NCHS Data Brief ■ No. 145 ■ March 2014

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Routine Prenatal Care Visits by Provider Specialty in the 

United States, 2009–2010

Sayeedha G. Uddin, M.D., M.P.H.; Alan E. Simon, M.D., M.P.H.; and Kelly Myrick, Ph.D., C.P.H.

Key findings

Data from the 2009 and 

2010 National Ambulatory 

Medical Care Survey 

and National Hospital 

Ambulatory Medical Care 

Survey

• At 14.1% of routine prenatal 

care visits in the United States 

in 2009–2010, women saw 

providers whose specialty was 

not obstetrics and gynecology 

(ob/gyn).

• The percentage of routine 

prenatal care visits that were 

made to non-ob/gyn providers 

was highest (20.5%) among 

women aged 15–19. 

• Visits to non-ob/gyn 

providers accounted for a 

higher percentage of routine 

prenatal care visits among 

women with Medicaid (24.3%) 

and women with no insurance 

(23.1%) compared with women 

with private insurance (7.3%). 

• The percentage of routine 

prenatal care visits to non-ob/

gyn providers was lower among 

women in large suburban areas 

(5.1%) compared with those in 

urban areas (14.4%) or in small 

towns or suburbs (22.4%).

Early and adequate prenatal care is a Healthy People 2020 objective 

(1). Previous studies have focused on practice patterns of obstetricians/

gynecologists or overall ambulatory care utilization by women (2–5). 

However, the amount of routine prenatal care delivered by obstetrics and 

gynecology (ob/gyn) providers and non-ob/gyn providers has not been 

quantified. Understanding which providers deliver prenatal care may yield 

valuable information about training and workforce needs. This report 

quantifies the amount of routine prenatal care delivered by non-ob/gyn 

providers among women aged 15–54 who were seen in physicians’ offices, 

community health centers, and hospital outpatient departments (OPDs).

Keywords: maternal health • antenatal care • ambulatory obstetric care 

The percentage of routine prenatal care visits at which 

women saw non-ob/gyn providers generally decreased with 

age.

0 20 40 60

Percentage of visits

80 100

Ob/gyn

provider

Non-ob/gyn

provider

35–54

years

30–34

years

20–29

years2

15–19

years1

 Patient age group

15–54

years

1

Statistically significant difference in the percentage of visits with non-ob/gyn providers compared with women in the 30–34 and 

35–54 age groups.

2

Statistically significant difference in the percentage of visits with non-ob/gyn providers compared with women in the 30–34 age 

group.

NOTE: Ob/gyn is obstetrics and gynecology.

SOURCES: CDC/NCHS, National Ambulatory Medical Care Survey and the Outpatient Department Component of the National 

Hospital Ambulatory Medical Care Survey, 2009–2010.

Figure 1. Routine prenatal care visits among women aged 15–54, by age and provider 

specialty: United States, 2009–2010

85.9

14.1

20.5

79.5

17.0

83.0

8.9

91.1

10.3

89.7
NCHS Data Brief ■ No. 145 ■ March 2014

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Overall, women aged 15–54 saw non-ob/gyn providers at 14.1% of their routine prenatal care 

visits in 2009–2010 (Figure 1). The percentage of visits to non-ob/gyn providers generally 

decreased with age: those aged 15–19 had the highest rates (20.5%), and those aged 30–34 and 

35–54 had the lowest rates (8.9% and 10.3%, respectively).

The percentage of prenatal visits to non-ob/gyn providers did not differ by 

race and ethnicity group in 2009–2010.

Generally, women of different race and ethnicity groups did not differ in the percentage of 

prenatal care visits at which they saw non-ob/gyn providers (Figure 2).

0 20 40 60 80 100

 Non-Hispanic

other

 Non-Hispanic

black

 Non-Hispanic

white

 Hispanic Ob/gyn

provider

Non-ob/gyn

provider

*Estimate does not meet standards of reliability or precision; relative standard error for estimate is 48%.

NOTES: Ob/gyn is obstetrics and gynecology. Non-Hispanic other includes those of non-Hispanic ethnicity and Asian, Native Hawaiian or other Pacific Islander, or 

American Indian or Alaska Native, or with more than one race reported. Hispanic refers to those with Hispanic ethnicity of any race.

SOURCES: CDC/NCHS, National Ambulatory Medical Care Survey and the Outpatient Department Component of the National Hospital Ambulatory Medical Care 

Survey, 2009–2010.

Figure 2. Routine prenatal care visits among women aged 15–54, by race and Hispanic origin and by provider specialty: 

United States, 2009–2010

Percentage of visits

 Race and ethnicity

20.4

79.6

11.9

88.1

17.0

83.0

*7.4

92.6
NCHS Data Brief ■ No. 145 ■ March 2014

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In 2009–2010, the percentage of routine prenatal care visits at which 

women saw non-ob/gyn providers varied by the expected source of 

payment.

The percentage of prenatal care visits that were made to non-ob/gyn providers was higher among 

women with no insurance (23.1%) and women with Medicaid (24.3%) compared with women 

with private insurance (7.3%) (Figure 3).

0 20 40 60 80 100

Uninsured

Medicaid

 Private

insurance1 Ob/gyn

provider

Non-ob/gyn

provider

Figure 3. Routine prenatal care visits among women aged 15–54, by expected source of payment and provider specialty: 

United States, 2009–2010 Payment source

Percentage of visits

7.3

92.7

24.3

75.7

23.1

76.9

1

Statistically significant difference in the percentage of visits with non-ob/gyn providers compared with women with Medicaid insurance or no insurance.

NOTES: Ob/gyn is obstetrics and gynecology. Uninsured was defined as the expected payment source being patient out-of-pocket payment, no charge, or charity. 

Sources other than those listed above account for 8.5% of routine prenatal care visits and are not shown: 5.7% with Medicare, worker’s compensation, or other 

sources, and 2.8% with an unknown payment source.

SOURCES: CDC/NCHS, National Ambulatory Medical Care Survey and the Outpatient Department Component of the National Hospital Ambulatory Medical Care 

Survey, 2009–2010.
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The percentage of routine prenatal care visits at which women saw 

non-ob/gyn providers varied by the geographic location of patients’ 

residence in 2009–2010.

The percentage of routine prenatal care visits that were made to non-ob/gyn providers was lowest 

(5.1%) among patients living in large fringe metropolitan areas (large suburban counties) 

(Figure 4). This is in comparison to those living in large central metropolitan areas (urban areas) 

and those living in small metropolitan or micropolitan areas (small towns and small suburban and 

rural counties), who saw non-ob/gyn providers at, respectively, 14.4% and 22.4% of their prenatal 

care visits.

0 20 40 60 80 100

Small metro/

micro

Medium metro

Large fringe

metro1

Large central

metro Ob/gyn

provider

Non-ob/gyn

provider

*Estimate does not meet standards of reliability or precision; relative standard error for estimate is 30%. †

Estimate does not meet standards of reliability or precision; relative standard error for estimate is 34%.

1

Statistically significant difference in percentage of visits with non-ob/gyn providers compared with women residing in large central metropolitan areas and those 

residing in small metropolitan or micropolitan areas.

NOTES: Ob/gyn is obstetrics and gynecology. Metro is metropolitan. Micro is micropolitan. Figure does not include 2.6% of routine prenatal care visits with 

unknown urban/rural location.

SOURCES: CDC/NCHS, National Ambulatory Medical Care Survey and the Outpatient Department Component of the National Hospital Ambulatory Medical Care 

Survey, 2009–2010.

Figure 4. Routine prenatal care visits among women aged 15–54 years, by patient residence area and provider specialty: 

United States, 2009–2010 Area of patient residence

Percentage of visits

14.4

85.6

*5.1

94.9

†

14.6

85.4

22.4

77.6
NCHS Data Brief ■ No. 145 ■ March 2014

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Summary

Non-ob/gyn providers delivered one out of every seven routine prenatal care visits in the 

United States in 2009–2010. Visits to non-ob/gyn providers occurred more frequently for women 

in younger age groups compared with women in older age groups. Although racial and ethnic 

disparities in the receipt of prenatal care have been previously noted (6,7), this analysis indicates 

that non-ob/gyn providers contributed similarly to the delivery of routine prenatal care among 

women of different racial and ethnic groups. Nearly one-quarter of routine prenatal care visits 

by women with Medicaid and by women with no insurance were to non-ob/gyn providers. The 

finding of a higher percentage of routine prenatal care visits to non-ob/gyn providers in large 

urban and small suburban and rural locations, compared with large suburban areas, is consistent 

with previous studies indicating that fewer ob/gyn providers practice in inner city areas and rural 

locations (8,9). This is the first report to quantify the amount of routine prenatal care performed 

by non-ob/gyn and ob/gyn providers and to document subgroups of pregnant patients for whom

non-ob/gyn providers perform a substantial proportion of routine prenatal care. 

Definitions

Routine prenatal care visit: Defined as a visit that had an International Classification of Diseases, 

Ninth Revision, Clinical Modification (ICD-9-CM) (10) diagnosis code of V22 (supervision of 

normal pregnancy) or V23 (supervision of high-risk pregnancy) or a reason for visit code of 

3205.0 (prenatal examination, routine) (11–14).

Obstetrician/gynecologist provider: Defined in the National Ambulatory Medical Care Survey 

(NAMCS) as a physician whose specialty is included in the obstetrics and gynecology specialty 

category (11–12). Defined in the National Hospital Ambulatory Medical Care Survey (NHAMCS) 

OPD component as obstetrics and gynecology clinics (13–14). 

Urban/rural classification of the provider’s ZIP code: Based on the Office of Management 

and Budget’s 2000 standards for defining metropolitan and micropolitan statistical areas, the 

December 2005 delineation of these areas, and vintage 2004 postcensal estimates of the resident 

U.S. population, the Centers for Disease Control and Prevention’s (CDC) National Center for 

Health Statistics (NCHS) developed this classification to study the association between urbanicity 

and health and to monitor the health of urban and rural residents. The six-level classification 

scheme is based on county or county equivalents. 

Large central metropolitan area—An urban area; specifically, a county in a metropolitan 

statistical area (MSA) with a population of 1 million or more that includes the entire 

population of the largest principal city of the MSA, or whose entire population resides in the 

largest principal city of the MSA, or that contains at least 250,000 of the residents of any 

principal city in the MSA. 

Large fringe metropolitan area—A large suburban area; specifically, a county in an MSA 

with a population of 1 million or more that does not qualify as a large central metropolitan 

area. 

Medium metropolitan area—A county in an MSA with a population of 250,000–999,999. 
NCHS Data Brief ■ No. 145 ■ March 2014

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Small metropolitan area—A small town or suburb; specifically, a county in an MSA with a 

population of 50,000–249,999. 

Small micropolitan area—A rural or nonmetropolitan county that is outside of any MSA 

(15). 

Expected source of payment for women with routine prenatal care visits: Classified as private if 

private insurance was documented, and Medicare was not documented. Classified as Medicaid if 

Medicaid was documented without Medicare or private insurance. Classified as uninsured if

self-pay, no charge, or charity was documented, and no other insurance was documented.

Data sources and methods

All estimates are from the 2009 and 2010 NAMCS and NHAMCS, both of which are conducted 

by NCHS. 

NAMCS is a national probability sample survey of office-based physicians. The sampling frame 

for the 2009 and 2010 NAMCS comprised all physicians from the master files of the American 

Medical Association and the American Osteopathic Association. Physicians are in scope if they 

are engaged in patient care activities; are nonfederally employed; and are not in the specialties of 

anesthesiology, pathology, or radiology. The NAMCS physician response rate was 62.4% in 2009 

and 57.3% in 2010. More details about NAMCS methodology are available elsewhere (11–12).

NHAMCS is an annual nationally representative survey of visits to nonfederal, general and 

short-stay hospital emergency departments and OPDs. The sampling frame for the 2009 

NHAMCS was constructed from products of Verispan L.L.C.; specifically, “Healthcare Market 

Index, Updated July 15, 2006” and “Hospital Market Profiling Solution, Second Quarter, 2006.” 

These products were formerly known as the SMG Hospital Database. SDI acquired Verispan in 

July 2008. The sampling frame for the 2010 NHAMCS was constructed from SDI’s “Hospital 

Market Profiling Solution.” The OPD visit response rate was 73% in 2009 and 74% in 2010. 

More details about NHAMCS methodology are available elsewhere (13–14). 

Visit data in this study were limited to visits for routine prenatal care (those with ICD-9-CM 

diagnoses of V22 or V23 or a reason for visit code of 3205.0). Data analyses were performed 

using three statistical packages: Stata version 12.0 (College Station, Tex.), SAS version 9.3 

(SAS Institute, Cary, N.C.), and SUDAAN version 11.0 (RTI International, Research Triangle 

Park, N.C.). Estimates with relative standard errors greater than or equal to 30% are considered 

to have lower precision. Differences by type of provider for selected subgroups of patients and 

visit characteristics were evaluated using t-tests for differences in percentages using p < 0.05 

as the level of significance. Statistical comparisons using t-tests account for the precision of the 

estimates being compared. No adjustments for multiple comparisons were made. All comparisons 

mentioned in the text are statistically significant unless otherwise noted. 

About the authors

Sayeedha G. Uddin and Kelly Myrick are with CDC’s National Center for Health Statistics 

(NCHS), Division of Health Care Statistics; Alan E. Simon is with NCHS Office of Analysis and 

Epidemiology. 
NCHS Data Brief ■ No. 145 ■ March 2014

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14. National Center for Health Statistics. National Hospital Ambulatory 

Medical Care Survey. Public use data file documentation. Hyattsville, MD. 

2010. Available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_

Documentation/NHAMCS/doc2010.pdf. 

15. National Center for Health Statistics. 2006 NCHS urban-rural 

classification scheme for counties. Hyattsville, MD: National Center for 

Health Statistics. Available from: http://www.cdc.gov/nchs/data_access/

urban_rural.htm.

Suggested citation

Uddin SG, Simon AE, Myrick K. Routine 

prenatal care visits by provider specialty in 

the United States, 2009–2010. NCHS data 

brief, no 145. Hyattsville, MD: National 

Center for Health Statistics. 2014.

Copyright information

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or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

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Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

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