TRENDS IN THE PERCENTAGE OF WOMEN WHO RECEIVED NO PRENATAL-CARE IN THE UNITED-STATES, 1980-1992 - CONTRIBUTIONS OF THE DEMOGRAPHIC AND RISKEFFECTS

Objective: To determine if the increase in the percentage of women who received no prenatal care in the United States relative to 1980 (from 1.3% in 1980 to 2.2% in 1989 and 1.7% in 1999) was due to increasing risks of no care in subgroups of women or increasing percentages of bi rths to women at high demographic risk of no care. Methods: We analyze d U.S. birth certificates for the period 1980-1992. The annual adjuste d odds of no prenatal care relative to 1980 were computed by logistic regression models that included year, maternal characteristics, and in teractions of these characteristics with year. We also examined change s in the annual distributions of births by maternal characteristics. R esults: The risk of no prenatal care in most subgroups increased durin g the early 1980s, peaked in the late 1980s, and declined thereafter. For example, among black women, the adjusted risk of no care more than doubled from 1980 to 1989. Throughout the 1980s and into the 1990s, t he percentage of births to women at high demographic risk of no care i ncreased. This increase in the percentage of births to women at high d emographic risk shows no sign of abating. Conclusions: During the 1980 s, increasing risks in subgroups of women drove the increase in the cr ude rate of no prenatal care. Despite decreases in the risks of no car e in the early 1990s, increasing percentages of births to women with h igh demographic risk for no care prevented a decrease in the crude rat e to the 1980 level.