social support, play a significant role in a woman's decision to seek early prenatal care and subsequent prenatal care services. the size of their "social support" encouraging prenatal care participation, increases the chance of early prenatal care utilization during the first trimester. when an increased length of time passes, women who have yet to have had an encouraging "social support" to seek early prenatal care might attend prenatal care on their own will; however, this is usually after the first trimester has passed. negative influences attitudes influence the decisions to accept or not accept specific prenatal care recommendations based on their knowledge gained from personal experiences and outside information from social networks. one reason women do not follow doctors' advice is due to the perception that the information given is false. women often hear and experience situations in which health professions were wrong. subsequent recommendations were then weighted to determine truth evaluability. many women who are distrustful of biomedicine will decline certain prenatal tests, citing their own bodily knowledge as more trustworthy than their doctor's high-tech interpretations. some minority women may opt to avoid the distress and discomfort of the medical care and refuse prenatal care entirely. having already borne healthy children increases the probability that mothers will not follow clinical recommendations, attributing positive prenatal situations to their past experiences. personal health could be self-defined with the recognition of their own symptoms and determining if they need to seek treatment of medical professionals. some mothers are quite uncomfortable with this lack of clearly communicated information and are consequently hesitant to pursue prenatal testing and counseling that health professionals would consider to recommend. disparities in accessibility although attitudes towards prenatal care can be assessed similarly between different socioeconomic backgrounds, there still exists a discrepancy between prenatal care services and knowledge about available prenatal care resources throughout the nation. analysis of trends depicting the use of prenatal care services constantly show the problem of underutilization, especially in disadvantaged populations within the united states. this discrepancy of the degree to which disadvantaged and advantaged populations use prenatal care service can be explain by social factors such as the limited availability of providers, inefficiency, poor organized health care delivery systems, and inadequate insurance coverage. rates of mothers accessing prenatal care late or no prenatal have decreased; although, since 2003, rates have plateaued. low-socioeconomic areas populations in urban inner-city settings have an increased risk of substandard prenatal care. low-socioeconomic areas experience higher rates of neonatal mortality, caused in large part by low-birth weights, than do women of higher income. this statistic has the chance to decrease with an increase in the number of women entering prenatal care programs. it is more likely that women of higher incomes seek prenatal care in comparison to lower income women. blacks, hispanics, single women, women with lower levels of education (less than 12 years), teenagers under 18, women over 40, women with three or more previous births, and women with fewer socioeconomic resources have a significantly lower opportunity for satisfactory health care services. minorities' access studies have shown a significantly higher risk for blacks and hispanics in receiving inadequate prenatal care. african-american expectant mothers are 2.8 times as likely as non-hispanic white mothers to begin their prenatal care in the third trimester, or to receive no prenatal care during the entirety of the pregnancy. similarly, hispanic expectant mothers are 2.5 times as likely as non-hispanic white mothers to begin their prenatal care in the third trimester, or to receive no prenatal care at all. latina women and african american women were likely to visit different types of health care professionals; latina women are more likely to go see an obstetrician while african american women are more likely to see a practitioner. minorities' perspective on their prenatal care experience was partly based on the interaction with their medical provider and whether they too were of minority background and of the same gender due to cultural familiarity in how physicians interact with their patients. latina paradox main article: mexican paradox a particularly consistent finding regarding the health of the latino population is that latina women, despite their many social and economic disadvantages (e.g., lower socioeconomic status, lower levels of education, less use of prenatal care, less access to health insurance), give birth to significantly fewer low birth weight infants and lose fewer babies to any and all causes during infancy in comparison to non-hispanic white women. this phenomenon is part of what is known as the “latina paradox” or “epidemiologic paradox”, which is a mortality advantage within the latino population. this cultural advantage begins to fade when latina women acculturate into mainstream american culture; thus, more acculturated latina women experience a higher infant mortality rate and give birth to more low-birth weight infants. exploring the factors that bring about the latina paradox at the individual and community levels may help identify new opportunities for policy interventions to optimize prenatal outcomes in u.s born latinas and other non-hispanic white ethnic groups. there is no definitive explanation for what leads to a mortality advantage. behavioral factors such as drug-use, alcohol consumption, and tobacco use may serve as a contribution to the paradox, since latina women smoke less, consume less alcohol, and use drugs less when pregnant compared to their non-hispanic white counterparts. cultural factors may be relevant to the latina paradox since foreign-born latina women have lower rates of low-birth weight babies than u.s. born latina women and non-hispanic white women. alternatively, community factors such as the acculturation of the community and the values of the community may also contribute to the paradox. unintended pregnancy unintended pregnancy precludes pre-conception counseling, and pre-conception care, and delays initiation of prenatal care. in unintended pregnancies, prenatal care is initiate later, and is less adequate. this adversely affects health of woman and of child, and the woman is less prepared for parenthood. delay from unintended pregnancy is in addition to that from other risk factors for delay. the united states rate of unintended pregnancies is higher than the world average, and much higher than that in other industrialized nations. almost half (49%) of u.s. pregnancies are unintended, more than 3 million unintended pregnancies per year. the rate of unintended pregnancy is even higher among the poor. in 1990 about 44% of births were unintended at time of conception; among poor women almost 60% of births were due to unintended pregnancies. health insurance of those women who become pregnant every year in the united states 13 percent are uninsured, resulting in severely limited access to prenatal care. according to children's defense fund's website, "almost one in every four pregnant black women and more than one in three pregnant latina women is uninsured, compared with one in nearly seven pregnant white women. without coverage, black and latina mothers are less likely to access or afford prenatal care." currently, pregnancy is considered a "pre-existing condition," making it much harder for uninsured pregnant women to actually be able to afford private health insurance. in 1990, 1995, and 1998, the expansion of medical increased the use of prenatal care and reduced ethnic differences in those who utilized health services. data has shown that those with access to medicaid account for 58 percent of women who underutilize prenatal care; those with access to another type of insurance coverage account for 11 percent of women who underutilize prenatal care. formal education women with fewer than 12 years of education are at high risk of underutilizing or lacking access to adequate prenatal care services. oftentimes, black and hispanic pregnant women have fewer years of formal education, which sparks a domino effect of consequences related to prenatal care. a lack of formal education results in less knowledge about pregnancy appropriate prenatal healthcare as a whole, fewer job opportunities, and a lower level of income throughout their adult life. consequences from lack of prenatal care without timely, thorough, and appropriate prenatal care, disadvantaged populations and those who do not utilize prenatal health services face higher risks of encountering consequences during prenatal, childbirth and post-partum experiences. mothers who receive late or no prenatal care are more likely to give birth to babies with health ailments. some health problems can be prevented by increasing both proper application and access of adequate prenatal care. nearly one-fifth of women in the united states do not seek prenatal care during their first trimester. delivery complications main article: maternal death without proper prenatal care services, there are an increase in complication rates such as: intrauterine growth restriction: the poor growth of babies while in the mother's womb preeclampsia: hypertension occurs during pregnancy preterm premature rupture of membranes: the rupture of the amnionic sac and chorion more than an hour before the start of labor gestational diabetes: women who have not previously suffered diabete prior to pregnancy exhibit high blood glucose levels during pregnancy due to the mother's lack of ability to secrete insulin. placenta previa: the placenta is attached to the uterine wall close to or covering the cervix preterm birth: babies are born less than 37 weeks of their full gestational age. premature newborns can suffer from immature lungs that is associated with respiratory complications. every year in the united states 875,000 women experience one or more pregnancy complications and 467,201 babies are born prematurely. low birth weight main article: low birth weight every year in the united states, 27,864 new borns are born with low birth weight. new borns of mothers who do not utilize prenatal care are three times more likely to have a low birth weight and five times more likely to die in comparison to new borns whose mothers regularly attended prenatal care check-ups. sesia et al. found a positive association with the number of prenatal care visits and birth weight. low birth weight are associated with prematurity and contributes to rates of infant mortality. congenital malformations main article: congenital disorder every year in the united states, 154,051 children are born with birth defects. congenital malformations may be caused by: genetic disorders intrauterine environment errors of morphogenesis, the biological process that causes an organism to develop its shape. chromosomal abnormality some commonly known congenital malformations are: cleft palate: a fissure or opening in the lip heart defects down syndrome: the presence of all or a part of an extra 21st chromosome. prenatal care deficits and postnatal environments work together in a complex manner to influence the outcomes of congenital disorders. infant mortality main article: infant mortality in 2000, the united states ranked 27th among industrialized countries for their relatively high infant mortality rate. data from 2003 shows that the infant mortality rate was 6.9 deaths per 1,000 per live births. every year in the united states, 27,864 infants die before their first birthday. the united states' mortality rate is one of the highest amongst other developed countries. it is associated with maternal health, socioeconomic conditions, and public health practices. inadequate use of prenatal care is a strong predictor of low infant birth weight, prematurity, and infant mortality. improving prenatal care although disadvantaged populations continue to face decreased access to high-quality prenatal care, there are suggested plans of actions with the purpose of decreasing the extent of health care inequalities. the healthy people 2010 program, a nationwide set of goals for health promotion and disease prevention, set a goal that by 2010, 90% of mothers, both of high and low incomes, would be able to access adequate care early. the 2020 healthy people goal for prenatal care is that 77.6% of pregnant females receive early and adequate prenatal care; 70% received such care in 2007. preventing unintended pregnancy preventing unintended pregnancies would have many desirable health, social and financial results, including increasing the proportion of pregnancies with adequate and timely access to prenatal care. programs to help reduce unintended pregnancy include increased education about and access to contraceptives and improved sex education. connection between physicians and patients for many patients, it is difficult to develop a long-standing and trusting relationship with healthcare providers. regardless of socioeconomic background, women will incorporate beneficial life style changes that are easily incorporated into their daily lives. data from browner et al. found that pregnant women do not regard prenatal recommendations to be authoritative simply because they were issued by clinical professionals, with that they tend to follow recommendations by their own