Community Participation Report

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Appendices

Appendix A
Recent reports suggest that the number of mothers seeking prenatal care dropped precipitously between 2004 and 2005. Tables 1A and 1B, below, shows prenatal care information since 1990. The trend has been that prenatal care visits beginning in the first trimester (as recommend by Healthy People 2010) has slowly but gradually increased to 82 percent of Texas mothers and 87 percent of Bexar County mothers in 2004 followed by a drop to 63 percent and 73 percent respectively in 2005. It seems unlikely that the behaviors of mothers would change so suddenly after 15 years of steady increases of one to two percent per year.

In 2003 the National Center for Health Statistics of the Centers for Disease Control and Prevention adopted a new birth certificate. This new birth certificate was adapted and introduced in Texas for use in 2005. The goal for the new certificate is “Making Vital Statistics More Vital.” Among the changes on the birth certificate was how information about prenatal care is obtained.

On the previous birth certificate the question for prenatal care asked: “Prenatal care began in what month 1st, 2nd, 3rd etc. Please specify _____” and “Number of prenatal care visits.” The new birth certificate obtains the information by asking “Date of first prenatal care visit MM/DD/YY; No prenatal care” and “Date of last prenatal care visit MM/DD/YY” and “Number of prenatal care visits.”

The more likely explanation is that prenatal care rates changed because of the method of data collection.

Table 2 shows the proportion of mothers reporting the month they began prenatal care by month in 2004 and 2005. Nineteen percent fewer mothers report that they started prenatal care in the first month of pregnancy in 2005 than in 2004. In 2004 mothers were asked in what month of your pregnancy did you began receiving prenatal care. In 2005 they were asked to provide the actual date they first received prenatal care. It is possible that in each case the mother answered honestly. In 2004 mothers could say they began prenatal care the first month they knew they were pregnant. In 2005 mothers were asked to provide the date of the first prenatal care visit. If measured from the date of last menses it may well have been more than four weeks before they learned they were pregnant, make an appointment and were able to see their physician.

It is likely that the lower rate in 2005 does not reflect a deterioration in the behaviors of mothers seeking prenatal care. Instead, we most likely have more accurate information about when mothers receive their first prenatal care visit. It will be necessary to monitor prenatal care rates over the next few years to know whether there has been a change in behavior.