Disparities in prenatal care utilization among racial/ethnic and nativity subgroups in the United States

Objective: To evaluate disparities in prenatal care among granular (disaggregated) racial/ethnic subgroups overall and by nativity. Methods: We analyzed singleton live births among United States (US) residents from the National Center for Health Statistics Birth Certificate Data (2018-2022) to evaluate first trimester prenatal care initiation and prenatal care adequacy using the Adequacy of Prenatal Care Utilization Index. We conducted multivariable logistic regressions and used marginal effects to assess adjusted differences among 7 broad racial/ethnic categories (e.g., Asian) and 16 disaggregated subgroups (e.g., Chinese). Disaggregated subgroups came from Asian, Native Hawaiian and Other Pacific Islander (NHPI) and Hispanic categories. Results: Among the sample (n = 15,882,850), 78.4 % had first trimester prenatal care, and 76.2 % had adequate prenatal care. Adjusted rates of first trimester prenatal care ranged from 60.1 % among NHPI individuals to 82.5 % among White individuals, and prenatal care adequacy ranged from 54.3 % among NHPI individuals to 80.1 % among White individuals. Compared to US-born individuals, foreign-born individuals had lower first trimester care and prenatal care adequacy among most racial/ethnic broad categories and subgroups. The rates of both outcomes among each NHPI subgroup were lower than every other racial/ethnic subgroup evaluated. Conclusions: Significant disparities in first trimester prenatal care initiation and adequacy exist based on race/ ethnicity and nativity, with the largest disparities among NHPI individuals. These findings highlight the need for focused public health interventions to address disparities in prenatal care access and quality, ultimately promoting both infant and maternal health equity.