Early prenatal care is one of the most important opportunities to improve maternal and infant health outcomes. Delaying prenatal care can reduce the chance of identifying complications early, which can contribute to disparities in maternal and infant health. For example, first-trimester prenatal care initiation has declined nationally, falling to 75.5 percent in 2024, with significant disparities persisting across racial and ethnic groups.¹ Patients who identify as Asian American (80.8 percent), Hispanic/Latino (67.8 percent), African American/Black (65.1 percent), American Indian and Alaska Native (64 percent), and Native Hawaiian and Other Pacific Islander (47.6 percent) continue to experience lower rates of first-trimester prenatal care compared with non-Hispanic White patients (82.1 percent).¹ In addition, women who identify as African American/Black, American Indian and Alaska Native, and Native Hawaiian and Other Pacific Islander have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to non-Hispanic White women, and babies born to patients from these racial and ethnic groups have higher mortality rates than those born to non-Hispanic White patients.² These differences often reflect a complex combination of systemic barriers and health inequities that can affect when patients first engage in prenatal care.

Drivers of delayed prenatal care

Many factors can contribute to delayed prenatal care and maternal and infant health disparities. Social determinants of health (SDOH), which are non-medical factors that influence health and health outcomes,³ such as limited access to maternity care,⁴ language barriers,⁵ health literacy barriers, unfamiliarity with resources, transportation issues, and other responsibilities,⁶ can play a significant role.² For example, over 2.3 million reproductive aged women in the United States live in counties without a single birthing facility or obstetric clinician, and over 3 million additional women live in counties with limited maternity care access.⁴ Language barriers can make it hard for patients to communicate with providers and office staff and understand medical terminology, which can create difficulties with accessing maternity care services and complicate interactions.⁵ In a survey by KFF, among adults with limited English proficiency, about half said that difficulty speaking or reading English made it challenging to complete at least one of several activities related to using health care in the past three years, including filling out forms, communicating with staff at a doctor’s office, understanding instructions from a health care provider, filling a prescription and knowing how to use it, or scheduling an appointment.⁷ And some patients may not understand the importance of prenatal care⁶ or recognize that they are pregnant until later in their pregnancy.⁸ These barriers to prenatal care highlight the need for individualized interventions tailored to the unique socioeconomic, cultural, and language needs and experiences of patients.

Addressing disparities in prenatal care initiation

Early prenatal care offers critical opportunities to identify maternal and fetal risks, address social and behavioral health needs, and establish a foundation for ongoing engagement throughout pregnancy. By understanding how care is accessed and experienced across diverse populations, and by implementing targeted, culturally responsive strategies, you can play a meaningful role in addressing the disparities in prenatal care initiation.

Some steps you can take include:

• Screening for SDOH barriers, such as access to care, transportation issues, scheduling constraints, and language access needs, during interactions with patients.
• Asking patients about their preferences and needs.
• Understanding the unique experiences of each patient.
• Using plain language, limiting medical jargon, providing written materials at appropriate reading levels, providing translated materials, and using interpreter services.

Taking these steps can help you to connect patients to resources, build understanding and trust,⁹ and improve care coordination, which can support patients in engaging in prenatal care earlier. Improving first-trimester prenatal care initiation among racial and ethnic groups is a practical opportunity to advance maternal health equity.

Cigna Healthcare^® offers maternal health resources, cultural competency and health equity resources, and language and accessibility services to support you and your patients.

Maternal health resources

The following resources offered by Cigna Healthcare can help to support your eligible patients throughout their pregnancies:

• Cigna Healthy Pregnancies, Healthy Babies^®: For eligible Cigna Healthcare members, this program aims to educate and support your patients at the very start of their pregnancies to help ensure healthy pregnancies and babies by connecting patients with a maternity specialist, supporting with care management, coordinating care, and helping patients to better understand all aspects of their pregnancies. Employers may offer incentives to patients who enroll in the program.

• Cigna Healthy Pregnancy^® app: This free app provides education, symptom tracking, and guided next steps for patients during pregnancy to help patients actively manage their pregnancies and keep themselves and their babies as healthy as possible. Through the app, patients can also make virtual or in-person appointments with in-network lactation consultants at no cost to the patients.

Cultural resources

The Cultural Competency and Health Equity web page offers educational resources to help you deliver culturally responsive care.

You can learn more about the cultural resources offered by Cigna Healthcare by reading Bridging the gap: Leveraging cultural resources for diverse patient care

Language and accessibility services

Cigna Healthcare offers discounted language assistance services rates for eligible patients with Cigna Healthcare coverage, including:

• Bilingual proficiency testing.
• Written translations.
• Verbal and American Sign Language (ASL) interpreters through telephonic, face-to-face, and video remote options.

If you are a network-participating provider, you can access these discounts through the contracts Cigna Healthcare has negotiated with professional language assistance vendors.

Learn more about the language assistance services and resources offered by Cigna Healthcare here.

1. Michelle Osterman, et al. “Changes in Timing of Prenatal Care Initiation: United States, 2021–2024.” CDC. 19 February 2026. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db550.htm.

2. Latoya Hill, et al. “Racial Disparities in Maternal and Infant Health: Current Status and Key Issues.” KFF. 03 December 2025. Retrieved from https://www.kff.org/racial-equity-and-health-policy/racial-disparities-in-maternal-and-infant-health-current-status-and-key-issues/.

3. U.S. Centers for Disease Control and Prevention (CDC). “Social Determinants of Health (SDOH).” CDC. 17 January 2024. Retrieved from https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html.

4. Ashley Stoneburner, et al. “Nowhere to Go: Maternity Care Deserts Across the US.” March of Dimes. 2024. Retrieved from https://www.marchofdimes.org/peristats/assets/s3/reports/2024-Maternity-Care-Report.pdf.

5. May Sudhinaraset, et al. “Maternity Care at the Intersections of Language, Ethnicity, and Immigration Status: A Qualitative Study.” Women’s Health Issues. November–December 2023. Retrieved from https://doi.org/10.1016/j.whi.2023.04.004.  

6. Morgan Yapundich, et al. “Evaluating Prenatal Care Compliance and Barriers to Prenatal Care Among Pregnant Individuals in Forsyth County, North Carolina.” North Carolina Medical Journal. 16 August 2024. Retrieved from https://doi.org/10.18043/001c.121419.

7. Samantha Artiga, et al. “Survey on Racism, Discrimination and Health: Experiences and Impacts Across Racial and Ethnic Groups.” KFF. 05 December 2023. Retrieved from https://www.kff.org/racial-equity-and-health-policy/survey-on-racism-discrimination-and-health/#c2c2afb4-1ddf-4b3a-b085-41d5c09b3166–h-section-1-racial-and-ethnic-differences-in-social-and-economic-factors-safety-and-police-interactions.

8. Valeria Holt, et al. “Patient-perceived barriers to early initiation of prenatal care at a large, urban federally qualified health center: a mixed-methods study.” BMC Pregnancy and Childbirth. 21 June 2024. Retrieved from https://doi.org/10.1186/s12884-024-06630-9.

9. American College of Obstetricians and Gynecologists. “Racial and Ethnic Inequities in Obstetrics and Gynecology [Committee Statement No. 10].” American College of Obstetricians and Gynecologists. 15 August 2024. Retrieved from https://www.acog.org/clinical/clinical-guidance/committee-statement/articles/2024/09/racial-and-ethnic-inequities-in-obstetrics-and-gynecology.