March of Dimes Foundation Data Book for Policy Makers Maternal, Infant, and Child Health in the United States 2 0 1 0 ©2009 by the March of Dimes. Permission to copy, disseminate or otherwise use information from the Data Book for Policy Makers is granted as long as appropriate acknowledgment is given. Prepared by: Office of Government Affairs March of Dimes 1146 19th Street, NW, Sixth Floor Washington, DC 20036 Telephone (202) 659-1800 Fax (202) 296-2964 For additional copies: March of Dimes P.O. Box 932852 Atlanta, GA 31193-2852 Phone (800) 367-6630 marchofdimes.com Item number 50-2461-10 For additional copies: March of Dimes P.O. Box 932852 Atlanta, GA 31193-2852 Phone (800) 367-6630 marchofdimes.com Item number 50-2461-10 The March of Dimes Data Book for Policy Makers: Maternal, Infant, and Child Health in the United States 2010 provides national and state data highlighting infant mortality, birth defects, preterm and low birthweight births, health insurance coverage for women and children, and prevention strategies. This easy-to-use resource guide is aimed at public policy makers and others seeking quick facts at their fingertips. Readers interested in more detail and regular updates of many of the data presented in this book should visit PeriStats, the March of Dimes interactive data resource at marchofdimes.com/peristats. Except where noted, information in this Data Book is for the United States. Where possible, data for Puerto Rico are included. The March of Dimes Data Book for Policy Makers was produced by Colleen Sonosky, Kate Morrand, and Marina L. Weiss of the Office of Government Affairs. Rebecca Russell, Todd Dias, Hui Zheng, and Vani Bettegowda of the March of Dimes Perinatal Data Center prepared much of the data. Don Komai of Watermark Design and Chintan Parikh from Publishing Resources provided services to assist the March of Dimes with the production of the publication. The March of Dimes is a national voluntary health agency founded in 1938 by President Franklin D. Roosevelt to support research and services related to polio. Today, the Foundation works to improve the health of women, infants and children by preventing birth defects, premature birth and infant mortality through research, community services, education and advocacy. The March of Dimes is a unique partnership of scientists, clinicians, parents, members of the business community and other volunteers affiliated with chapters in all 50 states, the District of Columbia, and Puerto Rico. We trust this Data Book and other March of Dimes resources that can be found at www.marchofdimes. com (Spanish language site www. nacersano.org) will be helpful as we work together toward the day when every baby is born healthy. Dr. Bruce C. Vladeck, Chair National Public Affairs Committee March of Dimes Dr. Jennifer L. Howse, President March of Dimes About PeriStats PeriStats, the March of Dimes interactive web resource (marchofdimes. com/peristats) offers the latest data on maternal, infant, and child health at national, state, and local levels. Users – from the general public to policy makers, researchers, providers, and students – will find the site comprehen- sive and easy to use. Look for the PeriStats logo on pages throughout the Data Book for Policy Makers. It’s a signal that more detailed – and perhaps more current information is available on the website. Updated at least annually, PeriStats covers data for multiple years for topics like birth rates, infant mortality, prematurity, and low birthweight; tobacco, alcohol, and illicit drug use; cesarean section rates; newborn screening; and health insurance coverage. Information by race, ethnicity, and maternal age is also available for many of these indicators. Users can compare data for counties, states, and the United States and can choose various output formats, including graphs, maps, tables, and slides which they can use in reports or presentations. Together, PeriStats and the Data Book are powerful tools for helping inform policy to improve maternal, infant, and child health in the United States. marchofdimes.com/peristats Contents Maternal, Infant, and Child Health Objectives for 2010 1 On an average day in the United States 2 Quick stats for the United States 3 Infant and Maternal Mortality Infant Mortality in the United States 6 Infant Mortality and Race/Ethnicity of Mother 8 Leading Causes of Infant Mortality 10 Maternal Mortality 12 Birth Defects Incidence of Birth Defects 16 Birth Defects Monitoring Programs 18 Newborn Screening 20 Newborn Screening: Categories of Disorders 22 Preterm and Low Birthweight Births Preterm Births 26 Prematurity and Low Birthweight 28 Risk of Preterm Births 30 Prematurity and Race/Ethnicity of Mother 32 Costliness of Preterm and Low Birthweight Babies 34 Prevention Importance of Prenatal Care 38 Patterns of Prenatal Care 39 Benefits of Folic Acid 40 Smoking During Pregnancy 42 Alcohol and Other Drug Use 44 Obesity 46 Childhood Immunization 48 Health Insurance Health Insurance and Access to Care 50 Health Insurance Coverage for Women of Childbearing Age 52 Health Insurance Coverage for Children 54 Medicaid’s Role in Maternal and Child Health 56 Children’s Health Insurance Program 58 Medicaid and CHIP: Eligibility and Enrollment 60 State Data State Infant Mortality Rates, 2003-2005 Average 65 Live Births, by State, 2006 68 Newborn Screening Requirements, by State, 2009 70 Preterm and Low Birthweight Births 72 Prenatal Care 84 Health Insurance 90 Immunizations 111 Newborn Screening Terms: A Glossary 112 Data Sources 116 Figures and Summary Tables Infant Mortality, 1950-2005 7 Infant Mortality, by Region, 2005 7 Infant Mortality, by Race/Ethnicity of Mother, 2005 9 Infant Mortality, by Hispanic Ethnicity of Mother, 2005 9 Leading Causes of Neonatal and Infant Mortality, 2005 11 Maternal Mortality, by Race, 1970-2006 13 Hospital Costs of Birth Defects, 2004 17 State Activities in Birth Defects Monitoring, 2009 19 Organizational Location of Birth Defects Programs, 2009 19 Funding Sources for Birth Defects Programs, 2009 19 State Newborn Screening Requirements, 2009: A Summary 21 Preterm and Very Preterm Births, 1996-2006 27 Percent Distribution of All Preterm Births, 2006 27 Incidence of Preterm and Low Birthweight Births, 2006 29 Low and Very Low Birthweight Births, 1996-2006 29 Preterm and Very Preterm Births, by Age of Mother, 2006 31 Preterm Births: Singleton, Twin, and Higher Order, 2006 31 Preterm and Very Preterm Births, by Race/Ethnicity of Mother, 2006 33 Preterm and Very Preterm Births, by Hispanic Ethnicity of Mother, 2006 33 Average Length of Stay and Average Medical Costs Among Preterm and Term Births, 2005 35 Conditions with the Highest Inpatient Hospital Costs, 2007 35 Awareness of Folic Acid Benefits Among Women of Childbearing Age, 1995 and 2008 41 Pregnant and Nonpregnant Women Reporting Smoking During the Past Month, 2007-2008 43 State Medicaid Coverage: Smoking Cessation Treatments for Pregnant Women, 2006 43 Women Ages 18-44 Reporting Binge Drinking During Past Month, 2003-2008 45 Obesity Among Women Ages 18-44, 1998-2008 47 Children with No Usual Source of Medical Care, by Type of Insurance Coverage, 2006-2007 51 Women Ages 15-44, by Type of Health Insurance Coverage, 2008 53 Women Ages 15-44 Who Are Uninsured, by Race/Ethnicity, 2008 53 Children Under Age 19, by Type of Health Insurance Coverage, 2008 55 Children Under Age 19 Who Are Uninsured, by Race/Ethnicity, 2008 55 Medicaid Enrollment and Expenditures, by Enrollee Characteristics, 2006 57 Family Planning Waiver Programs, by State, 2007 57 Children’s Health Insurance Program Enrollment, 2001-2008 59 States with Presumptive or Continuous Eligibility Under Medicaid and CHIP, 2007-2009 61 Contents (continued) State-by-State Data and Tables State Infant Mortality Rates, 2003-2005 Average 65 Infant Mortality Rates, by States, 2003-2005 Average 66 Live Births, by State, 2006 68 Newborn Screening Requirements, by State, 2009 70 Preterm Births, by State, 2006 72 Late Preterm Births, by State, 2006 74 Very Preterm Births, by State, 2006 76 Low Birthweight Births, by State, 2006 78 Very Low Birthweight Births, by State, 2006 80 Preterm Birth Rates, by State, 2006 82 Children’s Health Insurance Program, by Type of Program, 2009 83 Births to Women Who Received Early Prenatal Care, by State, 2006 (1989 Birth Certificate Revision) 84 Births to Women Who Received Early Prenatal Care, by State, 2006 (2003 Birth Certificate Revision) 85 Births to Women Who Received Late or No Prenatal Care, by State, 2006 (1989 Birth Certificate Revision) 86 Births to Women Who Received Late or No Prenatal Care, by State, 2006 (2003 Birth Certificate Revision) 87 Births to Women Who Received Adequate or Adequate-Plus Prenatal Care, by State, 2006 (1989 Birth Certificate Revision) 88 Births to Women Who Received Adequate or Adequate-Plus Prenatal Care, by State, 2006 (2003 Birth Certificate Revision) 89 Women Ages 15-44 Without Health Insurance, by State, 2006-2008 Average 90 Children Under Age 19 Without Health Insurance, by State, 2006-2008 Average 92 Income Eligibility Thresholds for Pregnant Women and for Children Under Medicaid, by State, 2009 94 Income Eligibility Thresholds for Pregnant Women and for Children Under CHIP , by State, 2009 96 Presumptive and Continuous Eligibility Under Medicaid and CHIP, by State, 2007-2009 98 Medicaid Enrollees, by Select Characteristics, by State, Fiscal Year 2006 100 Medicaid Expenditures, by Enrollee Characteristics, by State, Fiscal Year 2006 102 Stand-Alone and Medicaid Expansion CHIP Enrollees, by State, 2007-2008 104 Children’s Health Insurance Program Federal Allotments, by State, Fiscal Year 2009 106 Federal Matching Rates for Medicaid and CHIP, by State, Fiscal Year 2010 108 Births Funded by Medicaid, by State, 2003 109 Medicaid Coverage of Smoking Cessation Treatments, by State, 2006 110 Percent of Children 19-35 Months with Up-to-Date Immunizations, 2008 111 1 n Healthy People 2010, a series of national health objectives to be achieved by the year 2010, was released by the U.S. Department of Health and Human Services (HHS) in January 2000. These objectives are being used as a benchmark for measuring progress in health promotion and disease prevention. n The broad goals of this initiative are to increase the quality and years of healthy life and eliminate racial and ethnic disparities in health status. n A number of the Healthy People 2010 objectives concern maternal, infant, and child health. Among them are efforts to: q Reduce rates of infant and maternal mortality, preterm and low birthweight births, and birth defects q Increase the proportion of women receiving early and adequate prenatal care q Ensure appropriate newborn screening and follow-up testing and care n Many relevant objectives are referred to in this data book. More detailed information about the initiative is at the website healthypeople.gov. Maternal, Infant, and Child Health Objectives for 2010 E V E R Y 1 0 Y E A R S , H H S A S S E S S E S A N D R E P O R T S O N S C I E N T I F I C I N S I G H T S A N D L E S S O N S L E A R N E D F R O M T H E P A S T D E C A D E , A L O N G W I T H N E W K N O W L E D G E O F C U R R E N T D AT A , T R E N D S , A N D I N N O V A T I O N S . H E A L T H Y P E O P L E 2 0 2 0 W I L L R E F L E C T A S S E S S M E N T S O F M A J O R R I S K S T O H E A L T H A N D W E L L N E S S , C H A N G I N G P U B L I C H E A LT H P R I O R I T I E S , A N D E M E R G I N G I S S U E S R E L AT E D T O O U R N AT I O N ’ S H E A L T H P R E P A R E D N E S S A N D P R E - V E N T I O N . F O R I N F O R M AT I O N O N T H E D E V E L O P M E N T O F T H E R E V I S E D O R N E W O B J E C T I V E S S E T F O R H E A LT H Y P E O P L E 2 0 2 0 , S E E H E A L T H Y P E O P L E . G O V / H P 2 0 2 0 / 2 March of Dimes On an average day in the United States 11,686 1,487 964 329 237 173 78 babies are born babies are born preterm (less than 37 completed weeks gestation) babies are born low birthweight (less than 2,500 grams, or 5 1 /2 pounds) babies are born with a birth defect* babies are born very preterm (less than 32 completed weeks gestation) babies are born very low birthweight (less than 1,500 grams, or 3 1 /3 pounds) babies die before reaching their first birthday * Based on Centers for Disease Control and Prevention estimate of at least 120,000 babies born annually with major structural birth defects. Note: Numbers are approximations. Source: National Center for Health Statistics, 2006 final natality data and 2005 period linked birth/infant death data. Prepared by the March of Dimes Perinatal Data Center, 2009. [...]... March of Dimes 3 Infant and Infant and Maternal Maternal Mortality Mortality Infant Mortality in the United States Even though infant mortality in the United States dropped dramatically in the past century, significant room for improvement remains q q q The infant mortality rate remained relatively stable over the last several years More than 28,000 infants died before their first birthdays in 2005—a... occurs during the first year of life Source: National Center for Health Statistics, 2005 period linked birth/infant death data Prepared by the March of Dimes Perinatal Data Center, 2009 March of Dimes 11 Maternal Mortality n After a marked decline, the rate of maternal deaths in the United States has not substantially improved since the 1980s n There were 13.3 maternal deaths per 100,000 live births in 2006,... Central or South American Other Hispanic Total Hispanic Source: National Center for Health Statistics, 2005 period linked birth/infant death data Prepared by the March of Dimes Perinatal Data Center, 2009 March of Dimes 9 Leading Causes of Infant Mortality n n n n n For more than 20 years, birth defects have been the leading cause of infant mortality (death in the first year of life) By contrast,... rate of 6.9 deaths per 1,000 live births In 2005, the infant mortality rate was highest in the southern region of the United States Source: National Center for Health Statistics, 2005 period linked birth/infant death data Prepared by the March of Dimes Perinatal Data Center, 2009 I nfant M o r ta l it y r efe r s to death u nde r age one T he infant mo r ta l it y r ate is the n u mbe r of infant... affected individuals lack enzymes that break down amino acids, the building blocks of protein In others, there are deficiencies in enzymes that help the body get rid of the nitrogen in amino acid molecules Toxic levels of amino acids or ammonia can build up in the body, causing a variety of signs and symptoms, and even death q Organic Acid Metabolism Disorders: Diseases in this group result from the loss of. .. resulting in coma and death 22 March of Dimes q Hemoglobinopathies: These inherited diseases of red blood cells result in varying degrees of anemia (shortage of red blood cells), serous infection, pain, and damage to vital organs The symptoms are caused by abnormal kinds or amounts of hemoglobin (or both) – the main protein in red blood cells that carries oxygen from the lungs to every part of. .. report by the American College of Medical Genetics, recommending screening all newborns for 29 specific conditions, including metabolic disorders, hearing impairment, and others n Newborn screening requirements vary by states All states and the District of Columbia screen for hemoglobinopathies and amino acid metabolism disorders except Tyrosinemia type I Twenty-eight states and the District of Columbia... $2,566,067,700 * Includes birth defects not shown Source: Russo, CA and Elixhauser, A, 2007 March of Dimes 17 Birth Defects Monitoring Programs States play a vital role in preventing birth defects by maintaining birth defects monitoring programs These programs collect data for detecting birth defects trends and suggest areas for further research They also link people to needed services The Centers for Disease... District of Columbia test for all 29 recommended conditions n Financing of newborn screening varies by state as well Some states pay for screening using federal Maternal and Child Health Block Grant funds or other resources In others, parents must pay part or all of these costs, which may not be covered by insurance Coverage for treating disorders detected by newborn screening varies by health plan Sources:... Year Goal Infant Mortality by Region, 2005 Deaths per 1,000 live births 10 9 8 7 7.8 7.3 6.0 6 5.6 5 4 3 2 1 0 Midwest Northeast South West Source: National Center for Health Statistics, 2005 period linked birth/infant death data Prepared by the March of Dimes Perinatal Data Center, 2009 March of Dimes 7 Infant Mortality and Race/Ethnicity of Mother n African-American infants are nearly two and a half . PeriStats and the Data Book are powerful tools for helping inform policy to improve maternal, infant, and child health in the United States. marchofdimes.com/peristats Contents Maternal, Infant, and. March of Dimes Foundation Data Book for Policy Makers Maternal, Infant, and Child Health in the United States 2 0 1 0 ©2009 by the March of Dimes. Permission to copy, disseminate or otherwise. Except where noted, information in this Data Book is for the United States. Where possible, data for Puerto Rico are included. The March of Dimes Data Book for Policy Makers was produced