Percent of Live Births by Level of Prenatal Care and Ancestry of Mother,
Central Michigan District Health Department, Michigan Residents 2017

Kessner Index
Kessner Index Total
Births
Hispanic
Ancestry
Adequate 61.7 67.9
Intermediate 26.7 19.6
Inadequate 11.5 12.5
Total 100.0 100.0

Kotelchuck Index
Kotelchuck Index Total
Births
Hispanic
Ancestry
Adequate Plus 32.2 41.1
Adequate 37.6 35.7
Intermediate 10.8 5.4
Inadequate 18.5 14.3
Total 100.0 100.0

 

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: 2017 Michigan Geocoded Birth File, Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services