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Number of Live Births by Level of Prenatal Care,
Race and Ancestry of Mother, Michigan Residents 2009

Kessner Index
Kessner Index Race Arab
Ancestry
Hispanic
Ancestry
All Races White Black American Indian Asian and Pacific Islander All Other Race
Adequate 79,754   63,002   11,729   492   2,919   1,278   2,328   5,097  
Intermediate 25,112   17,512   6,017   216   730   516   763   2,240  
Inadequate 9,347   5,614   3,031   59   326   220   540   730  
Total 117,309   87,471   22,292   776   4,072   2,132   3,766   8,253  

Kotelchuck Index
Kotelchuck Index Race Arab
Ancestry
Hispanic
Ancestry
All Races White Black American Indian Asian and Pacific Islander All Other Race
Adequate Plus 42,333   32,687   7,009   238   1,515   676   1,242   2,806  
Adequate 44,284   35,350   6,106   314   1,614   721   1,236   3,043  
Intermediate 10,023   7,155   2,270   81   295   197   334   675  
Inadequate 14,279   9,050   4,226   119   442   361   694   1,383  
Total 117,309   87,471   22,292   776   4,072   2,132   3,766   8,253  

Note: Kessner Index: The Kessner Index is a classification of prenatal care based on the month of pregnancy in which prenatal care began, the number of prenatal visits and the length of pregnancy (i.e. for shorter pregnancies, fewer prenatal visits constitute adequate care.)  

Kessner Index Measurement Definitions:

Adequate: Care that began within the first trimester and included an average of at least one or two additional prenatal visits per month of gestation, depending on the length of gestation.

Intermediate: Care that began during the second trimester of pregnancy with correspondingly fewer visits, or began during the first trimester but with fewer visits than would be appropriate for the length of gestation.

Inadequate: When no care was received or if care began during the third trimester. It is also inadequate if care began during the first or second trimester but less than five visits occurred, when the length of gestation was 34 weeks or more. When the length of gestation was less than 34 weeks, care is defined as inadequate when care began during the first or second trimester but a number of visits less that four occurred, that number depending on the actual weeks of gestation.


Kotelchuck Index: The Kotelchuck Index, also known as Adequacy of Prenatal Care Index (APNCU), is a two-factor index that utilizes two independent and distinct dimensions: Adequacy of Initiation of Prenatal Care and Adequacy of Received Services. The month in which care is initiated is grouped not by trimester, but into four adequacy groupings. The expected number of visits is based on the ACOG standard and is shown as the ratio of actual visits to recommended number of visits.  

Kotelchuck Index Measurement Definitions:

Adequate Plus: Prenatal care begun by the 4th month and 110% or more of recommended prenatal visits were received.

Adequate: Prenatal care begun by the 4th month and 80% - 109% of recommended prenatal visits were received.

Intermediate: Prenatal care begun by the 4th month and 50% to 79% of recommended prenatal visits were received.

Inadequate: Prenatal care begun after the 4th month or less than 50% of recommended prenatal visits were received.


Records with unknown level of prenatal care are included only in the total row.

Records with race not stated are included only in the "All Races" column.
Source: 2009 Michigan Resident Birth File, Division for Vital Records & Health Statistics, Michigan Department of Community Health
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