A couple sits with their newborn inside their Bentonville, Arkansas, home earlier this month. Nearly a quarter of pregnant women aren’t getting prenatal care in the early stages of pregnancy, according to a new analysis from the U.S. Centers for Disease Control and Prevention. (Photo by Antoinette Grajeda/Arkansas Advocate)
Nearly a quarter of pregnant women aren’t getting prenatal care in the early stages of pregnancy, according to a new analysis from the U.S. Centers for Disease Control and Prevention.
The share of pregnant women getting prenatal care had been improving: It rose between 2016 and 2021 to a high of more than 78%, but then declined to 75.5% by 2024, wiping out previous gains.
The trend is worrying because getting care early in pregnancy can improve the likelihood of a healthy pregnancy and baby.
The decrease in early prenatal care held true for nearly all race and ethnic groups, but the drops were sharpest for Native Hawaiian and Other Pacific Islanders, Black women and American Indian and Alaska Native women.
By 2024, less than half of Native Hawaiian and Other Pacific Islander mothers received prenatal care in their first trimester — the first three months of pregnancy.
Anne Markus, a professor at George Washington University’s Milken Institute School of Public Health, said that because the statistically significant decline began around 2021, two events could explain some of the decrease: the COVID pandemic, with its associated stay-at-home orders, and the U.S. Supreme Court’s Dobbs decision in 2022 that dismantled the constitutional right to abortion.
“Both disproportionately affected, and continue to affect, communities of color, and the decline in early entry into prenatal care has been disproportionately bigger for racial and ethnic minorities since 2021,” said Markus, whose work focuses on public policy and access to health care. She was not involved in the analysis.
A lack of early prenatal care has also been disproportionately seen in “very young women who are more likely to have a pregnancy that they do not want,” Markus said. “The Dobbs decision and the fear and uncertainty it generated could be particularly relevant in explaining this disproportionate effect observed in the data.”
The share of women getting late care — beginning in the seventh month of pregnancy or later — or no care at all increased in more than half of states from 2021-2024. Utah saw the biggest rise in late or no care, followed by Massachusetts and Rhode Island. The number of Utah women getting late or no prenatal care jumped 54%, up to nearly 6% of women.
More than 1 in 10 women had late or no prenatal care by 2024 in Florida, Georgia, Hawaii, New Mexico and Texas.
“Geographic and financial barriers to accessing care are often behind late entry to recommended care, including prenatal care,” Markus said.
Late or no prenatal care decreased in six states: Arkansas, New Hampshire, South Carolina, Tennessee, West Virginia and Wisconsin.
The CDC compiled the report based on information from birth certificates, and includes information for all births that occurred in the United States.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
People shop for groceries at a Walmart store in Ohio. State officials across the country are looking to crack down on fraud and mistakes in the Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps. (Photo by Marty Schladen/Ohio Capital Journal)
State officials across the country are looking to crack down on fraud and mistakes in the nation’s largest food assistance program, spurred by looming federal rules that will force states with high error rates to pay more.
But the Republican proposals mostly focus on more frequently verifying the eligibility of individual households that participate in the Supplemental Nutrition Assistance Program (SNAP), rather than on broader administrative shortcomings that allow most of the waste and fraud to occur.
Policies such as verifying recipients’ eligibility each month — which can involve cross-checking multiple databases or collecting extra documentation — might increase state agencies’ workloads without lowering error rates. This is especially likely if states don’t boost funding to handle the extra paperwork, investigate fraud or resolve recipient and agency errors.
Eliza Kinsey, an assistant professor at the University of Pennsylvania’s Perelman School of Medicine who focuses on hunger, said staffing shortages, outdated technology and changes to eligibility rules that require oversight are making it harder for state agencies to avoid overpaying or underpaying recipients — the errors that will cost states money under the new federal rules.
“The fact that we’re seeing error rates that are higher really makes sense, given the context of what’s going on in SNAP right now,” Kinsey said.
SNAP serves nearly 42 million people — more than 1 in 10 U.S. residents. More than half are children under 18 or adults 60 and older.
Each month, participating households receive an average of $187 in benefits per person to buy food.
SNAP, formerly known as food stamps, is a federal-state program that provides recipients with a debit card that can be used to purchase food at grocery stores and other retailers. SNAP errors and fraud often get conflated, but they’re largely separate issues: Errors are unintentional mistakes by SNAP agencies or recipients, while fraud is intentional theft.
SNAP errors occur when the state overpays or underpays SNAP recipients. They’re caused either by unintentional recipient mistakes — forgetting to report a change in how many people live in the household, for example — or by an agency processing error, such as incorrectly calculating a household’s expenses.
States have encountered instances of individual recipient fraud, though they can go uninvestigated when resources are scarce. Large sums, in the millions, have been stolen by sophisticated crime rings that electronically “skim” money from the debit cards that SNAP recipients use to purchase food.
State SNAP error rates include recipient fraud, recipient errors, and state agency errors.
Alabama earned local and national media attention last year when initial U.S. Department of Agriculture data from early 2025 showed it leading the nation in stolen SNAP benefit claims, ahead of much more populous California and New York.
“There’s a lot of talk about SNAP fraud, and a lot of it is misrepresented,” Nancy Buckner, commissioner of the Alabama Department of Human Resources, which administers Alabama’s SNAP program, told state lawmakers at a January budget hearing. “The biggest SNAP fraud in this country are those people that are doing it electronically.”
In recent years, her department noticed SNAP purchases being made in states nowhere near Alabama, she said, including New York, Pennsylvania, Massachusetts and Maine.
“It was obvious to us we don’t have that many Alabama clients shopping in those other states,” she said. This month, Alabama became the second state, behind California, to issue SNAP debit cards to recipients with the kind of microchips that are standard on commercial debit cards. Chipped cards are harder to steal from than those with magnetic strips only.
In the middle of it all, states are staring down massive cuts in federal funding. President Donald Trump’s One Big Beautiful Bill Act puts states on the hook for more administrative costs and forces states to pay a higher share of benefits, in some cases hundreds of millions of dollars, if they have higher error rates.
“The federal government is telling states, you have to pay more in administrative costs, and you have to bring your error rates down simultaneously,” said Kinsey. “It feels like those two changes are in opposition with each other.”
Error prone
Last month, Alabama state lawmakers grilled Buckner, demanding to know her plan for lowering the state’s error rate.
Under Trump’s new law, Alabama’s SNAP administrative costs will rise by $39 million. Meanwhile, the state’s error rate, which Buckner expects to be about 9%, is below the national average, but high enough to allow the feds to force the state to cover 10% of its SNAP benefits starting in fiscal 2028.
The federal government is telling states, you have to pay more in administrative costs, and you have to bring your error rates down simultaneously. It feels like those two changes are in opposition with each other.
– Eliza Kinsey, assistant professor at the University of Pennsylvania’s Perelman School of Medicine
All told, Alabama could be on the hook for an additional $200 million or more per year by 2028.
“Is there anything that can be done to prevent running into that $200 million wall?” Alabama state Sen. Greg Albritton, a Republican, asked Buckner during a budget hearing in January. “Right now I think that the train’s got the light on, heading straight for us.”
Buckner said she hoped for some extra wiggle room from the feds, but provided few details on how the department could lower Alabama’s error rate enough to avoid financial penalties.
Currently, the federal government pays for SNAP benefits and splits administration costs 50/50 with states. But starting in October, under the One Big Beautiful Bill Act, all states will be on the hook for 75% of their own administrative costs. And the new law allows the feds to penalize states for their SNAP errors, requiring them to pay from 5%-15% of their SNAP benefit costs if their error rates are over 6%.
The only states under the 6% threshold, per the most recent data available from USDA, which oversees the program, were Idaho, Nebraska, Nevada, South Dakota, Utah, Vermont, Wisconsin and Wyoming.
Republicans say these new rules will reduce the federal government’s investment in SNAP while giving states some “skin in the game” when it comes to being responsible with federal money.
“One of the problems is the federal programs don’t mandate the prevention, detection and prosecution of fraud,” said Dawn Royal, with the United Council on Welfare Fraud, a national membership group focused on fraud in public assistance programs. “And so states are unwilling to spend state money in order to protect federal money.”
The Alabama Senate is currently considering a bill that would require state agencies to conduct monthly checks of other state databases to make sure SNAP enrollees remain eligible.
Buckner told state lawmakers that increasing eligibility checks for SNAP benefits would “shoot that error rate up, way up.” The state’s Legislative Fiscal Office estimated the additional work for both Medicaid and SNAP under the pending bill could cost $16.7 million per year.
“Monthly reporting is not the answer to that, at all,” she said.
But other states are looking at similar measures.
Lawmakers in states including Idaho, Kansas and Wyoming have introduced bills to require their state SNAP administrators to check eligibility of SNAP recipients more frequently. Missouri, Oklahoma and Utah bills would require verification of citizenship or legal immigration status before approving applicants for SNAP benefits. A Wisconsin bill would require the state’s Democratic governor to bow to a White House demand to turn over state data on SNAP recipients.
And in Arizona, GOP lawmakers wanted to go even further than the new federal requirements. Last week Democratic Gov. Katie Hobbs vetoed a package of Republican bills that would have required the state agency administering SNAP to get its error rate below 3% by 2030 or face financial penalties, and cut an additional 10% from its budget if the state failed to take corrective action.
States target fraud
SNAP fraud has made state and national headlines in recent years, but there’s not a broad consensus on the scale of the problem nor how to address it.
Some SNAP fraud is perpetrated by recipients who lie in order to get SNAP benefits for which they’re not eligible. But there’s also organized electronic SNAP theft, which involves thieves taking control of EBT accounts through electronic methods such as card skimming or cloning, bot attacks and phishing scams. Skimming is a form of theft where devices are illegally installed inside sales terminals at a store and capture card data. That data is then used to make unauthorized purchases or steal from the victim’s account.
In December, a longtime USDA employee was sentenced to two years in prison for her role in what the U.S. Department of Justice called a “sprawling fraud and bribery scheme” that generated more than $66 million in unauthorized SNAP transactions. The same month, two Romanian nationals were indicted for their role in allegedly stealing more than $160,000 in benefits in Oregon and elsewhere. In 2025, California reported more than $100 million in stolen funds from California SNAP recipients’ EBT cards.
States reported replacing more than $360 million in stolen benefits from fiscal 2023-2025, according to federal data. Experts and state officials differ on whether recipients or organized crime rings are the biggest threats to SNAP. But since the federal government stopped reimbursing stolen SNAP benefits at the end of 2024, more states are looking at ways to address fraud.
States including Arkansas, Maryland, Massachusetts, Michigan, New Jersey, Oklahoma and Virginia are joining Alabama and California in rolling out chip cards to make it harder for skimmers to steal SNAP benefits.
“SNAP fraud is rampant,” said Royal, of the United Council on Welfare Fraud. “If anybody tells you that there’s not SNAP fraud out there, they’re trying to pull the wool over your eyes. It exists in all 50 states. It is definitely a plague on the taxpayers.”
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
Alabama state Sen. Matt Woods, a Republican, speaks to a colleague on the floor of the Alabama Senate in January. The Senate passed a bill Woods sponsored that would prohibit civil courts from issuing nondisclosure agreements against survivors of child sexual abuse. (Photo by Brian Lyman/Alabama Reflector)
Editor’s note: If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988. There is also an online chat at 988lifeline.org.
Cindy Clemishire was 12 years old on Christmas night in 1982 when a traveling evangelist staying with her family first abused her.
According to Clemishire, the sexual abuse continued over the next four years. She eventually told her family and the abuse stopped. But her abuser, Robert Morris, went on to found Gateway Church in Texas, which became one of the largest megachurches in the nation.
When Clemishire sought restitution in 2007, Morris’ attorney offered her $25,000 if she would sign a nondisclosure agreement that would prevent her from speaking publicly about the abuse. She refused.
“Had I agreed to that NDA, Robert would have continued to have power over me,” Clemishire told Texas lawmakers last May, as she urged them to pass a state law that would ban nondisclosure agreements in child sexual abuse civil cases.
“Because I refused to sign that NDA at 37,” she said, “I am able to sit here today at 55 years old and share my story in hopes of helping others.”
Texas Gov. Greg Abbott, a Republican, signed the bill into law last June. Texas joined other states, including California, Missouri and Tennessee, in prohibiting nondisclosure agreements, or NDAs, from being used in civil settlements that involve child — and in some states, adult — sexual abuse.
Because I refused to sign that NDA at 37, I am able to sit here today at 55 years old and share my story in hopes of helping others.
– Cindy Clemishire, sexual abuse survivor and advocate for state law reform
This year, Clemishire’s home state of Oklahoma, as well as Alabama and Georgia, are considering similar laws.
Oklahoma’s bill was introduced this week. Last month, Alabama lawmakers unanimously passed identical bills in the state House and Senate. If one of the bills passes the other chamber, it will head to the governor’s desk. In Georgia, Republican Gov. Brian Kemp announced during his final State of the State address last month that he would support a version of the law.
Kemp said the bill would “further protect our children, expose abusers, and save lives by preventing the silence imposed on far too many victims.”
Many of the new bills are versions of Trey’s Law, model legislation — first passed in Missouri — named for Trey Carlock, a survivor of child sexual abuse. Carlock died by suicide in 2019 at age 28. Though his abuser was convicted of sexually abusing several boys, Carlock had signed a nondisclosure agreement in a civil settlement that prevented him from speaking about his abuse at Kanakuk, a popular Christian sports camp based in Missouri, and the camp’s role in enabling the abuse.
Elizabeth Phillips, Carlock’s sister, later founded the Trey’s Law movement in his memory. Trey’s Law works to get NDA bans passed at the state and federal levels.
Such bills attempt to address a civil litigation issue that gained increased attention during the #MeToo movement. Organizations such as Kanakuk that are caught up in child abuse allegations sometimes offer financial settlements to abuse survivors in exchange for their signing agreements that legally restrict them from speaking publicly about the abuse or the organization’s role in it.
Critics of these kinds of NDAs say they’re a legal tool — originally intended to protect confidential corporate information — that’s been misused to suppress survivors’ stories and shield organizations that enable abuse.
“NDAs may be presented as legal formalities, but in cases like mine, they are tools that continue the abuse,” Clemishire told Texas lawmakers last year. “They protect the abuser and keep victims in shame. They prevent the children from being protected and they make it harder to stop abuse from happening again.”
State laws vary in their protections. California enacted a law in 2016 banning NDAs for felony sex offenses, child sexual abuse and sexual assault against vulnerable adults, such as older adults and those with disabilities. Tennessee‘s 2018 law voids NDAs in child sexual assault claims. New Jersey, New York and Pennsylvania have placed restrictions on NDAs. Various courts have also struck down some NDAs that appeared to be designed to hide misconduct.
There’s not currently a federal law analogous to Trey’s Law, though Congress has tried to address the issue. The 2022 federal Speak Out Act specifically targets preemptive NDAs used in workplaces. It nullifies nondisclosure contracts that are signed, often as a condition of employment, before a dispute involving sexual assault or sexual harassment happens. But the law doesn’t apply to NDAs signed after allegations are made.
Much of the new state legislation, such as in Oklahoma and Texas, applies retroactively, nullifying older NDAs. Alabama’s bill would only apply to contracts entered into or amended after the measure is signed into law.
It’s difficult to find public detractors for such legislation. It’s one of the few issues that has, so far, united both sides of the political aisle. In the handful of states that have enacted bans on NDAs in sexual assault cases, they’ve passed with unanimous or near-unanimous bipartisan support.
But in Alabama last month, Republican state Sen. Greg Albritton expressed concern that a blanket ban could harm churches and institutions like the Boy Scouts of America that have faced civil allegations that they ignored child abuse or protected abusers.
“That nondisclosure statement is a lifeline, very often, for the institution to continue its efforts in trying to do good,” Albritton told Alabama lawmakers from the Senate floor, adding that he believes NDAs allow organizations to implement reforms and move forward. “If we pass this, we could be doing damage to institutions — including churches, including those not-for-profit organizations — that are doing their best to do good in the communities.
“I would caution that eliminating that tool from civil procedure does more harm to our society than it does good.”
The lawmaker sponsoring Alabama’s bill is another Republican, state Sen. Matt Woods. The Alabama version of Trey’s Law is his first bill in the Senate, after he was elected in a June 2025 special election. He said the bill was brought to his attention by some of Carlock’s relatives who live in his home county.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
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