Appendices

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.

Table 1

Texas
Year	Total Births	Care Began First Trimester	Pct 1st Trimester	No or 2nd or 3rd Trimester	No Prenatal Care	Pct No Prenatal Care
1990	316,257	210,589	66.6	33.4	10,613	3.4
1991	317,680	212,205	66.8	33.2	12,789	4.0
1992	320,713	220,267	68.7	31.3	12,673	4.0
1993	321,961	226,201	70.3	29.7	12,470	3.9
1994	321,088	236,442	73.6	26.4	6,973	2.2
1995	322,669	242,550	75.2	24.8	>6,300	2.0
1996	330,238	251,438	76.1	23.9	5,846	1.8
1997	333,829	257,266	77.1	22.9	5,823	1.7
1998	342,199	266,152	77.8	22.2	6,816	2.0
1999	349,157	271,133	77.7	22.3	7,195	2.1
2000	363,325	276,720	76.2	23.8	7,197	2.0
2001	365,092	283,822	77.7	22.3	6,777	1.9
2002	372,369	295,284	79.3	20.7	6,812	1.8
2003	377,37	300,927	79.7	20.3	5,415	1.4
2004	360,612	305,345	81.9	18.1	6,536	1.8
2005	372,652	237,692	63.8	36.2	17,699	4.7
Change from 2004 to 2005 = 18.1

Table 1B

Bexar County
Year	Total Births	Care Began First Trimester	Pct 1st Trimester	No or 2nd or 3rd Trimester	No Prenatal Care	Pct No Prenatal Care
1990	22,067	16,958	76.8	23.2	346	1.6
1991	22,224	16,919	76.1	23.9	391	1.8
1992	22,215	17,174	77.3	22.7	432	1.9
1993	22,714	18,193	80.1	19.9	421	1.9
1994	22,879	18,389	80.4	19.6	326	1.4
1995	22,564	18,527	82.1	17.9	247	1.1
1996	22,869	19,306	84.4	15.6	187	0.8
1997	22,952	19,548	85.2	14.8	246	1.1
1998	23,367	19,644	84.1	15.9	257	1.1
1999	23,597	19,769	83.8	16.2	287	1.2
2000	24,033	20,242	84.2	15.8	255	1.1
2001	23,742	20,211	85.1	14.9	285	1.2
2002	25,023	21,642	86.5	13.5	293	1.2
2003	24,927	21,659	86.9	13.1	286	1.1
2004	24,735	21568	87.2	12.8	150	0.6
2005	27,839	20,316	73.0	27.0	1337	4.8
Change from 2004 to 2005 = 14.2

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.

Table 2

Month PNC Began	2004 Births	Pct	2005 Births	Pct
Total	24,735		27,691
01	7,794	31.5	3,352	12.1	19.4
02	9,774	39.5	10,423	37.6	1.9
03	4,000	16.2	6,541	23.6	-7.4
04	1,440	5.8	2,763	10.0	>-4.2
05	901	3.6	1,457	5.3	-1.6
06	455	1.8	884	3.2	-1.4
07	224	0.9	565	2.0	-1.1
08	114	0.5	335	1.2	-0.7
09	33	0.1v	182	0.7	-0.5v
None	150	0.6	1,337	4.8	-4.2
Missing	327	1.3	1,371	5.0	-3.6
Total	25,212		29,210

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.