Healthy People 2020 recommends improvements in rural women’s health in the United States, and specifically, prenatal care. A rural Virginia health department requested this study to assess prenatal care and obstetrical delivery options for impoverished women in the Central Shenandoah Valley.

Births to resident mothers between 2000 and 2011 were examined by payer source, care source, first prenatal visit timing, and delivery location. Providers, public health nurses, and women were interviewed to assess barriers.

Resident women delivered 32,423 infants between 2000 and 2011. Prenatal care initiation differed by payer source and care source. Approximately 89% of privately insured patients initiated prenatal care in the 1st trimester, compared to 66% of Medicaid, and 57% of uninsured women. Approximately 80% of private care women initiated prenatal care as recommended; 50% of public care women did so. Overall 21% of Central Valley women were unable to obtain 1st trimester prenatal care.