Pregnant women who are Black, live in a rural area or have a household income under $50,000 experience significant disparities in maternity care, a What to Expect survey found.
In May and June 2022, What to Expect surveyed 1,406 women who were either pregnant or had given birth within the last 12 months about their maternity care. Key findings:
1 in 4 pregnant women have felt ignored or dismissed by a maternity care provider: 10 percent by their primary provider and 19 percent by another provider.
Women who earn less money tend to live farther away from their providers. A woman making less than $50,000 a year is five times more likely to live more than 30 miles from her maternity care provider than a woman who makes more than $125,000.
Black women are more likely than white women to have delayed first prenatal appointments. They are also three times more likely to have their first prenatal appointment at 16 weeks or later.
Black and Hispanic/Latina women are getting their first ultrasounds later than white women. White women are 14 percent more likely than Black women to have their first ultrasound during the first trimester. Black and Hispanic/Latina moms-to-be are two times more likely than white moms-to-be to have their first ultrasound after 12 weeks.
Higher-income women have better virtual access to their practitioners. Women with a higher household income ($125,000 or more) are 32 percent more likely to have access to their practitioner through a virtual patient portal than women with a household income of less than $50,000.
Every mother deserves a safe pregnancy, and while pregnancy-related deaths are rare, in the United States, they’re not rare enough: women in this country are more than twice as likely to die from pregnancy- or childbirth-related complications than women in other high-income countries.
Disparities in care are a major reason why the U.S. is falling short when it comes to maternal health. And What to Expect’s findings are a stark reminder that the quality of prenatal care a mom receives in this country varies enormously depending on where she lives, her income and the color of her skin.
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The survey revealed some good news, namely that the vast majority of pregnant women do receive prenatal care. Eighty five percent of the moms-to-be we surveyed have had at least one prenatal appointment, while an additional 11 percent have their first appointment scheduled. Ninety six percent say they feel confident they’re receiving the prenatal care they need, and the overwhelming majority felt that their pain management wishes and birth plans were respected by their labor and delivery team.
1 in 4 pregnant women feel dismissed
While these numbers are encouraging, the survey also identified areas where care can be improved. For example, 1 in 4 pregnant women report feeling ignored or dismissed by a maternity care provider: about 10 percent by their primary provider and 19 percent by another provider.
The survey also shed light on some of the disparities in care that pregnant women and new moms experience based on their race, socioeconomic status and geographic location.
Below, some of the most significant findings from the survey.
Black women are getting prenatal care later
It’s no secret that there are vast disparities in maternal health care based on a woman’s race, which is one reason why the maternal mortality rate is so much higher for Black moms in the U.S. Our survey reinforced that there are clear disparities in when and how Black and Hispanic/Latina moms-to-be receive care, as well as how they’re treated by practitioners.
Although it’s generally recommended that women make an appointment with their practitioner as soon as they find out they’re pregnant, with a first prenatal visit ideally happening in the second month of pregnancy, Black women are more likely to have these initial appointments later, our survey found.
White moms-to-be are most likely to have their first prenatal appointment by 8 weeks (70 percent), significantly more than Black moms-to-be (59 percent). Black women are also twice as likely to have their first prenatal visit at 13 weeks or later when compared to white women.
delayed prenatal appointments
This trend continues in the later weeks of pregnancy: 9 percent of Black moms-to-be have a first prenatal visit at 16 weeks or later (compared to 3 percent of white moms-to-be), and 4 percent of Black moms-to-be don’t receive prenatal care until 21 weeks or later (compared to only 1 percent of white and Hispanic/Latina women).
In addition to delayed prenatal visits, our survey found that Black and Hispanic/Latina women are receiving first ultrasounds later, too. Ultrasounds are an important piece of prenatal care — in early pregnancy, they confirm fetal heartbeat and the baby’s position in your uterus, and later on, they screen for fetal growth and placenta location.
Among the women we surveyed, the first ultrasound is most commonly scheduled between weeks 6 and 12. But 10 percent of Black and Hispanic/Latina women report having their first ultrasound later on, during weeks 13 to 15.
White women feel better about their prenatal care overall
White women report more favorable prenatal care experiences in other ways, too. For example, they are more likely to receive written materials on a variety of topics during their first prenatal appointment, including information about genetic testing, office visits/scope of care, prenatal classes and the flu vaccine.
And while 69 percent of white moms-to-be say they are allowed to bring their partner with them to prenatal visits “all the time,” only 64 percent of Black moms-to-be and 53 percent of Hispanic/Latina moms-to-be report the same.
The survey also identified differences in where expectant moms receive care and how they get to appointments. Black moms-to-be are less likely to have their first prenatal appointment at a doctor’s office, and more likely to have it at a facility like a walk-in or stand-alone clinic: 12 percent of Black mothers had their first appointment at a community health center or walk-in clinic, compared to 5 percent of Hispanic/Latina and only 2 percent of white moms.
What’s more, Black women are more likely to rely on someone else for help getting to prenatal appointments. They are five times more likely to take a taxi or rideshare to their prenatal visits (5 percent vs. 1 percent for white women) and more likely to rely on someone else to drive them (39 percent vs. 28 percent for white women), for example.
And when it comes to how they feel about the prenatal care they’re receiving, 76 percent of white moms-to-be report feeling confident about the quality of care they’re getting, compared to just 65 percent of Black moms-to-be who feel the same.
Black moms also have more complicated pregnancies
A number of pregnancy-related complications disproportionately affect Black women, and our survey seemed to support this. About one-third of the women we surveyed (32 percent) say their pregnancy is considered “high risk,” but this rate was higher for Black moms (at 39 percent).
Of those new moms we surveyed whose labor was induced, the majority were induced because their practitioner recommended it (56 percent), followed by a maternal health issue (43 percent). But Black moms were most likely to have labor induced because of a health issue with their baby (33 percent vs. 16 percent total).
Black moms were also more likely than other ethnicities to need an emergency C-section, a procedure that comes with more risks for both mothers and babies.
Moms with higher household incomes report better maternity care experiences
Although racial and ethnic disparities remain highly concerning when it comes to maternal health, other factors can also result in differences in care. Moms with higher household incomes report better maternity care experiences overall.
For example, married moms-to-be, those living with a partner and those with household incomes above $75,000 are more likely to have their first appointment earlier when compared to single and lower-income parents.
And although 96 percent of the moms-to-be we surveyed say they feel like they can speak freely with their maternity care provider, 100 percent of expectant mothers who earn $125,000 or more say they can. Women from households earning more than $125,000 a year are also more likely to feel like their practitioner “always” listens to their concerns.
Women who earn $125,000 or more annually are more likely to have their first ultrasound in the first trimester compared to those who make less than $50,000. And at postpartum visits, practitioners are more likely to discuss breastfeeding with women from households earning more than $125,000 a year compared to moms earning $50,000 or less.
During the pandemic, telehealth experienced a surge in popularity. But women with higher household incomes appear to have more virtual access to their practitioners: they are 32 percent more likely to have a virtual patient portal they can use to communicate with providers, and 50 percent more likely to have had a prenatal visit conducted using telehealth. That’s potentially problematic, since a woman who makes less than $50,000 is also five times more likely to live more than 30 miles from her maternity care provider than one who makes more than $125,000, our survey found.
Race and ethnicity intersect with socioeconomic status, too. Forty one percent of the Black mothers we surveyed report a household income of less than $50,000 a year compared to 24 percent of white mothers – making Black women even more vulnerable to experiencing various maternal health and health care disparities.
Location also plays a role in the type of care moms receive
Millions of Americans live in “maternity care deserts” with limited access to prenatal care. Although most of these “deserts” are in rural parts of the country, about one-fifth are in urban areas. Living further from your maternity care provider or having less access to them can make it harder for moms-to-be to keep up with prenatal appointments, as well as make emergency care less accessible. Our survey found some notable differences in care depending on where moms live.
Of the mothers we surveyed, Black and Hispanic/Latina women were more likely to live in urban settings than white mothers, who were more likely than other groups to live in suburban or rural areas.
Women in rural areas were significantly more likely to live more than 30 miles from their practitioners, as well as more than 30 miles from their hospital or birthing center. However, urban and suburban moms were more likely to use patient portals to connect with their practitioners than rural moms.
distance and prenatal care
Although some might assume that people living in rural areas don’t receive as quality care as those in other settings, our survey found that’s not necessarily the case. Although accessibility can be an issue, women living in rural settings were more likely to feel that their practitioner “always or sometimes” listens to their concerns compared to moms living in urban or suburban areas.
Moms living in urban areas were seven times more likely to feel like their pain management or birth plans were “not very well respected.” Women living in urban areas were also five times more likely than suburban moms to report not receiving breastfeeding support in the hospital, and suburban moms were significantly more likely to have their first prenatal visit at 8 weeks or earlier.
Similarly, suburban moms were most likely to have discussed key prenatal topics with their practitioner during their first appointment, and they were also more likely to receive written information about various prenatal health topics compared to moms living in rural or urban areas.
Moms who hire doulas are still the minority, though Black moms-to-be use them more than others
Doulas are trained professionals who provide emotional and physical support during pregnancy, childbirth and the postpartum period. While hiring a doula remains the exception rather than the norm, Black moms-to-be are turning to these skilled birth attendants more than other groups, our survey found. This could be in part because it’s becoming increasingly known that doulas may help Black, Indigenous and People of Color (BIPOC) mothers by reducing the maternal mortality rate and improving birth outcomes.
Only 9 percent of moms reported using a doula or other type of prenatal or postnatal delivery room support, and rural moms-to-be were the least likely to plan on or to use a doula. Black women were the most likely to use or intend to use a doula (14 percent vs. 10 percent total). And Black women with BIPOC providers were also more likely (14 percent) to use or plan on using a doula compared to white moms with white providers (9 percent).
#BumpDay continues to raise awareness about maternal health disparities
Happily, the majority of women we surveyed shared positive experiences about their prenatal care. Most moms-to-be feel respected and listened to, and say they are getting care throughout their pregnancies.
However, the results of this survey are a reminder that many women still experience significant prenatal care disparities that can have implications on their health and the health of their babies, particularly Black and Hispanic/Latina women, as well as women with lower household incomes.
Every mother deserves a safe pregnancy, and the quality of your prenatal care should never depend on where you live, your ability to pay or the color of your skin. That’s why What to Expect holds #BumpDay every year to raise awareness about the need for equitable care for every mom, everywhere. Learn more about the critical issues impacting moms and find out how to participate in #BumpDay on July 20.
Methodology: #BumpDay survey fielded by What to Expect May-June, 2022. Respondents were U.S. women, age 18+ pregnant or with a baby 0 to 12 months old, totaling 1,406 respondents.