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IMPACT OF EARLY PRENATAL CARE ON THE COMMUNITY Prenatal care is essential in obstetric care as it ensures the health and wellness of both mothers and the fetus during pregnancy till delivery (Wilson et al., 2021). Early prenatal care impacts maternal and child health positively through the provision of health education on pregnancy and labour, early detection of risks and complications in pregnancy through the implementation of preventive measures, monitoring of fetal development, provision of nutritional and lifestyle guidance, creation of a birth plan and improved health of neonates at birth (Manyeh et al.,2020). Early prenatal care, however, becomes a burden for women from low-income communities due to several factors that include few health facilities offering obstetric care within their geographical location, lack of enough finances to cater for transport and healthcare services, lack of insurance coverage to act as a means for incurred health care expenses. Cultural and spiritual beliefs are barriers to care access, as well as limited awareness of the importance of early prenatal care (Dahab & Sakellariou, 2020). All these, among other barriers to early prenatal care among women from low-income communities, have led to the creation of Maryland House Bill 1101 in Maryland. The primary purpose of this bill is to establish the Maryland Maternity Care Access Program and the Maryland Maternity Care Access Program Fund. Early first-trimester prenatal counselling is essential in maternal and child health by building trust between the pregnant woman and the health care providers. Building trust creates a sense of security that promotes open communication and a strong bond, making it easy to provide care. Additionally, prenatal counselling provides psychological support as pregnancy can lead to emotional challenges such as stress and anxiety. Moreover, prenatal counselling provides a chance for pregnant women to ask questions, clear any doubts and alleviate anxiety through open

dialogue with the health care providers. Early prenatal care also leads to a reduction of adverse maternal and child health outcomes by reduction in incidences of low birthweight, preterm births and congenital disabilities through the monitoring of fetal development, management of chronic conditions and risks in pregnancy through frequent health monitoring and nutritional and lifestyle counselling and enhanced maternal mental health through counselling, supportive relationship and health education (Fonseca et al., 2023). Women from low-income communities lack access to quality prenatal care due to various factors. Women from low-income communities have access to poor-paying jobs, and the money they get caters to basic needs such as food and shelter and everyday expenses; hence, little is left to cover health care and aid in the payment of health insurance, which helps cover up for extra expenses incurred while seeking care. With little or no left for health care, women from low- income communities seek other options on how to get quality prenatal care, leading them to take up extra jobs that take up their time. Hence, they need more time to visit healthcare centres for comprehensive care. Most women from low-income communities are located in underserved areas which lack an adequate number of healthcare facilities, and the few healthcare facilities present have limited to no obstetric care professionals, making healthcare inaccessible and of poor quality (Dahab & Sakellariou, 2020). Poor health education and promotion systems among women from low-income communities contribute to limited awareness of the importance of early prenatal care, which, in turn, leads to less urgency by pregnant women in seeking early prenatal care as they see no importance for it. Cultural and spiritual beliefs also influence mothers' trust in

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the health care systems as they listen to their peers or those who have had the same experience and implement the interventions they took instead of adhering to health care recommendations. Disparities in access to early prenatal care are discussed, supported and emphasized by a study by Krukowski et al. (2022) among women in the USA who participated in a Pregnancy Risk Assessment Monitoring Systems survey in 2016. A window for change to personal and systemic factors that may compromise the health of women and infants is provided through early prenatal care. However, about 15% of women who participated in the study reported not receiving prenatal care as early as they wished. Various factors such as lack of enough health care facilities offering obstetric care and financial constraints in the health care system were common.38.1% of the women reported that no prenatal care appointments were available, 28.2% reported not having enough finances or insurance coverage to pay for the visit, 27.3% reported that the inadequate number of health care providers would not start prenatal care and 22.5% reported not having a Medical card. All these factors collected from the population that participated in this study show notable disparities in prenatal care access persist among U.S. women from low- income communities who are less educated and are a minority race and ethnic group because they are located in underserved areas (Michelle & Osterman, 2016). According to a study carried out by Tikkanen et al. (2020), it shows that the maternity care system faces significant challenges in the United States because of the lack of personnel and adequate finances to seek care. The maternity care system has a limited number of maternal health care providers, that is, obstetricians, gynaecologists and midwives, compared to the

number of patients seeking care. Very few women also have access to Medicaid Cards to pay for maternity care; hence, they end up opting for home-based care and deliveries. All these contribute to poor quality of maternal and child health, which, as showed in the study in 2018, there were 17 maternal deaths for every 100,000 live births in the U.S. (Tikkanen et al., 2020), which was twice the number reported in most high-income countries. The redesigning of clinical and operational processes will lead to an increase in early prenatal visits and reduced risks associated with pregnancy for both mother and fetus, leading to positive pregnancy outcomes and reducing maternal and neonatal mortalities and morbidities. This study, therefore, will try and focus on how the Maryland House Bill 1101 is going to have a positive impact on maternal and child health through early prenatal care services once implemented. The aims for the establishment of the Maryland Maternity Care Access Program and the Maryland Maternity Care Access Program Fund through the Maryland House Bill 1101 in the health department were the creation of funds through taxing of personal income, development of pregnancy support centres and the allocation of funds from the budget for the 2025 financial year (Nelson, 2020). The bill provides a method for tax checkoffs on the personal income tax that goes directly to the Maryland Maternity Care Access Program Fund so that all citizens contribute to maternal and child health. The bill will also ensure the creation of pregnancy support centres whose main aim is to provide vital services and resources for pregnant mothers. The bill also will receive funding from the government beginning in the 2025 financial year, where the governor is required to allocate $3 million for the maintenance and implementation of the Maryland Maternity Care Access Program. A comptroller is then responsible for the implementation of the method created for the collection of tax check-offs and the management of the funds allocated to the Maryland Maternity Care Access Program Fund. The Maryland Department of Health is the

oversight board for the establishment and sustenance of the pregnancy support centres, allocation of funds and coordination of other organizations that will collaborate to ensure the effectiveness of the implemented Maryland Maternity Care Access Program Fund. Maternal and child health plays a crucial role in the development and growth of a community. The growth and development of every human being begins at conception. The ability of every health system to provide quick and easy access to early prenatal care is one of the most significant contributions to maternal and child health. Early prenatal care contributes to the safe transition from pregnancy through labour to postpartum care by reducing complications and risks that may be experienced during pregnancy. Most countries, states, or communities can achieve early prenatal care by ensuring the health system is well equipped through building and creating pregnancy support centres, creating insurance policies to provide financial support for all mothers, equipping pregnancy support centres with adequate resources and personnel and creation of health education and promotion programs to create awareness on maternal and child health which when all these factors are implemented they lead to positive pregnancy outcomes. The health care system should also foster the creation of health care bills and legislations to contribute to the promotion and provision of quality health care. More bills and legislations like the Maryland House Bill 1101 should be created and implemented by most health care systems in different continents. Bills and legislation that support maternal and child health contribute to the reduction of maternal and neonatal morbidities and mortalities by providing safe and secure environments for the provision of care. Bills and legislation also help create funds to help facilitate maternal and child health programs, making it easy to access obstetric care by women from low-income communities by reducing the disparities experienced while seeking care.

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References Dahab, R., & Sakellariou, D. (2020). Barriers to accessing maternal care in low-income countries in Africa: a systematic review. International journal of environmental research and public health , 17 (12), 4292. Fonseca, M. C., Medeiros, M. A. F., Pessoa, R. A. M., Costa, R. D. C. A., da Silva Ribeiro, S., de Menezes, P. P., ... & dos Santos Braz, D. C. (2023). The importance of prenatal care in primary care by health professionals: a literature review. Caderno de ANAIS HOME . Krukowski, R. A., Jacobson, L. T., John, J., Kinser, P., Campbell, K., Ledoux, T., ... & Kruper, A. (2022). Correlates of early prenatal care access among women: data from the pregnancy risk assessment monitoring system (PRAMS). Maternal and Child Health Journal , 1–14. Manyeh, A. K., Amu, A., Williams, J., & Gyapong, M. (2020). Factors associated with the timing of antenatal clinic attendance among first-time mothers in rural southern Ghana. BMC pregnancy and childbirth , 20 (1), 1–7. Michelle, J., & Osterman, M. (2016). Timing and adequacy of prenatal care in the United States. National Vital Statistics Report, 67 , 1–14. Nelson, K. (2020). “To Infinity and Beyond”: A Limitless Approach to Telemedicine Beyond State Borders. Brooklyn Law Review , 85 (3), 11. Tikkanen, R., Gunja, M. Z., FitzGerald, M., & Zephyrin, L. (2020). Maternal mortality and maternity care in the United States compared to 10 other developed countries. The Commonwealth Fund , 10 .

Wilson, A. N., Ravaldi, C., Scoullar, M. J., Vogel, J. P., Szabo, R. A., Fisher, J. R., & Homer, C. S. (2021). Caring for the carers: Ensuring the provision of quality maternity care during a global pandemic. Women and birth , 34 (3), 206-209.

RHODA.edited_1.edited

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