Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 29;22(1):136.
doi: 10.1186/s12978-025-02084-0.

Changes in the utilization of prenatal and delivery services in the United States prior to, during, and after the COVID-19 pandemic

Hannah Silverstein  1   2 , Larissa Jennings Mayo-Wilson  3   4 , Anna Austin  4
Affiliations

Changes in the utilization of prenatal and delivery services in the United States prior to, during, and after the COVID-19 pandemic

Hannah Silverstein et al. Reprod Health. .

Abstract

Background: Starting in March 2020, the COVID-19 pandemic strained the healthcare system in the United States, directly and indirectly changing the provision of many types of care, including maternity care. This paper describes longer-term changes in maternal health services utilization in the U.S. during the COVID-19 pandemic.

Methods: Using United States monthly aggregated birth record data from 2016 to 2023, we examined changes in the average number of prenatal visits (overall and by delivery pay type) and total births (overall, by pay type, and by birthplace) before, during, and after the pandemic. We estimated monthly time series models replicating pre-pandemic patterns from January 2016 to February 2020. We then extended those models to predict monthly levels of each outcome had COVID-19 not occurred from March 2020 through December 2023. We compared observed and predicted levels from March 2020 onward, assessing differences associated with COVID-19.

Results: There were persistent and significantly lower-than-expected levels of average number of prenatal care visit across all COVID-19 months. There was also a temporary significant drop in total births during 2020 that recovered to expected levels in 2021, except for an increase in the total self-pay births in 2023. Patterns by pay type were similar to the overall patterns observed. Total non-hospital births were significantly higher than expected for the entirety of the pandemic, with large increases in intentional home births.

Conclusion: Most initial changes to maternity care persisted throughout and continued after the pandemic, resulting in lower levels of prenatal care visits and higher numbers of home births. These findings show sustained changes to maternity care provision and access prompted by COVID-19, which highlight how vulnerable maternity services are to healthcare disruptions and suggest prolonged effects on equitable access to safe care.

Keywords: Birth records; Births; COVID-19; Delivery; Health equity; Maternal health services; Pandemic; Pregnant; Prenatal care; United States.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Office of Human Research Ethics at the University of North Carolina, Chapel Hill determined that this analysis (IRB submission record number: 23–2691) did not require IRB approval because it did not constitute as human subjects research under federal regulations [45 CFR 46.102 (e or l) and 21 CFR 56.102(c)(e)(l)]. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Observed and predicted levels (95% confidence intervals) of and relative percent differences in average number of prenatal care visits per birth overall and by pay type. Note 1: Observed and predicted 95% CIs displayed in this graph are not comparable. The observed, gray 95% CIs are calculated from the individual-level standard deviation in average prenatal care across births. The predicted 95% CIs in blue and pink reflect the standard deviation of average prenatal care nationally across months. Note 2: The y-axis scale is narrow to maximize the visibility of the 95% CIs. Note 3: Note: Percent differences were calculated relative to the model prediction, using the following equation: formula image
Fig. 2
Fig. 2
Observed and predicted levels (95% confidence intervals) of and relative percent differences in total births overall and by pay type. Note 1: Observed and predicted 95% CIs displayed in this graph are not comparable. The observed, gray 95% CIs are calculated from the individual-level standard deviation in average prenatal care across births. The predicted 95% CIs in blue and pink reflect the standard deviation of average prenatal care nationally across months. Note 2: The y-axis scale is narrow to maximize the visibility of the 95% CIs. Note 3: Note: Percent differences were calculated relative to the model prediction, using the following equation: formula image
Fig. 3
Fig. 3
Observed and predicted levels (95% confidence intervals) of and relative percent differences in total births overall and by birthplace. Note 1: Observed and predicted 95% CIs displayed in this graph are not comparable. The observed, gray 95% CIs are calculated from the individual-level standard deviation in average prenatal care across births. The predicted 95% CIs in blue and pink reflect the standard deviation of average prenatal care nationally across months. Note 2: The y-axis scale is narrow to maximize the visibility of the 95% CIs. Note 3: Note: Percent differences were calculated relative to the model prediction, using the following equation: formula image
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Ducharme J. World Health Organization Declares COVID-19 a “Pandemic.” Here’s what that means. TIME. 2020; Available from: https://time.com/5791661/who-coronavirus-pandemic-declaration/.
    1. World Health Organization. Listings of WHO’s response to COVID-19. WHO Newsletter. 2020. Available from: https://www.who.int/news/item/29-06-2020-covidtimeline. [cited 2022 Oct 26].
    1. Centers for Disease Control and Prevention. CDC Museum COVID-19 Timeline. Available from: https://www.cdc.gov/museum/timeline/covid19.html#Early-2021. [cited 2023 Sep 14].
    1. Blumenthal D, Fowler EJ, Abrams M, Collins SR. Covid-19 — Implications for the Health Care System. N Engl J Med. 2020;383(15):1483–8. Available from: http://www.nejm.org/doi/10.1056/NEJMsb2021088. - PubMed
    1. Wilensky GR. The COVID-19 Pandemic and the US Health Care Workforce. JAMA Heal Forum. 2022;3(1):e220001. Available from: http://journals.sagepub.com/doi/10.1177/1062860617738328. - DOI - PubMed

MeSH terms

LinkOut - more resources