GROUP PRENATAL CARE
WHAT IS GROUP PRENATAL CARE AND WHY IS IT IMPORTANT?
Group prenatal care is a model of prenatal care facilitated by a trained healthcare provider, and delivered in a group setting, which integrates health assessments, education and skills building, and peer social support.1,2 Group prenatal care typically serves expectant parents with low-risk pregnancies who do not require individual monitoring. The groups include 8 to 12 people of similar gestational age who meet every 2 to 4 weeks, totaling 15 to 20 hours in prenatal care over the course of their pregnancies, compared to 2 to 4 hours in traditional individual care.3,4,5
Early and Regular Prenatal Care Improves the Likelihood of a Healthy Pregnancy
The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics recommend evaluating the needs and risks of expectant parents early and continuously throughout prenatal care.6 Research shows that pregnant individuals who receive adequate care early in pregnancy experience positive perinatal outcomes through the education, risk screening, and physical assessments included in prenatal care visits.7,8
Group Prenatal Care Adds Social Support to Traditional Prenatal Care
Group prenatal care augments the individual prenatal care model in ways that can positively impact expectant parents and their families by integrating family members and peer support into prenatal care and education, which can be a protective factor for an expectant parent’s psychosocial health. Further, group prenatal care includes more contact with providers and medical support services, which may better serve the needs of participants.9
Expectant Parents May Be More Likely to Attend Group Prenatal Care Visits Compared to Traditional Prenatal Care
Group prenatal care emerged as an alternative form of care, in part as a response to challenges with accessing individual prenatal care.10 Group prenatal care provides expectant parents with more time with providers and is intended to improve the relationship between providers and patients. Expectant parents who choose group prenatal care over individual care may be more likely to attend more of their scheduled visits if group prenatal care meets their needs in ways that individual care does not.
CenteringPregnancy Is the Most Prominent Model of Group Prenatal Care
CenteringPregnancy is the predominant model of group prenatal care. It is the most widely studied model and the model on which other forms of group prenatal care are often based.11 CenteringPregnancy is currently being implemented in approximately 350 sites across 39 states.12
Other group prenatal care programs were examined for the Roadmap, but no additional programs had evaluations that met our criteria for strong causal studies. Studies of Expect With Me and the March of Dimes Supportive Pregnancy Care program found beneficial and mixed results for families, respectively. However, studies of both programs did not meet our strong causal study criteria. Other, less rigorously studied group prenatal care programs include Pregnancy & Parenting Partners and Honey Child.
Search the Prenatal-to-3 Policy Clearinghouse for an ongoing inventory of rigorous evidence reviews, including more information on group prenatal care.
WHAT IMPACT DOES GROUP PRENATAL CARE HAVE AND FOR WHOM?
Participation in group prenatal care improves the likelihood that mothers receive adequate prenatal care. Impacts on mothers’ physical and emotional health and on breastfeeding initiation have been found to be both positive and null. The most rigorous studies on healthy and equitable births typically find no differences between group and traditional prenatal care suggesting that group prenatal care can be a safe alternative to traditional care.
More Research Is Needed to Determine the Potential of Group Prenatal Care to Decrease Racial and Ethnic Disparities
Systemic racism, combined with discrimination within hospital and health care delivery systems, is one of the drivers of poorer quality prenatal care and adverse birth outcomes among people of color.13 Some existing evidence indicates that group prenatal care benefits Black mothers—Black mothers participating in group prenatal care were significantly less likely to receive inadequate prenatal care or have a preterm birth compared to Black mothers who did not participate in group prenatal care.14,15 These results, however, are not sufficient to conclude that group prenatal care addresses racial disparities in prenatal care or birth outcomes. Future research should focus on examining the differential impacts of group prenatal care by race and ethnicity.
For more information on what we know and what we still need to learn about group prenatal care, see the evidence review on group prenatal care.
WHAT ARE THE KEY POLICY LEVERS TO INCREASE ACCESS TO GROUP PRENATAL CARE?
In contrast to the evidence for the four state-level policies that are included in this Roadmap, the current evidence base does not identify a specific policy lever that states should adopt and fully implement to increase access to group prenatal care services to all expectant parents who want this type of care.
We identified two key state policy levers that states can implement to increase access to group prenatal care services in their state. The two key state policy levers include:
- Offer an enhanced Medicaid reimbursement rate to incentivize group prenatal care, and
- Invest funding to pilot or scale up group prenatal care in the state.
Key Policy Lever: Offer an Enhanced Medicaid Reimbursement Rate to Incentivize Group Prenatal Care
States can implement Medicaid billing codes that reimburse providers for group prenatal care at a rate that is higher than traditional prenatal care. As of October 2024, 14 states (Arizona, California, Georgia, Louisiana, Maryland, Michigan, Missouri, Montana, New Jersey, North Carolina, Ohio, South Carolina, Texas, and Utah) allow Medicaid to reimburse providers at a higher rate than traditional prenatal care, which may help increase access to services.
In these states, the enhanced reimbursement rates vary considerably, with some states offering an additional $40 to $50 per patient, per visit for group prenatal care, and other states offering a rate that only provides additional funding to providers if they serve large groups. Five states implemented enhanced reimbursement rates since in the last year: Arizona, Georgia, Michigan, Missouri, and North Carolina.
CenteringPregnancy has worked with many states to create billing codes within respective state Medicaid programs and the program model recommends that states reimburse providers at least an additional $45 per patient, per visit. Some states require that group prenatal care models are certified CenteringPregnancy programs to be reimbursable, but other states are not specific as to which group prenatal care model can receive the enhanced reimbursements.
Despite having billing codes and enhanced reimbursements, some states do not always “turn on” or use the billing codes for reasons such as lack of education about the services/codes and/or low reimbursement rates. For example, although Louisiana, Montana, and Utah offer enhanced reimbursement rates for group prenatal care, in 2024, the states did not have any CenteringPregnancy sites, which may indicate that the billing codes are not being used.
Key Policy Lever: Invest Funding to Pilot or Scale Up Group Prenatal Care
Another funding mechanism is to invest state funds to provide grants or discretionary funding to pilot initiatives that reimburse group prenatal care services at a rate that is higher than traditional prenatal care, or to scale up a group prenatal care model in the state. Nine states (Illinois, Indiana, Maryland, Michigan, Montana, New Jersey, New Mexico, Oklahoma, and Texas) allocate funds to provide grants to expand access to group prenatal care services or use discretionary funding to pilot initiatives that reimburse providers at an enhanced rate. Oklahoma is the only new state to invest in pilots or expansions of group prenatal care programs in the last year.
States Also Support Group Prenatal Care Through Nonfinancial Initiatives
States have also taken nonfinancial steps to encourage group prenatal care by recognizing it as an effective strategy for improving maternal and child health outcomes and/or by listing CenteringPregnancy as a resource on state websites. Of the 19 states that recognize group prenatal care as an effective strategy, seven states (Illinois, Indiana, Michigan, Montana, New Jersey, North Carolina, and South Carolina) also provide support through enhanced reimbursements or grant funding to support pilot programs.
For more information on the state policy levers to maximize the reach and effectiveness of group prenatal care see our State Policy Lever Checklists.
HOW DOES ACCESS TO GROUP PRENATAL CARE VARY ACROSS STATES?
Group prenatal care can be offered by health providers using their own method or other models, however, national data on the number of group prenatal care sites in a state are only available for the CenteringPregnancy model, which is the model with the only rigorous evidence base, to date.
Based on the most recent estimates from 2024, 39 states offered at least one CenteringPregnancy site. Twelve states (Alaska, Delaware, Idaho, Kansas, Kentucky, Louisiana, Montana, New Mexico, South Dakota, Utah, Vermont, and Wyoming) had no CenteringPregnancy sites in 2024.
Of the 39 states that have at least one CenteringPregnancy site in the state, 12 states have only a single site. In comparison, California and Ohio have the greatest number of sites—46 and 37, respectively. The number of families served at each site, however, is unavailable.
WHAT PROGRESS HAVE STATES MADE IN THE LAST YEAR TO INCREASE ACCESS TO GROUP PRENATAL CARE SERVICES?
In the last year, several states made policy changes and considered legislative action to expand access to group prenatal care services. Five states (Arizona, Georgia, Missouri, Michigan, and North Carolina) newly implemented enhanced reimbursement rates for group prenatal care services.
Georgia reported that it now offers an additional $30 per patient, per visit, for up to 10 visits, but that only one managed care organization in the state currently uses the rate. Missouri began offering group prenatal care coverage at a rate of $40 per patient, per visit on December 1, 2023. Additionally, in October 2024, both Arizona and Michigan implemented enhanced reimbursement rates for group prenatal care services, both at rates of $45 per patient, per visit. Finally, after enacting legislation in 2023 that directed the Department of Health and Human Services to create an enhanced Medicaid reimbursement rate for group prenatal care, North Carolina finalized its enhanced reimbursement of $250 per group, when five or more visits are attended, retroactive to July 1, 2023.
States also took steps to ensure enhanced reimbursement rates for group prenatal care include Federally Qualified Health Centers (FQHCs), which may be an important step for reaching expectant parents who have low incomes and who are most likely to be impacted by racial disparities in infant and maternal health outcomes. In the last year, both Michigan and North Carolina implemented reimbursement rates which are inclusive of FQHCs.
Finally, Ohio advanced legislation to provide recurring funding for CenteringPregnancy services and other evidence-informed group pregnancy education programs, as well as targeted outreach to expectant parents who are at risk or who live in regions of the state where there are gaps in services. The bill, which would direct funding to areas with the highest levels of infant and maternal mortality, passed the House but had not been taken up by the Senate. As of October 2024, the legislature was still in session.
For more information on each state’s progress on group prenatal care, find our individual state summaries under Additional Resources below (and here).
ADDITIONAL RESOURCES
NOTES AND SOURCES
- American College of Obstetricians and Gynecologists. (2018). Group prenatal care: ACOG committee opinion No. 731. Obstetrics & Gynecology, 131(3), e104–8. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/03/group-prenatal-care#:~:text=Evidence%20suggests%20patients%20have%20better,group%20prenatal%20care%20causes%20harm
- Ickovics, J.R., Kershaw, T.S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., & Rising, S.S. (2007). Group prenatal care and perinatal outcomes: A randomized controlled trial. Journal of Obstetrics and Gynecology, 110(2 Pt 1), 330-339. dx.doi.org/10.1097/01.AOG.0000275284.24298.23 [Group Prenatal Care Evidence Review Study C]
- American College of Obstetricians and Gynecologists. (2018). Group prenatal care: ACOG committee opinion No. 731. Obstetrics & Gynecology, 131(3), e104–8. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/03/group-prenatal-care#:~:text=Evidence%20suggests%20patients%20have%20better,group%20prenatal%20care%20causes%20harm
- Ickovics, J.R., Kershaw, T.S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., & Rising, S.S. (2007). Group prenatal care and perinatal outcomes: A randomized controlled trial. Journal of Obstetrics and Gynecology, 110(2 Pt 1), 330-339. dx.doi.org/10.1097/01.AOG.0000275284.24298.23 [Group Prenatal Care Evidence Review Study C]
- American Academy of Pediatrics and the American College of Obstetrics and Gynecologists. (8th Ed.) (2017). Guidelines for perinatal care. https://www.acog.org/clinical-information/physician-faqs/-/media/3a22e153b67446a6b31fb051e469187c.ashx
- American Academy of Pediatrics and the American College of Obstetrics and Gynecologists. (8th Ed.) (2017). Guidelines for perinatal care. https://www.acog.org/clinical-information/physician-faqs/-/media/3a22e153b67446a6b31fb051e469187c.ashx
- American College of Obstetricians and Gynecologists. (2018). Group prenatal care: ACOG committee opinion No. 731. Obstetrics & Gynecology, 131(3), e104–8. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/03/group-prenatal-care#:~:text=Evidence%20suggests%20patients%20have%20better,group%20prenatal%20care%20causes%20harm
- National Institutes of Health. (2017, January 31). What is prenatal care and why is it important? https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care
- Centering Healthcare Institute (n.d). CenteringPregnancy. https://www.centeringhealthcare.org/what-we-do/centering-pregnancy
- American College of Obstetricians and Gynecologists. (2018). Group prenatal care: ACOG committee opinion No. 731. Obstetrics & Gynecology, 131(3), e104–8. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/03/group-prenatal-care#:~:text=Evidence%20suggests%20patients%20have%20better,group%20prenatal%20care%20causes%20harm
- American College of Obstetricians and Gynecologists. (2018). Group prenatal care: ACOG committee opinion No. 731. Obstetrics & Gynecology, 131(3), e104–8. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/03/group-prenatal-care#:~:text=Evidence%20suggests%20patients%20have%20better,group%20prenatal%20care%20causes%20harm
- Centering Healthcare Institute. (n.d.). Locate Centering Sites. https://centeringhealthcare.secure.force.com/WebPortal/LocateCenteringSitePage
- Taylor, J., Novoa, C., Hamm, K., & Phadke, S. (2019, May 2). Eliminating racial disparities in maternal and infant mortality. A comprehensive blueprint. Center for American Progress. https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparities-maternal-infant-mortality/
- Ickovics, J.R., Kershaw, T.S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., & Rising, S.S. (2007). Group prenatal care and perinatal outcomes: A randomized controlled trial. Journal of Obstetrics & Gynecology, 110(2 Pt 1), 330-339. dx.doi.org/10.1097/01.AOG.0000275284.24298.23 [Group Prenatal Care Evidence Review Study C]
- Crockett, A. H., Chen, L., Heberlein, E. C., Britt, J. L., Covington-Kolb, S., Witrick, B., Doherty, E., Zhang, L., Borders, A., Keenan-Devlin, L., Smart, B., & Heo, M. (2022). Study J: Group vs traditional prenatal care for improving racial equity in preterm birth and low birthweight: The Centering and Racial Disparities randomized clinical trial study. American Journal of Obstetrics and Gynecology, 227(6), 893.e1-893.e15. https://doi.org/10.1016/j.ajog.2022.06.066 [Group Prenatal Care Evidence Review Study J]
