mothers starting care in the first trimester of

pregnancy and 10 percent of the births to

mothers starting care in the last trimester. The

differential in proportion of babies of low birth

weight for mothers having no care compared

with mothers starting care in the third trimester is considerably reduced when premature

births are excluded from the comparison. The

effect of the exclusion of premature births is

the same for both racial groups (table S).

Age of Mother

Teenage girls and women 40 years of age or

older were more likely than were women in

other age groups to bear babies of low birth

weight. For all groups, the proportion of lowbirth-weight infants increased when the start of

20
Table S. Percent of infants of low birth weight, by time of

initiation of prenatal care, period of gestation, and race:

Total of 39 reDortinq States and the District of Columbia,

1975

Period of gestation and race

All racesl

All gestational ages .. ............ ........ ....

37 weeks or more ............................

White

All gestational ages .... ........ ...... .. ......

37 weeks or more ............................

Black

All gestational ages ..................... .....

37 weeks or more ...................... ......

Care

start- No

ing in prethird natal

tri- care

mester

8.3 20.1

5.1 7.9

6.9 16.7

4.2 6.2

12.2 27.4

7.6 11.1

Ratio

of

percents

2.4

1.5

2.4

1.5

2.2

1.5

1Includes races other than white and black.

care was delayed to the second or third trimester

of pregnancy, and receiving no care at zJl was

generally associated with a dramatic elevation in

the incidence of low birth weight (table T). However, the increased likelihood of low birth

weight when no care is received is due, in part,

to the large number of women with no care who

deIiver prematurely, and thus lack the opportunity to receive care. For a more detailed explanation of this point, see the preceding section, “Effect of Premature Delivery.” The risk of low birth

weight was considerably higher for black than

for white babies when mothers were under 40

years of age, no matter when care was initiated.

However, at older ages this racial differential was

reduced somewhat.

Educational attainment is of necessity limited for young girls and is, therefore, an inadequate measure of socioeconomic status for teenagers. For women who were old enough to have

completed at least a high school education, the

same relationship between low birth weight,

timing of care, and years of school completed,

previously noted for all women, was observed.

That is, for each age group, the years of school

completed was a more important predictor of

the extent of low birth weight than was the

trimester of pregnancy that care was initiated.

Number of Prenatal Visits

Table U presents the proportion of low-birthweight babies according to the number of prenatal visits and the time of pregnancy prenatal

care was begun. In general, as the frequency of

visits increased, the proportion of babies that

were of low birth weight declined. This relationship was true regardless of what point in

pregnancy prenatal care was initiated. When

care was limited to 1-4 visits, 19.6 percent of the

babies were of low birth weight; when mothers

made 13-16 visits, onIy 3.3 percent of the babies

were of low birth weight. However, when more

than 16 visits were made, the percent low birth

weight rose to 5.1. This is probably an indication that women having this intensity of care

had a higher than average number of complications of pregnancy. A study of a large number

of births during the years 1961 and 1962 found

that there was an increase in perinatal mortality

among the offspring of mothers who had made

16 or more prenatal visits. These women showed

a marked increase in the number of maternal

complications. 17

At each level of visits, a higher proportion of

black than of white babies were of low birth

weight. Although these racial differences were

not large when mothers made 1-8 visits, for

mothers making 9-12 visits the proportion of

low-birth-weight black babies was slightly more

than twice that of white babies. The largest

racial difference was seen for mothers making

13-16 visits, where the percent low birth weight

was nearly 2Y2 times higher for black than for

white babies.

It is of interest that for nearly all visit categories, earlier care was associated with a greater

proportion of babies of low birth weight. For

example, when 5-8 visits were made, the proportion low birth weight was 17.4 percent for care

starting in the first or second month, but only

5.4 percent when care was delayed until the

seventh to ninth month of pregnancy. These

large differences in percent low birth weight

are not seen when premature births are excluded from the comparison, as shown in table

V. This is an indication that such births are

more heavily represented in the early care categories for most visit levels.

Table W shows the percent low birth weight

for different levels of educational attainment

21
Table T. Percent of infants of low birth weight, by age of mother, month of pregnancy prenatal care began, and race of child: Total of

39 reporting States and the District of Columbia, 1975

Month of pregnancy prenatal care began and race of child

All racesl .................... .. ............ .. .............. ...... .... ...... ..................................

Ist and 2d month ........... ...... .............................. .. ...... .. ...... ................ ........................

3d month ... .............................................. ...... ...... ...................... ........ ........................ .

4th-6th month .... ...... ................ ................ ...... .. .... ........ .. .............. ...... ...................... ..

7th-9th month ................................. ........ ...................................................................

No prenatal care ....... ........................................ ........ .............................. ....................

White ....................... ........................................................................................

Ist and 2d month .... ...... ........ .............. ................ .......... ............ .......... ...... .............. ...

3d month ........ .. ................ ........ .................................... .......... ............ .. ......................

4th-6th month ... ............................................ .......... ...... .......... ...... .............................

7th-9th month .. .. ...... .......... ........ ........ ...... ...... .. ........ ...... .. ...... ........ .. .... ........ ..............

No prenatal care ...................................................... .......... ...... ................ ...................

Black ... ................ ...................................... .............................................. .........

1st and 2d month ........... .............................................. ...... ...................................... ..

3d month ....................... .......................... ........................ .............. .............................

4th-6th month .......... ................ ................ ................ ...................... ............................

7th-9th month ........... .................................................... .............................................

No prenatal care ............................................................... .. .............. ............. .............

1Include5 races other than white and black

according to the number of prenatal visits. It is

apparent that at all educational levels the probability of a low-birth-weight outcome declined

dramatically as the number of visits increased, up

to 16 visits. In addition, when more than 8 visits

were made, there was, in general, a consistent

decline in the percent low birth weight as years

of schooling increased.

It was not possible to analyze further these

data according to differences in income within

each level of schooling. However, a study of factors influencing prenatal care in the Boston

metropolitan areall determined that for women

having the same educational background, those

with higher incomes were more likely to receive

adequate care as measured by the time of initiation of care and the number of visits. Thus the

intensity of care (as measured by number of

visits) may be a further refinement in measurement of socioeconomic status within each educational category. The association between low

birth weight and number of prenatal visits thus

may be to some extent a secondary one, deTotal

7.5

6.5

6.9

8.9

8.7

22.6

6.3

5.7

5.9

7.2

7.3

19.4

13.2

12.1

12.4

13.2

12.0

27.7

Under

20 years

10.3

9.4

9.4

10.4

9.8

26.3

8.3

7.6

7.6

8.4

8.0

23.6

15.0

14.9

14.3

13.1

30.3

18.2

Age of mother

20-29 30-39

years years

6.8 I 7.3

6.0 6.5

6.3 6.8

8.0 8.5

8.0 8.2

20.7 20.5

5.8 6.4

5.4 6.0

5.5 6.0

6.6 7.3

6.7 7.8

17.2 16.9

12.2 12.3

-L11.4 10.9

11.3 12.0

12.4 12.6

11.5 10.4

26.0 27.4

40 years

and over

9.7

8.6

8.6

10.6

9.4

21.0

8.7

8,0

7.5

9.4

9.1

24.8

13.0

11.1

13.4

14.6

10.9

15.0

pendent in part on the socioeconomic status of

the mother.

Marital Status of Mother

No matter at what point in pregnancy prenatal care began, out-of-wedlock births were

more likely than were other births to be of low

birth weight (table X). When care began in the

first 2 months of pregnancy, the incidence of

low birth weight was approximately two-thirds

greater among white illegitimate births than

among white legitimate births (9.2 compared

with ‘5.5 percent ) and more than one-third

higher among black illegitimate births than

among black legitimate births (14.9 percent

compared with 10.8 percent ). This differential

by marital status was considerably reduced when

care was delayed until the second or third trimester of pregnancy.

For legitimate white births, the percent Iow

birth weight rose slightly with each delay in

starting care, from 5.5 percent in the first and

second months of pregnancy to 6.8 percent in

22
Table U. Percent of infants of low birth weight, by month of pregnancy prenatal care began, number of prenatal visits, and race: Total

of 37 reporting States and the District of Columbia, 1975

Month of pregnancy

prenatal care bagan

Number of prenatal visits and race Total No

prenatal

care

1St

and

2d

4th6th

8.7

. . .

21.7

8.6

4.8

3.9

5.9

7.1

7th9th

8.7

. . .

11.5

5.4

4.2

2.9

3.7

7.4

3d

6.8

-

. . .

30.2

12.2

4.6

3.1

5.2

5.8

AH racesl ........ ...... ........ ...... ...... ........ ........ ...... ........ ...... ...... .. .... ...... .. ............. 7.4 6.4

=

. . .

30.5

17.4

5.1

3.3

5.1

5.6

22.2

22.2

. . .

. . .

. . .

. . .

. . .

18.9

No visits ................ .. ...... ................ .................. .. .................. .............. .............................

14 visits ...................... .. ........ .... .. ...... .. ................................ ...... ........ .............................

5-8 visits ........ ...... .......... ...................................... .............. .. ...... ............ .................... .....

9-12 visits ..... ............ .. .............. ............ .............. .............. .. ...... ...... ...... ...................... ....

13-16 visits ......... .............. .............................................. ................ ...... .................... ......

17 visits or more ..... ...................... ............ .......................................... ...........................

22.2

19.6

11.5

4.9

3.3

5.1

White . ...... .. ...... .. ...... ...... .. .................... ............................ .................................... 6.2

18.9

18.5

10.8

4.3

2.9

4.4

13.2

18.9

. . .

. . .

. . .

. . .

. . .

27.9

27.9

. . .

. . .

. . .

. . .

. . .

. . .

31.3

16.9

4.5

2.9

4.4

12.3

. . .

30.8

11.5

4.0

2.7

4.4

12.3

. . .

30.6

15.3

9.0

7.2

9.6

. . .

20.7

7.4

4.0

3.3

4.6

13.2

. . .

23.9

11.8

8.2

6.8

9.6

. . .

10.1

4.7

3.3

1.9

1.9

12.3

. . .

14.9

7.8

7.2

7.7

11.8

13-16 visits .. .. ...... .......... ...... ...... .. ............ ...................................................... .. ............ .. .

17 visits or mora .......... ............ .................................................................... .. ................

Black ................... .. ........ ...... ........ ................................ .. .................. .. ............ ......

No,4 visits ....... .. ...... .. ...... ...... .. ...... .................................... ................................................

5-8 visitsjljII:IljlllIIIII jJJl~llll~I:~llIll:jl; IllllljIIJJlllllJlllllIlIIIllljl:lIIlljlJjJIIllljIIJljjIjI:jIllIlIl:III;lIlJ::

9-12 visits . ................ ...... ........ .. ...... ........ ...... .................................. ................ ................

13-16 visits ............. .. ...... .. .... ........ .. .................... ............................................................

17 visits or more ........... ...... .. ...... .. ............ ................ ...............m.... ...................... ...........

1Includes races other than whtte and black.

27.9

22.4

14.0

9.0

7.1

9.5

. . .

30.7

19.8

9.6

7.1

9.3

—

Table V. Percent of full-terml infants of Iow birth weight, by month of pregnancy prenatal care began andnumber of Prenatal visits:

Total of 35 reporting States and the District of Columbia, 1975

Month of pregnancy

prenatal care began

No

prenatal

care

8.0

~

8.0

. . .

. . .

. . .

. . .

. . .

Number of prenatal visits Total 1St

md

2d

—

2.9

=

. . .

6.7

4.7

2.9

2.1

2.8

4th6th

7th9th

5.3

=

. . .

6.8

4.0

2.9

1.9

5.1

3d

3.3

=

. . .

7.6

4.8

3.0

2.3

3.3

4.4

=

. . .

6.9

5.0

3.3

2.8

3.9

Total .................................... .................... ................ .................. .........................

No visits ........ ...... ...... .......................................................... ................ ............ ....................

~=14 visits ... .. ........ ............................ ...... .. ...... ...... .......... ...... .................... .................... ........

......... .. ............................ ................ ......................................................................

9-12 visits ...... .. ...... .. ...... .. ............ .. ...... ........ ............ .. ............ .. ...... ...... ...... .. ...... ...... .. .... .. ...

13-16 visits .... ........ ...... .. ...... ...... .................................... .................... ........ ...... .. .................

17 visits or mora ....................... .............. ............................................................................

3.5

8.0

6.9

4.8

3.0

2.2

3.0

137 week of gestation or more.

23
Table W. Percent of infants of low birth weight, byeducational attainment ofmother, number ofprenatal visits, andrace ofchild: Total

of 35 reporting States and the District of Columbia, 1975

Years of school completed by mother

Number of prenatal visits and race of child Total 16 or

more

5.0

18.9

22.2

11.9

3.8

2.6

4.2

4.5

0-8

10.4

=

20.7

17.1

10.8

6.8

5.3

6.7

9.0T

9-11 12

10.1 6.8

24.0 21.0

19.7 19.9

11.7 11.2

6.5 4,6

5.0 3.1

7.0 4.8

8.4 5.8

13-15

5.9

16.8

21.0

11.9

4.2

2.8

4.7

5.1

All racesl ...................... .. .............. .. ...... .. ...... .......... .................................... 7.5

=

22.2

19.6

11.5

4.9

3.4

5.2

White ............ ...................................................................... ................ .............. 6.2

!

20.6 18.5

18.7 19.1

10.7 10.6

5.5 4.1

4.1 2.8

5.9 4.1

14.6 12.1

28.8 25.4

21.9 22.3

14.0 13.5

9.9 8.5

9.3 6.3

10.6 9.3

18.9

18.5

10.8

4.3

2.9

4.4

17.7

75,3

9.8

6.0

4.7

5.4

15.5

28.8

21.8

13.9

11.2

9.0

12.2

13.1

20.6

11.3

3.8

2.5

4.2

11.1

24.2

23.7

15.0

7.9

6.1

8.7

14.9

21.6

11.6

3.4

2.4

3.7

Black ................... .. ...................... ..................................................................... 13.2 9.8

27.9

22.3

13.9

9.0

7.1

9.6

31.1

29.5

15.7

7.9

5.0

7.8

l~ncludes ~aceS other than white and black.

Table X. Percent of infants of low birth weight, by month of pregnancv ~renatal care began, legitimacy status, and race: Total of 33

reporting ”States and the District of Columbia, 19;5 - “

Month of pragnancy

prenatal care began

Legitimacy status and race

-.

1St No

4th- 7thand 3d

pre2d

6th 9th natal

care

I otal

t

7.4 6.4

6.5 509

12.8 12,5

6.8 [ 8.7 8.6

h

20,0

~

7.4 15.8

10,8 25.3

6.2 7.5

12.2 12.2

-lt- 13.3 12,3

11.5 10,8 -t12.6 13.3

11.2 11.6 -t12.5 27.2

10.9 22.5

15.1 14.9 14.3 14.5 13.4 29.4

lIncludes races other than white and black.

24
Table Y. Percent of infants of low birth weight, by month of pregnancy prenatal care began, area of residence, and race: Total of 42

reporting States and the District of Columbia, 1975

Area of residence and race

All racesl .................................... ............ ...... .................................................

Metropolitan counties .... ...... .............. ...... ...... .......... .... ........ ........ .......... ........ ...... ..........

Nonmetropolitan counties .. ............................ ...... .. ...... ...... ...... ...... ...............................

White ....................... ...................... .................... .............................. ....................

Metropolitan counties ..... .................................... ...... ............................ .................. .......

Nonmetropolitan counties ................................. ........ ...... .............. ................................

Black ... .. ...... .. ...... ........ ...... ...... .. .............. ...... ............ .. .... .............. ...... .. ............ ..

Metropolitan counties ... ............................ .......................... ...... .....................................

Nonmetropolitan counties ......... .. .... .. ...... ...... .. .... ........ ...... .. ...... ...... .. .... .. ...... ...... ..........

1lnclude~ ~aceS other than white and black.

the last trimester of pregnancy. However, for

white out-of-wedlock births, the percent low

birth weight was 10wer when care started late in

pregnancy. There was virtually no change in the

risk of low birth weight according to the timing

of care for black legitimate births, but as observed for white out-of-wedlock births, the proportion low birth weight declined with delay in

care for black out-of-wedlock births. However,

these declines were not found when the comparison was limited to full-term out-of-wedlock

births. The perkent low birth weight for white

out-of-wedlock fill-term births increased from

4.4 when care started in the first 2 months of

pregnancy to 5.1 when care was delayed to the

last trimester; for black out-of-wedlock births,

the corresponding rise was from 7.1 percent to

8.7 percent. It is evident, then, that premature

out-of-wedlock births (of low birth weight) are

Total

7.4

~

7.5

7.0

6.2

6:2

6.2

13.1

13.3

12.6

Month of pregnancy

prenatal care began

++

6.4 6.8 8.5

6.5 7.1 8.8

6.1 6.5 8.o

E

5.7 5.9 7.0

5.7 5.9 7.0

5.6 5.9 7.0

12.0 12.4 13.2

12.1 12.6 13.4

11.9 11.8 12.6

8.3

~

8.3

8.2

6.9

6.7

7.3

12.2

12.2

12.0

No

prenatal

care

20.1

20.2

19.9

16.7

16.2

18.0

27.4

27.2

27.9

more heavily represented in the earlier than in

the later care categories.

Area of Residence

The risk of low birth weight for white babies

was the same in metropolitan and nonmetropolitan areas, but was slightly higher for black

babies in metropolitan than in nonmetropolitan

areas (table Y). The timing of prenatal care does

not change this relative risk of low birth weight

for black babies. That is, the incidence of low

birth weight was consistently greater in metropolitan areas, except when mothers received no

care. For white babies, although the risk of low

birth weight was the same in both areas when

care began in the first or second trimester, when

care was delayed past this point, the risk was

somewhat higher in nonmetropolitan areas.

000

25
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by Robert J. Armstrong. Vital and Health Statistics.

Series 20-No. 12. DHEW Pub. No (HSM) 72-1055.

Health Services and Mental Health Administration.

Washington. U.S. Government Printing Office, May 1972.

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Death: An Analysis by Maternal Risk and Health Care.

Washington. Institute of Medicine, National Academy

of Sciences, 1973.

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of the National Institute of Neurological Diseases and

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gweigley, E. S.: The pregnant adolescent.J. A m. Diet.

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influencing prenatal care. N. Engl. J. Med. 265(1): 1-6,

July 6, 1961.

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weight and infant growth and development in the first

year of life. Obstet. Gynecoi. 31(3): 417-423, Mar. 1968.

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altitude on birth weight and gestation, in D. M. Reed

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1977. pp. 81-104.

14Garn, S. M., Shaw, H. A., and McCabe, K,, D.: Ef.

fects of socioeconomic status and race on weight-defined and gestational prematurity in the United States,

in D. M. Reed and F. J. Stanley, eds., The Epidemiology of Prematurity. Baltimore-Munich. Urban &

Schwarzenberg, 1977. pp. 127-143.

15Terris, M., and Glasser, M.: A life table analysis

of the relation of prenatal care to prematurity. Am. ].

Public Health 64(9): 869-875, Sept. 1974.

16Shwartz, S., and Vinyard, J. H., Jr.: Preniital care

and prematurity. Public Health Rep. 80(3): 2!37-248,

Mar. 1965.

17 Kane, S. H.: Significance of prenatal care. Obstet.

Gynecol. 24(l): 66-72, July 1964.

18National Center for Health Statistics: Unpublished

data from the 1972 National Natality Survey.

26
LIST OF DETAILED TABLES

1. Live births by month of pregnancy prenatal care began, numbar of prenatal visits, and race: Total of 37 reporting States and

the District of Columbia, 1975 ,................................................................................................................................. ................ 28

2. Live births by month of pregnancy prenatel care began and race: 42 reporting States and the District of Columbia, 1975 ...... 29

3. Live births by number of prenatal visits and race: 38 repcwting States and tha District of Columbia, 1975 .............................. 32

27
Table 1. Live births by month of pregnancy prenatal care began, number of prenatal visits, and race: Total of 37 reporting States and the District of Columbie,

1975

Month of pregnancy prenatal care began

7th

?0.565

No

prenatal

care

16,175

16,175

..4

. .

. . .

. .

..<

. . .

. . .

. . .

. . .

..!

. . .

8,629

Number of prenatal

visits and race

Total

Not

stated

5th 6th 8th

23.980

9th

—

9.944

1St 2d 3d 4th

All races . ....... .. ...

No visits ...... ...... ...... .. .. .... .... .

1-2 visits ....... ............ .. .. .......

34 visits ....... ...... .... .... .. .......

5-6 visits ....... .............. .. .......

7-8 visits ... .... ................ .......

9-10 visita ....... .. ........ ...... .....

11-12 visits .. ........ .... ...... .... ..

13-14 visits ....... .. ........ .... .. .. .

15-16 visits .. ...................... ..

17-18 visits ................ ..........

19 visits or more ...... .. .. .. ......

Not stated .. .... .. ............ .. .. ....

White ......... .... .......... .

NO visits ..... ........ .............. ....

1-2 visits ....... ........ .... .. .........

3-4 visits ....... ............ .. ...... ...

5.6 visits ..... .. ............ .. .. .......

7-8 visits ... .... ................ .......

9.10 visits ... .... .. .. .. .... .... .. .... .

11-12 visits .... .......... ............

13-14 visits ............ .. ...... ......

15-16 visits ... .... .. ...... ...... .. .. .

17-i8 visits ......... ...... .... .... ...

19 visits or more . .. .... ........ .. .

Not stated .... .. .... ........ .. ...... ..

Black ..... .... ....... ... .. ....

No visits .... .. .............. ...........

1-2 visits ............ .............. .. ..

3-4 visits ....... ...... ...... .. .. ...... .

5.S visits .. ............ .. .... ........ ..

7-8 visits .. ............ .. .... ..........

9.10 visits ....... .......... .... .. .... .

11-12 visits .............. ............

13-14 visits .. ............ ............

15.16 visits ....... .. ............ .....

17-18 visits .. .. ...... ...... .. ....... .

19 visits or more ... .............. .

Not stated ...... .. .............. ......

1,721,206

16,175

36,306

74,435

142,265

224,429

368,396

431,339

180,512

99,946

21,691

24,260

101,452

1,382,134

8,629

19,834

43,766

95,391

171,511

306,374

376,582

160,940

86,508

16,850

20,03B

73.711

294,348

151,559

. . .

757

1,551

3,998

9,530

24,326

45,785

30,218

20,703

4,517

6,588

3,585

124,073

. . .

393

780

2,491

6,911

19,345

38,736

26,088

17,572

3,853

5,441

2,463

23,600

587,192

.,.

1,822

5,57E

18,22S

53,942

125,683

207,031

93,462

50,063

11,249

11,171

8,662

514,213

. . .

1,04C

3,41s

13,062

43,68E

109,787

188,281

85,364

44,84Z

10,094

9,632

7,0W

61,017

446,015

-

. . .

2,722

9,004

32,362

65,337

127,742

129,677

42,492

21,412

4,348

4,396

6,523

370,141

. . .

1,414

5,320

22,342

52,096

108,244

112,908

37,821

18,138

3,699

3,49C

4,669

65,561

190,467

. . .

2,798

10,609

29,003

43,285

53,945

31,610

9,092

4,803

1,003

1,184

3,255

140,949

. . .

1,274

6,005

18,917

32,233

42,288

25,443

7,501

3,720

807

819

1,942

44,081

104.481 63.184 87.624

-

. . .

965

1,182

1,629

1,808

2,777

2,611

1,083

643

121

180

74,525

64,697

. . .

3,52E

12,784

23,06C

27,311

21,86:

9,32E

2,55:

1,44:

261

472

1 ,B6S

69,947

. . .

1,71!

7,01:

14,90[

18,951

15,904

6,867

1,97C

1 ,02C

18E

31:

991

30,78$

. . . . . .

6,024

11,060

11,209

6,740

3,009

1,162

401

179

33

6:;

26,363

. . .

7,423

8,061

4,790

1.797

737

473

144

100

20

35

400

15,775

. . .

5,591

133s

66C

24~

28C

323

lli

5e

14

Ze

673

6,48C

4,576

12,667

17,305

14,333

8;029

3,441

949

542

125

144

1,073

40,867

8,629

. . .

. . .

.,.

. . .

. . .

. . .

. . .

.,.

. . .

. . .

. . .

6,379

6,379

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

2,276

7,196

11,147

10,034

5,758

2,54E

744

399

74

1Oc

591

. . .

3,209

6,782

7,615

4,794

2,195

852

324

137

21

51

383

12,252

. . .

2,463

3,725

3,079

1,623

705

259

a

12

7

286

. . .

4,425

5,297

3,393

1,335

506

364

106

80

17

30

222

6,734

. . .

2,479

2,250

1,109

365

203

94

33

20

3

5

173

. . .

3,631

1,295

485

163

186

250

88

44

12

23

403

2,735

. . .

1,685

516

142

62

91

64

23

14

2

5

231

—

. . .

557

660

1,030

1,308

2,161

2,233

926

555

85

139

55,043

19,828 21,392

. . .

2,073

4,932

5,435

3,716

1,897

803

190

132

49

43

457

6,379

14,239

27,272

41,613

46,119

53,357

45,704

15,787

11,522

2,416

3,800

26,130

. . .

1,627

6,280

7,275

7,368

5,188

2,078

512

387

68

151

855

. . .

323

464

540

546

573

334

141

76

29

39

18,327

. . .

332

709

1,386

2,308

4,312

6,082

3,218

2,684

532

1,005

1,030

. . .

795

1,924

4,517

8,872

13,344

16,641

6,487

4,352

972

1,373

1,740

. . .

1,181

3,320

8,989

11,483

16,748

14,067

3,778

2,826

571

830

1,768

. . .

1,381

4,152

9,138

9,776

10,196

5,282

1,357

996

178

342

1,263

lIncludes races other than white and black.

28
Table 2. Live births by month of pregnancy prenatal care began and race: 42 reporting States and the District of Columbia, 1975

Area and racel

All reporting areas ... .. ....

White ..... .. ............ .. .......... ........

Black .............. .............. ........ ...

Arizona.., .... .. ........ .... .. .......... .. .. ....

White ... .. .. ...................... .. ........

Black ... .. ........ .... .. .... ...... ........ ..

California .... .. ..... ..... ............ ..........

White .......... ............ ............ .....

Black .......... .. .. .... .. .. ...... .... .. .....

Colorado ........ .. .. .. .. .. .. .. ...... .... .. .. ...

White ........ .......... .. .... .... .. .. .......

Black ... ............ .. ...... .. .. .......... ..

Cormacticut ............. ............ .... .....

White ...... .. .......... ............ .... .....

Black .... .. .. .......... ...... .... ...........

Delaware .... .... ........ ............ ...........

White ....... .......... .... .. .......... ......

Black ....... ............ ............ .. ......

District of Columbia ...... ............ .. .

White .. .. ...... .. ............ .... .... .... ...

Black ............ ...........................

Florida ....... .... ............ .. ...... .. .. .......

White ........ .......... .. .. .......... .. .....

Black ........ .. .. .......... .... ........ ......

Georgia ........... .. .. ...... .... .. .. .. ........ ..

White .. ........ ...... .. ...... ...... ........ .

Black .. .. ...... .... .. ............ .. .... .. ...

Hawaii ........... .. .. .......... .. .. ...... .... ....

White .............. ............ .. .......... .

Black ............ .. .......... .. .. ...... .. .. .

lllinOis ... .... .. .............. .......... .. .. ......

White ... .............. .. .......... .. ........

Black ........ .. ........ ...... ...... ...... ...

Indiana ............... .. ........ .. ............ .. .

Whit . ....... ...... .. .. .. ...... .. .. .... ....

Black .... .. ............ .. .. .......... .. .. .. .

10wa ........ ....... ....... .............. ..........

Whita .... .... ............ .. .. .......... .....

Black .... .............. ...... ........ ..... ..

Kansas ... .............. ............ .. ........ .. ..

White ........... ....... ....... ............ ..

Black ........... .......... .. ............ ....

Kentucky .......... .. ............ .......... .. ..

White ............. ............ .. .......... ..

Black ...... ...... ...... ............ .. .. .... .

Louisiana ..... .... ........ ............ .. .... ...

White ........ ..... ....... .... ...... .. .. .. ...

Black ........ ..... ............ .. .......... ..

Maine .. .............. ............ ............ ....

White . .......... .. .......... .. .......... ....

Black ...... .... ........ ............ .........

See fcmtrmte at end of table.

Total

2.707.551

2,194,05B

442,420

39,070

33,350

1,532

317,359

266,978

32,98B

40,081

37,442

1,784

35,537

31,077

4,067

B,000

6,136

1.784

9,719

1,295

8,299

105,180

77,244

26,B76

79,662

51,338

27,862

15,711

4,308

338

169,366

130,454

35,669

82,403

73,216

8,756

41,375

40,208

840

33,BB7

30,835

2,425

54,590

49,682

4,667

67,898

40,843

26,6B3

15,233

15,041

62

1st

and

2d

1.1622&

1,023,671

131,407

14,180

13,039

400

14B,858

127,365

13,835

19,146

18,136

6B6

20,00s

1B,226

1,585

2,942

2,516

391

2,53B

540

1,957

34,223

28,731

5,214

29,879

22,106

7,606

6,488

1,594

94

73,233

61,286

10,607

30,631

28,731

1,737

21,376

20,905

320

15,813

14,610

974

22,333

20,910

1,331

32,484

23,627

B,66B

6,430

6,354

22

3d

696.70f

579,00B

100,567

8,380

7,461

31B

79,064

65,B13

6,752

10,302

9,627

475

7,976

6,943

944

2,839

2,267

654

1,537

219

1,291

20,697

15,741

4,726

17,403

11,404

5,800

4,269

1,483

114

45,721

36,673

8,273

20,524

18,897

1,529

12,375

12,066

231

9,924

9,114

632

12,303

11,268

970

13,624

7,954

5,795

4,630

4,580

13

4th

296,107

221,228

66,472

4,639

3,927

212

33,644

27,6B7

4,320

4,267

3,946

226

2,206

1,74B

430

817

562

244

672

101

758

10,853

6,985

3,B69

8,776

4,612

4,1OB

2,024

584

46

20,572

14,202

6,007

7,670

6,595

1,055

3,815

3,695

92

3,676

3,276

329

6,035

5,301

708

6,642

2,682

3,923

1,940

1,912

15

Month of pregnancy prenatal care began

5th

184,777

114,224

45,094

3,035

2,414

1B6

19,692

16,214

2,415

2,333

2,116

145

1,214

900

302

393

221

166

781

49

724

6,933

3,917

2,843

5,031

2,346

2,849

1 #284

320

30

11 ,B49

7,408

4,205

3,959

3,203

730

1,734

1,636

81

1,646

1,569

219

3,401

2.877

496

4,198

1,344

2,B31

848

B35

6

6th

100,704

68,322

28,808

2,265

1,763

126

12,093

10,082

1,328

1,392

1,246

88

574

434

134

243

143

98

40B

36

370

4,5B7

2,587

1,963

3,489

1,602

1,867

666

132

22

7.234

4,424

2,689

2,037

1,671

356

855

797

42

1,020

890

104

2,201

1,845

346

2,599

79B

1,791

353

343

5

7th

66,558

45,621

1B,192

1,BB2

1,444

104

8,321

7,035

831

933

644

60

349

251

90

148

97

49

318

14

297

2,961

1,724

1,193

2,322

1,139

1,161

400

88

18

4,628

2,774

1,754

1,284

1,060

220

492

456

18

624

526

76

1,412

1,185

219

1,719

580

1,131

241

236

8th

39,061

27,036

10,115

1,459

1,073

62

4,529

3,847

409

571

50B

34

229

167

62

89

57

32

175

29

146

1,693

1,112

548

1,530

75B

762

279

51

2

2,495

1,557

679

644

516

122

251

231

15

3B6

32B

40

889

743

140

9B0

335

639

118

114

1

9th

15,473

10,581

3,994

700

472

22

1,701

1,456

150

224

198

18

106

B8

16

16

12

4

106

22

82

607

403

195

993

531

458

115

17

2

996

605

374

242

195

45

10s

95

B

136

122

8

423

357

62

430

163

25B

42

40

No

prenatal

care

34,720

21,983

11,274

1,020

531

36

4,267

3,69B

383

33B

2B4

26

173

129

40

46

20

24

488

10

452

1,244

773

457

424

156

256

62

16

1.839

948

971

59B

442

154

137

131

4

20B

162

33

593

492

97

603

193

406

40

39

Not

stated

111,182

B2,384

26,497

1,510

1,226

66

4,B90

3,781

565

575

537

26

2,701

2,191

484

367

243

122

2,518

275

2,224

21,282

15,271

5,769

9,815

6,672

3,093

134

24

8

719

576

130

14,814

11,906

2,810

231

197

29

252

238

10

5,000

4,684

29B

4,439

3,167

1,241

591

5BB

29
Table 2. Live births by month of pregnancy prenatal care began and race: 42 reporting States and the District of Columbia, 1975–Con.

Area and race] Total

52,049

37,011

13,948

133,934

109,548

23,233

56,428

53,975

1,116

43,555

22,489

20,743

68,162

56,921

10,611

11,974

10,692

66

23,666

22,236

1,045

9,012

7,633

946

10,051

9,919

51

90,202

71,891

16,971

235,605

183,214

47,498

80,247

54,582

23,628

10,594

9,822

93

158,301

136,289

20,886

41,653

33,744

4,188

33,276

31,447

759

10,261

9,546

587

1St

and

2d

25,524

20,133

4,940

61,412

52,701

8,228

22,641

21S66

338

19,250

12,502

6,643

33,998

29,850

3,882

6,056

5,651

32

10,639

10,171

371

4,134

3,684

304

4,431

4,383

20

36,835

32,204

4,071

96,079

83,837

10,455

35,966

28,465

6,746

4,471

4,236

18

78,804

70,290

7,968

16,921

14,887

1,075

15,570

14,884

271

5,651

5,320

272

3d

12,927

9,291

3,333

38,272

32,281

5,671

16,513

15,883

286

10,096

5,336

4,695

18,499

13,889

2,446

3,215

2,922

19

6,945

6,617

242

2,240

1,941

204

3,359

3,324

10

23,659

19,775

3,522

58,448

47,714

9,496

21,003

14,585

5,867

3,175

2,981

40

42,960

37,378

5,360

10,309

8,539

976

9,187

8,707

203

2,950

2,764

147

4th

4,960

2,830

2,023

15,351

11,883

3,344

7,527

7,175

154

5,403

2,041

3,322

6,942

5,434

1,434

1,209

1,042

5

2,754

2,535

162

1,051

855

142

1,143

1,122

12

9,493

7,064

2,311

26,834

18,466

7,711

9,943

5,478

4,159

1,316

1,217

15

16,175

13,039

2,994

5,241

4,016

689

3,599

3,349

109

690

623

53

Month of I

5th

2,732

1,408

1,262

7,763

5,476

2,195

3,033

2,833

100

3,223

987

2,211

4,022

2,881

1,109

549

430

5

1,326

1,190

107

516

384

78

461

456

2

5,479

3,616

1,767

15,490

9,705

5,364

5,773

2,724

2,859

664

604

8

8,523

6,559

1,912

3,025

2,160

484

1,887

1,738

74

324

280

40

Inancy prenatal care began

6th

1,436

696

690

4,219

2,640

1.327

1,627

1,653

66

2,026

536

1,478

2,321

1,794

501

356

276

722

631

66

342

250

66

246

237

2

3,655

2,314

1,281

10,150

6,107

3,794

3,355

1,477

1,767

395

345

2

4,538

3,519

983

2,045

1,392

354

1,020

949

27

160

132

24

7th

807

415

365

2,460

1,617

814

1,147

1,033

46

1,210

346

852

1,509

1,163

313

230

148

2

427

365

40

251

192

35

139

137

2,266

1,460

780

7,255

4,269

2,779

1,975

902

1,000

244

196

2

2,736

2,092

618

1,532

1,032

242

720

660

22

108

96

9

8th

413

220

178

1,317

861

433

644

560

26

768

192

568

907

728

163

139

87

1

297

250

26

146

104

26

87

81

2

1,280

821

441

4,904

2,943

1,862

994

449

514

155

123

4

1,246

968

268

1,036

700

164

389

348

13

36

31

3

9th

124

50

68

458

301

152

294

256

12

279

75

194

389

312

70

65

41

1

131

102

13

74

50

14

15

14

1

479

309

164

1,816

1,090

683

319

151

164

50

32

2

452

340

100

413

266

55

192

175

7

12

10

2

No

prenatal

care

433

209

215

1,066

556

603

183

163

6

550

150

388

933

356

573

93

43

1

113

88

7

193

122

71

41

41

933

443

490

4,772

2,336

2,381

713

255

446

82

46

2

1,091

755

330

378

245

47

304

270

6

35

34

1

2,693

1,759

874

1,616

1,032

566

2,619

2,463

82

750

324

392

642

514

120

60

52

312

287

11

65

51

6

129

124

2

6,123

3,885

2,144

9,857

6,747

2,983

206

96

106

42

42

1,776

1,409

353

753

487

102

408

367

27

296

256

36

lTotal for each area includes races other than white and black.

30
Table 2. Live births by month of pregnancy prenatal care began and race: 42 reporting States and the District of Columbia, 1975–Ccm.

Area and racel

South Carolina ......... ............ .........

White . .......... .. .. .......... .. ........ .. ..

Black ............. ...................... ....

South Dakota ...... .. .......... .. .......... ..

White ....... ...... ............ .. ... ....... ..

Black ...... .. .... .... .. .. .......... .. .......

Tennessee ....... .. .......... .. .......... .... ...

White . .............. ............ .......... ..

Bleck ........ .. .. ...... .. .. .......... .......

Texas ......................... .. ..... ..... .......

White ........ .. .......... .. ...... .. .... .. ...

Black ........ ....... ..... .. .......... .......

Utah ... ...................... .....................

White ... ...... .. .. .... .. .... ............ .. ..

Black ............. ............ ............ ..

Vermont ... .... ...... .............. ............

White ...... ............ ....... ..... .........

Black .... .. .... ........ ...... ...... .. .......

Washington ...... .......... .. ............ .....

White ... .. .......... ............ .......... ..

Bleck .... .. .. ........ .. .......... .. .........

West Virginia ......... .. ..... .................

White ........ ...... ...... .. .......... .. .....

Black ....... ...... ............ ............ ..

Wisconsin ................... ........ .... .. .....

White .... .... ............ .. .......... .. .....

Black ... ............ .. ...... .... .. ...... ....

Wyoming ... ..... ............ .. ............ .....

White ..... .. .......... ............ ....... ...

Black ... .. .. ...... .. .. ......................

Total

46,6S1

26,035

1S,340

11 ,2m

9,744

53

61,901

46,108

13,489

215,467

1s1,515

32,314

31,567

30,601

140

6,643

6,589

16

50,604

45,9ss

1 ,s75

27,27S

26,107

1,065

65,167

80,302

3,828

6,932

6,658

76

1St

and

2d

17.374

12,563

4,709

3,852

3,577

6

25,719

21,665

3,924

90,160

79,66s

9,440

17,027

16,640

54

2,333

2,316

5

25,191

23,414

713

9,179

8,922

217

29,292

27,671

1Z76

3,129

3,043

18

3d

13,207

S,594

4,522

3,327

3,102

10

14,899

11,956

2,682

55,404

47,000

7,971

8,295

8,068

36

2,221

2,205

3

12,953

11,840

454

7,056

6,814

223

23,791

22,148

1,315

1,928

1,864

78

4th

6,225

3,144

3,021

1,720

1/528

lB

6,992

4,916

2,043

23,103

17,634

5,310

2,293

2,223

10

980

971

5

5,373

4,773

267

4,072

3,889

162

6,222

5,467

615

748

6s7

20

Mcmth of pregnancy prenatal care began

5th

3,640

1,373

2,237

652

674

10

3,940

2,625

1,302

13,563

10,153

3,314

971

911

10

475

468

2

2,595

2,241

143

2,446

2,326

112

2.523

2,210

247

441

422

12

6th

2,265

631

1,436

507

359

2,739

1,653

1,072

9,116

6,S98

2,159

382

351

s

246

245

1,438

1,229

90

1,555

1,434

119

1,362

1,152

163

245

229

2

7th

1,520

5s5

926

302

175

4

1,669

1,072

584

6,752

5,347

1,329

272

232

6

177

176

1

S56

712

42

1.021

944

71

77s

652

S7

161

150

2

8th

802

321

476

26B

147

882

624

249

3,S23

3,230

865

169

150

2

86

85

576

468

36

680

619

57

501

407

55

8S

93

9th

312

121

188

106

61

392

28S

100

1,408

1,139

256

46

38

21

21

204

152

12

276

254

20

153

126

10

43

31

4

No

precare

449

152

295

22s

56

1,043

485

554

7,876

6,291

1,549

104

52

30

29

248

186

9

378

340

38

247

214

23

46

42

Not

stated

867

331

528

88

65

3

3,626

2,823

779

4,162

3,S25

321

2,006

1,916

14

74

73

1,168

973

S9

615

565

46

298

255

38

93

87

lTOtal for eacII area includes races cxher than white and black.

31
Table 3. Lwe births by number of prenatal visns and race: 38 reporting States and the Dmtrict of Columbia, 1975

Total

1 792174

-

1,435,771

310,506

38,965

33,25~

1,526

40,045

37,414

1,778

35,228

30,764

4,066

7,807

6,957

1,776

9,434

1,161

8,191

105,138

77,210

26,868

79,643

51,326

27,855

15,704

4,303

336

169,322

130,400

35,885

81,966

72,773

8,754

41,366

40,199

840

33,865

30,817

2,421

63,743

48,843

4,659

67,778

40,746

26,660

15,226

15,033

62

133,252

108,864

23,220

56,410

53,959

1,116

43,547

22,483

20.741

None

16J4J

8,982

6,591

1,010

523

34

330

280

24

172

128

40

46

20

24

466

10

452

1,242

771

457

423

166

256

62

16

1,936

946

971

597

441

154

137

131

4

208

162

33

593

492

97

593

189

400

40

39

1,083

553

503

163

153

6

560

150

388

lTotal for each area includes races other than whine

1-2

37J52J

20,579

14,790

1,780

1,178

88

778

675

65

334

220

112

124

72

52

254

18

234

2,898

1,552

1,306

1,600

583

1,231

340

54

12

3,762

2,016

1,684

1,032

793

231

404

358

30

469

381

68

1,432

1,165

259

2,158

519

1,624

169

165

1

2,088

1,176

5a3

784

700

24

1,736

281

1,427

I black

34

77 ,02C

45,281

28,30i

2,765

1,996

16E

1,702

1,557

85

66C

486

16E

24~

134

112

442

26

414

5,151

2,739

2,356

3,682

1,203

2,363

836

144

26

8,880

5,026

3,697

1,986

1,564

398

918

835

63

1,016

845

130

2,565

2,123

422

4,062

1,030

3,012

567

576

3

4,914

3,019

1,837

1,863

1,763

66

3,358

625

2.710

5.8

147,270

98,371

43,552

4,311

3,314

284

3,165

2,677

189

1,430

1,112

304

478

264

168

663

84

794

8,539

5,313

3,138

6,162

2,579

3,561

1,510

334

34

17,673

11,256

6,267

4,475

3,838

612

2,441

2,315

98

2,150

1,866

227

4,772

4,130

616

6,509

1,965

4,617

1,248

1,225

5

10,170

7,120

2,944

5,174

4,892

106

5,218

1,351

3.63o

7a

232,150

176,498

48,696

5,603

4,776

243

5,593

5,161

293

2,737

2,243

460

834

578

246

940

136

790

10,508

7,477

2,980

6,313

4,590

3,645

2,503

709

72

27,571

19,934

7,087

8,349

7,319

986

5,366

5,178

135

3,882

3,484

308

7,499

6,730

715

7,731

3,260

4,400

2,536

2,495

12

16,626

12,692

3,779

9,517

9,304

220

5,629

2,163

3.400

Number of prenatal visits

9-10

382,503

316,720

56,857

7,355

6,572

261

8,769

8,267

343

6,553

5,847

822

1,196

896

288

1,844

278

1,%4

14,916

11,392

3,374

13,016

6,472

4,463

3,321

1,041

80

41,951

33,694

7,469

17,498

16,793

1,808

11,783

11,497

200

7,106

6,503

480

13,529

12,496

984

11,043

6,565

4>386

3,994

3,950

17

28,815

24,113

4,441

15,157

14,618

273

7,963

4,327

3,561

11-12

45Q5KJ

395,472

49,623

8,043

7,421

230

10,496

9,696

410

11,094

10,106

840

3,549

2,977

550

1,469

272

1,187

20,170

15,064

4,926

16,941

13,380

3,487

3,982

1,125

64

41,267

36,800

4,781

16,939

15,809

1,058

11,943

11,865

169

11,666

10,630

767

11,398

10,583

771

12,795

9,508

3,103

3,796

3,760

11

36,474

34>213

3,954

13,481

13,051

220

8,756

6,063

2,646

13-14

169,629

168,823

16,901

4,141

3,862

96

4,792

4,513

197

5,152

4,698

412

714

558

144

499

99

395

9,300

8,181

1,020

6,512

6,724

1,725

1,708

508

28

14,377

12,555

1,560

7,588

7,158

382

4,786

4,694

69

4,322

4,059

213

3,600

3,356

234

6,482

5,308

1,151

1,121

1,105

7

15,119

13,711

1,303

4,899

4,766

60

3,956

2,920

1,024

15-16

lo&57J

91,124

12,56C

Z,loe

1,96C

84

2,426

2,311

77

3,025

2,713

290

256

210

36

194

56

138

6,702

5,834

826

6,083

4,867

1,372

818

210

14

7,596

6,116

1,336

4,124

3,899

207

2,331

2,280

40

2,084

1,943

128

1,968

1,792

164

5,539

4,455

1,082

616

610

3

8,737

7,376

1,289

1,746

1,667

53

2,822

2,051

761

17.18

22,295

19,364

2,494

638

508

14

569

536

26

490

446

38

34

26

8

44

6

36

1,637

1,477

143

1,109

859

240

244

66

1,293

1,064

206

819

585

34

466

469

8

466

454

25

466

430

34

1,480

1,236

240

107

107

1,521

1,241

272

405

383

14

1,568

1,289

278

190r

more

MJ5J

20,437

3,691

684

564

1/)

7W!

664

30

651

465

84

28

22

6

101

E

1,379

1,178

191

1,106

6401

264

242

64

1,839

1,291

525

842

794

48

561

638

10

484

439

36

595

531

62

1,823

1,332

485

191

167

2

2,538

1,871

653

386

344

18

1,034

762

270

Not

stated

101,994

74,120

26,247

732

582

30

721

678

30

3,030

2,518

486

304

180

122

2,316

180

2,122

22,696

16,292

6,419

12,578

78284

5,228

138

32

8

977

701

259

17,907

14,759

3,034

237

219

14

59

51

6

5,326

5,015

291

7,463

5,240

2,180

621

614

1

3,187

1,799

1,362

2,431

2,319

54

964

478

446
Table 3. Live births by number of prenatal visits and race: 38 reporting Stat= and the Oixrict of Columbia, 1975-Con.

Amn and racel

Missouri ...................................

White ..................................

Black ..................................

Montana ...................................

White ..................................

Black ..................................

Nebraska ..................................

White ..................................

Black ..................................

Nevada.....................................

White ..................................

Black ..................................

New Hampshire ........................

Whim ..................................

Black ..................................

New Jersey ..............................

White ..................................

Black ..................................

North Carolina .........................

White ..................................

Black ..................................

North Dakota ...........................

White ..................................

Black ..................................

Oklahoma ................................

White ..................................

Black ..................................

Oregon .....................................

White ..................................

Black ..................................

Rhcde Island.,.., ......................

White ..................................

Black ..................................

South Carolina .........................

White .................................

Black ..................................

South Dakota ...........................

White ..................................

Black ..................................

Tennessee. ................................

White ..................................

Black ..................................

Utah .........................................

White ..................................

Black ..................................

Vermont ..................................

White ..................................

Black ..................................

Virginia ....................................

White ..................................

Black ..................................

Washington ..............................

White ..................................

Black ..................................

We5t Virgima. ...........................

White ..................................

Black ............................... ...

Total

58,153

56,915

10,EOB

11,986

10.586

66

23,8S3

22,233

1,045

S,BOS

7,835

940

10,040

9,910

51

BS,263

70,21S

16,B1S

S0,S69

55,016

23,814

10,5B9

9,s17

93

41,141

33,243

4,178

33,203

31,378

759

10,256

9,541

587

46,663

2B,021

1B,336

11,245

9,739

53

61,91 E

4S,13C

13,48!

31,557

30,591

14C

6,807

6,553

lE

-,40E

52,325

15,921

50,56C

45,94E

1,87!

26,64S

25,477

1,~$

None

933

356

573

93

43

1

114

S9

7

191

120

71

39

39

906

434

472

715

255

44s

80

44

2

3S6

239

43

304

270

6

33

32

1

447

150

2s5

22B

!34

1,043

465

554

102

547

30

29

653

342

204

246

1S4

9

3B0

341

39

1-2

1,4S6

922

549

204

11s

2

313

233

47

1S5

129

34

77

76

1

1,322

724

592

2,126

677

1,377

211

135

2

1,191

672

229

403

34B

2s

66

54

11

1,271

340

92B

456

200

1,953

1,054

890

191

140

2

119

11s

1,279

71 s

53B

645

495

59

972

S91

77

3-4

2,596

1,756

802

427

303

2

735

620

73

365

260

63

195

1S9

4

3,170

1,640

1,292

4,327

1,505

2,64S

774

666

4

2,257

1,440

466

993

B94

44

203

177

23

2,600

775

1,B08

632

429

3,526

1,965

1,545

499

443

10

297

293

1

2,622

1,465

1,01s

1,344

1,065

124

1,S60

1,72S

123

5-5

5,201

3,602

1,322

952

741

5

1,824

1,670

107

635

507

76

620

&39

4

6,869

4,479

2,293

7,338

3,174

3,S46

1,844

1,52U

6

4,043

2,8S7

643

1,902

1.744

5s

56B

520

59

4,068

1,431

2,613

1,352

1,112

2

5,61 S

3,566

2,02B

1,240

1,152

10

670

665

2

4,B69

2,ss0

1 ,s03

2,S73

2,419

1S5

3,476

3,291

173

7-s

S,556

6,767

1,897

1,69S

1,395

6

3,683

3.444

170

1,042

662

126

1,317

1 ,2ss

5

12,131

6,938

3,055

10,075

5.671

4,024

1,S61

1,B2B

17

6,34S

5,029

737

3,6S8

3,45e

111

1,807

1,516

74

6,515

3,330

3,34C

1 ,9s1

1,749

12

7,724

5,562

2,118

2,69S

2,59S

14

1,227

1,21E

:

7,57C

4.37C

2,54:

5,61 S

4,96E

294

5,17:

4,S3C

21;

Number of prenatal visits

9-10

15,067

12,940

1,992

3,207

2,S52

25

6,316

6,453

262

1,s79

1,573

202

2,539

2,509

12

21.719

17,962

3,406

15,845

10,505

4,577

2,470

2,348

26

S,542

7,18s

774

6,901

6,560

129

2,660

2,522

125

9,190

5,5s3

3,532

2,884

2.487

14

11,963

9,847

2,258

5,554

5,440

16

1,s21

1,9113

7

13,B13

10,0s8

3,486

10,359

9,465

364

5,443

5,257

171

11-12

17,527

15,832

1,741

3,580

3,373

15

6,079

5,796

213

2,346

2,070

192

2,657

2,621

11

22,846

20,173

2,147

21,082

16,750

4,001

2,1 S9

2,100

20

S,SB1

7,53s

616

S,B49

S,462

143

2,780

2,567

158

12,283

S,756

3,434

2,443

2,324

16

16,B32

13,622

2,124

11,565

11,351

42

1,449

1,440

2

22,655

16,454

3,638

16,1S3

15,057

459

4,431

4,302

97

13-14

S,7C6

7,923

724

931

6SS

5

2,355

2,252

6Q

1,106

961

B6

1,502

1,467

7

S,933

S,041

800

10.719

9,0s7

1,480

Sw

748

12

44560

38947

290

5,052

4,819

98

1,034

974

44

4,660

3.752

1,074

902

SBS

4

5,125

4,632

467

5,602

5,450

26

5s5

562

1

B.8B6

7,662

1,095

6,548

6.124

172

2,224

2.129

S7

1S16

5,170

4,364

772

886

623

3

1,072

1,033

32

Wo

534

48

863

676

3

3,88s

3,466

376

5,836

4,971

S6S

328

306

2,s11

2,432

220

3,163

3,012

75

640

Soo

35

2,950

2,243

596

346

320

2

3,45s

3.031

417

1,258

1.239

4

254

252

1

5,630

4,523

1,032

3,s45

3,412

74

876

S55

19

17-18

1,011

S57

151

78

71

196

1B5

11

13B

116

16

142

139

2

73s

642

86

1.105

941

149

42

40

2

747

B5S

57

841

793

2B

102

92

B

774

603

166

71

66

SW

794

54

223

219

37

37

m

511

71

692

651

Is

176

16a

8

19 of

more

1,10s

905

191

110

97

1

204

193

9

236

21 s

lB

134

133

1

694

806

7s

1,430

1,171

241

50

46

2

779

696

63

666

631

16

167

159

s

8s9

524

174

77

78

843

78s

173

28s

287

32

32

4W

396

80

967

901

22

90

86

Not

7s7

838

94

142

104

1

292

265

14

193

166

10

135

133

1

5,247

2,911

2,222

38s

20s

155

40

36

818

536

100

430

3s9

23

376

328

43

1,Oos

422

576

73

51

3

3,863

3,003

S57

2,337

2,221

16

S6

S4

641

40s

117

1,439

1,207

104

1,548

1,463

6a

lTotal for each areti includes races other than white and black.

33
Table 3. Live births by number of prenatal visits and race: 38 reporting States and the District of Columbia, 1975-Con.

1

None I 1-2

247 661

214 537

23 98

46 ! 132

_2&

34

1,774

1,464

206

300

26s

4,335 8.498

3,647 7,789

377 543

547 1.113

619 1,056

8 20

Number of prenatal wsits

9-10

16,732

15,566

694

1,671

1 ,6W

22

11-12

21,251

19,633

1,166

1,655

1$15

16

13-14

7,465

7,069

305

666

660

4

16-18 17-18

1

2,793 590

2,646 544

121 41

531 264

606 228

23 31

99 -L 111

99 106

lTotaI for each area includes rat- other tltm white and black.

34
APPENDIX

CONTENTS

Technical Appendix ...............................................................................................................................

Sources of Data .................................................................................................................................

ReDorting Areas ................................................................................................................................

Sarkple S;ze .......................................................................................................................................

Residence Classification ....................................................................................................................

Completeness of Reporting and Reporting Bias ................................................................................

Definition of Terms ..........................................................................................................................

Stadadwation of Percent Distfiution of Bifisby Month of Rc~mq Prenatal Cme Be~ .......

36

E

39

39

39

40

40

LIST OF APPENDIX TABLES

I. Areas reporting month of pregnancy prenatal care began, 1969-75, and total number of prenatal

visits, 1972-7.5 ............................................................................................................................. 37

II. Percent of births with prenatal care information missing, by race: Reporting areas, 1969-1975 ..... 39

35
TECHNICAL APPENDIX

Sources of Data

The data presented in this report were derived from birth certificates filed in each of the

registration areas of the United States. The main

body of these statistics is published annually by

the National Center for Health Statistics in volume I of the Vital Statistics of the United States.

Additional information is also available in the

form of unpublished tabulations. A complete

discussion of the generation of birth statistics

may be found in the Technical Appendix of

these volumes.

Reporting Areas

The 1968 revision of the U.S. Standard

Certificate of Live Birth incorporated two questions concerning prenatal care–the month of

pregnancy prenatal care began and the total

number of prenatal visits. Statistics on the

month of pregnancy prenatal care began were

initially published in 1969, when data were

available from the birth certificates of 38 States

and the District of Columbia. By 1975, the reporting areas for this item had expanded to encompass 42 States and the District of Columbia.

Some States are excluded from the reporting

area because the data collected on when prenatal care began are not sufficiently detailed.

Pennsylvania and Virginia reported the beginning of prenatal care by trimesters rather than

by individual months, and Massachusetts collected prenatal care information for only a small

sample of births.

Tabulations showing the total number of

prenatal visits are available beginning in 1972,

when data were available from 36 States and the

District of Columbia. In 1973, two additional

States joined the reporting area, which remained

unchanged in 1974 and 1975. New York State is

excluded from the reporting area for total

number of prenatal visits because only the New

York City birth certificates included this item.

The composition of the reporting areas for

the years 1969-75 is shown in table I. The size

of the reporting area is reduced when tables

include information on education of mother,

legitimacy status of child, and period of gestation. This is because the birth certificates of

States that include questions on prenatal care

may not also request information for these other

variables. Items such as age of mother, birth

weight, and birth order are reported by all

States. Consequently, the size of the reporting

area does not change when these variables are

shown.

Changes in composition of reporting areas. –

Although the trend data presented in this report

are based on a varying number of States, it is

believed that year-to-year comparisons can be

usefully made. During the period covered by this

report, changes in the composition of the reporting areas for month of pregnancy prenatal

care began and number of prenatal visits have

had only a minimal effect on their demo~aphic

makeup. The percent distributions of births

by age of mother and birth order of child are

nearly identical in each year for the actual reporting area and the group of States which reported in all years (constant reporting area).

There are relatively minor differences, never

exceeding 1 percentage point, between racial

distribution in each year.

The availability of tabulations of data by

detailed month of pregnancy prenatal care began

for individual States made it possible to compare

the distribution of births b y month of pregnancy

prenatal care began in the actual and the constant reporting areas. Differences in each year

are very minor. Lack of comparable data by

State precluded a similar detailed comparison

for number of prenatal visits.

36
Table i. Areas reporting month of pregnancy pranatal care began, 1969-75, and total number of prenatal visits, 1972-75

[Unless otherwise noted, areas also reported educational attainment of mother, legitimacy status of child, and date of Iast normal

menstrual period]

Month of pregnancy pranatal

I

Total number of

care began prenatal visits

Area

*

1974 1970 1974

and 1973 1972 and 1969 and 1973 1972

1975 1971 1975

Alabama

Alaska

Arizona x x x x x x x x

Arkansas

1,2X 1,2X 1,2X 1,2X 1,2X

x x x x x x x x

California

Colorado

2,3X 2,3x 2,3x 2,3x

x x x x x x

x x

lx lx lx x x1)(

x x x x x x x

Connecticut

Delawara

District of Columbia

Florida

2X 2)( 2X 2X

x x x x x x x x

Georgia

Hawaii

Idaho

Illinois X1X1X1X1X1X 1X1X

x x x x x x x x

x x x x x x x x

Indiana

Iowa

x x x x x x x x

x x x .x x x x x

x x x x x x x x

x x x x x x x x

Kansas

Kentucky

Louisiana

Maine

2X I 1,2)( ] 1,2)( ] 1,2X I 1,2X I I ] Maryland

I I I 12X1 I I

Massachusetts

Michigan X1X1X1X1X1X 1X1X

x x x x x x x x

x x x x x x x x

Minnesota

Mississippi

x x x

I

x x x

I

Missouri x x

See footnotes at end of table.

37
Table 1. Areas reporting month of pregnancy prenatal care began, 1969-75, and total number of prenatal visits, 1972-75–Con.

[Unless otherwise noted, areas also reported educational attainment of mother, legitimacy status of child, and date of last normal

menstrual period]

Month of pregnancy prenatal Total number of

care begen prenatal visits

Area

1974 1970 1974

and 1973 1972 and 1969 and 1973 1972

1975 1971 1975

Montana 2)( 2X 2)( 2)( 2)( 2X 2X 2X

Nebraska x x x x x x x x

Nevada 2X 2)( 2)( x x 2)( 2)( 2)(

New Hampshire x x x x x x x x

New Jersey x x x x x x x x

New Mexico

New York 2X 2)( 2)( 2X 2X

North Carolina x x x x x x x x

North Dakota x x x x x x x x

Ohio 2X 2)( 2X 2)( 2X

Oklahoma x x x x x x x x

Oregon x x x x x x x x

Pennsylvania

Rhode Island x x x x x x x x

South Carolina x x x x x x x x

South Dakota x x x x x x x x

Tennessee x x x x x x x x

Texas 1,3X 1,3X 1,3)( 1,3X 1,3X

Utah x x x x x x x x

Vermont 2X 2X 2X 2X 2X 2X 2X 2)(

Virginia 3X 3X 3X

Washington lx lx lx lx 1)( lx lx lx

West Virginia x x x x x x x x

Wsconsin 3X 3X 3X 3)( 3X 3)( 3X 3X

Wyoming x x x x x x x x

1 Did not report educational attainment of mother.

2Did not report legitimacy status of child.

3Did not report date of last menstrual period.
Sample Size

Birth statistics for the years 1969-71 are

based on a 50-percent sample of birth certificates. Data shown in this report for 1972-75

are based on 100 percent of the birth certificates

from States participating in the Cooperative

Health Statistics System (CHSS) and on a 50-

percent sample of births from all other States.

Beginning in 1972, States providing data

through CHSS were Florida, Maine, Missouri,

New Hampshire, Rhode Island, and Vermont.

The following States were added in subsequent

years: Michigan, Colorado, and New York (excluding New York City) in 1973; Illinois, Iowa,

Kansas, Montana, Nebraska, Oregon, and South

Carolina in 1974; and Louisiana, Maryland,

North Carolina, Oklahoma, Tennessee, Virginia,

and Wisconsin in 1975. A discussion of sampliig

procedures and sampling errors may be found in

the Technical Appendix of volume I of Vital

Statistics of the United States for these years.

Residence Classification

AU tables included in this report are by place

of residence. Births to U.S. residents occurring

outside this country are not reallocated to the

United States. Beginning in 1970, births to nonresidents of the United States occurring in the

United States have been excluded from tabulations by place of residence. Prior to this year,

births occurring in the United States to nonresident mothers were considered as births

to residents of the place of occurrence.

Data shown in this report refer only to

births occurring within the areas reporting prenatzd care information to residents of these

areas. For tables showing prenatal care crossclassified by educational attainment of mother,

the data are further limited to births occurring

in areas reporting both educational attainment

and prenatzd care to residents of these areas.

Similar limitations apply to tables that include

information on legitimacy status of child and

period of gestation.

Completeness of Reporting

and Reporting Bias

Information on month of pregnancy prenatal care began and total number of prenatal

Table 11. Percent of births with prenatal care information missing, by race: Reporting areas, 1969-75

I

Month of

mecsnancv ITotal number of

I

pren;tal ce-re Iprenatal visits

began

White Black White Black

1975 ....................... ...........

1974 ..................................

1973 ........... .......................

1972 ............................ ......

1971 ........... .......................

1970 ..................................

1969 ... ...............................

3.8

3.8

4.0

3.6

3.8

4.1

4.7

6.0

5.9

6.2

5.2

5.3

6.2

6.6

6.2

5.0

5.3

5.0

. . .

. . .

. . .

8.5

7.6

7.4

6.3

. . .

. . .

. . .

visits was more fully reported for white than for

black births as shown in table II.

Births for which prenatal care information

is missing are excluded in the computation of

medians and percents. This procedure implies

that such births have the same characteristics

as births for which prenatal care information is

known. However, comparison of births with prenataI care information missing and births with

this information reported shows that for the

former there is an excess of out-of-wedlock and

fourth and higher order births, and mothers are

more apt to have low educational attainment. In

addition, there is a higher proportion of teenage

mothers. Since these characteristics are associated with fewer prenatal visits and delay in seeking care, estimates of the median number of prenatal visits shown in this report are probably

overstated and the percent of women receiving

late or no care are understated. However, since

the proportion of births with prenatal care information missing is relatively small, the net

effect of excluding these births is minimal.

A survey of women having a legitimate live

birth in 1972 permitted comparison of the reporting of the number of prenatal visits on birth

certificates with information provided by

mothers after birth.18 There was perfect agreement from these two sources of information for

only 16 percent of the births. Nearly half of the

mothers indicated they had made more visits;

for slightly more than one-third of the births,

NOTE: A list of references follows the text.

39
the birth certificate showed a greater number of

prenatal care visits than the mother recalled.

Some of these discrepancies may arise because

the person completing the birth record may not

have knowledge of visits made to other physicians or clinics earlier in the pregnancy. The net

effect of such misstatements would be to reduce

the average number of prenatal visits and t.o shift

the time of the start of prenatal care toward a

later trimester. The exact extent of such bias is

unknown.

Definition of Terms

Late or no prenatal care. –For purposes of

this report, late or no prenatal care is defined as

care that begins in the third trimester of pregnancy or no care during pregnancy.

Trimester of pregnancy prenatal care began. –The first trimester of pregnancy encompasses the first, second, and third months of

pregnancy; the second trimester, the fourth,

fifth, and sixth months of pregnancy; the third

trimester, the seventh, eighth, and ninth months

of pregnancy.

Race of child. –Births are classified according to the race or national origin of the parents:

white, black, or other. The category, “white,”

comprises births reported as white, Mexican,

Puerto Rican, and Cuban. The category, “other

races,” includes American Indian, Chinese,

Japanese, Hawaiian and part-Hawaiian, Filipino,

and “other” births. Since the race of the mother

and child are identical for most births, for ease

and clarity in writing this report, the racial

identification given to the mother is that of the

child. Thus, the term “white mothers” actually

refers to white births.

Metropolitan area of residence. –Metropolitan areas are composed of the standard metropolitan statistical areas established by the Office

of Management and Budget, except in, the New

England States, where metropolitan areas consist

of the metropolitan State economic areas established by the U.S. ‘Bureau of the Census. All

areas not designated as metropolitan are classified as nonmetropolitan.

Standardization of Percent Distribution of Births by Month of Pregnancy

Prenatal Care Began

To eliminate the effects of age of mother

and birth-order changes between 1969 and 1975

on the distribution of births by month of pregnancy care began, the direct method of standardization was used. The 1969 distributions of

births by age of mother and birth order for each

racial group were used as the standard populations in this procedure. Standardization for age

of mother and birth-order differences was performed separately for each racial group using

the following formula:

where

ml =

ma =

~=

P=

standardized percent for given race

proportion of births in each prenatal

care status group, for given race

standard population in each age-ofmother/birth-order group for given

race

total standard population for given race

o

40

00

* u. s. G13VEMW+NT PRINTING OFFICE s ISTS Z60-937,2.
VITAL AND HEALTH STATISTICS Series

Series 1. Programs and Collection Procedures. -Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions and data collection methods used and include

definitions and other material necessary for understanding the data.

St%es 2. Data Evaluation and Methods Research. –Studies of new statistical methodology including experimental tests of new survey methods, studies of vital statistics collection methods, new analytical

techniques, objective evaluations of reliability of collected data, and contributions to statistical theory.

Series 3. Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and health

statistics, carrying the znaly sis further than the expository types of reports in the other series.

Series 4. Documents and Committee Reports. –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 10. Data From the Health Interview Survey. –Statistics on illness, accidental injuries, disability, use of

hospital, medical, dental, and other services, and other health-related topics, all based on data collected

in a continuing national household interview survey.

Series 11. Data From the Health Examination Survey and the Health and Nutrition Examination Survey. –Data

from direct examination, testing, and measurement of national samples of the civilian noninstitutionalized population provide the basis for two types of reports: (1) estimates of the medically defined

prevalence of specific diseases in the United States and the distributions of the population with respect

to physical, physiological, and psychological characteristics and (2) analysis of relationships among the

various measurements without reference to an explicit finite universe of persons.

Series 12. Data Fro m the Institutionalized Population Surveys. –Discontinued effective 1975. Future reports from

these surveys will be in Series 13.

Sm.es 13. Data on Health Resources Utilization. –Statistics on the utilization of health manpower and facilities

providing long-term care, ambulatory care, hospital care, and family planning services.

Series 14. Data on Health Resources: Manpower and Facilities. –Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health

occupations, hospitals, nursing homes, and outpatient facilities.

Series 20. Data on Mortality. –Various statistics on mortality other than as included in regular annual or monthly

reports. Special analyses by cause of death, age, and other demographic variables; geographic and time

series analyses; and statistics on characteristics of deaths not available from the vital records based on

sample sumeys of those records.

Series 21. Data on Natality, Marriage, and Divorce. –Various statistics on nataiity, marriage, and divorce other

than as included in regular annual or monthly reports. Special analyses by demographic variables;

geographic and time series analyses; studies of fertility; and statistics on characteristics of births not

available from the vital records based on sample surveys of those records.

Series 22. Data From the National Mortality and Natality Surveys. –Discontinued effective 1975. Future reports

from these sample sr.uveys based on vital records will be included in Series 20 and 21, respectively.

Series 23. Data From the National Survey of Family Growth. –Statistics on fertility, family formation and dissolution, family planning, and related maternal and infant health topics derived from a biennial survey

of a nationwide probability sample of ever-married women 15-44 years of age.

For a list of titles of reports published in these series, write to: Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Service

Hyattsville, Md. 20782
Ncl+s U S DEPARTMENT OF HEALTH EDUCATION, AND wELF4Rk

P.bl,c Hmlth S,,.,.,

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