# Presentation: 492333

## Healthy People 2010 Focus Area 16:Maternal, Infant, and Child HealthProgress ReviewSeptember 20, 2007

## Approximately 6 million pregnancies each year in U.S.
U.S. infant mortality internationally ranked 29th (2004)
Birth defects affect 1 in 33 U.S. births annually
2005 (preliminary) U.S. cesarean rate is highest ever recorded 
Breastfeeding saves on health care costs: reduced sick care visits, prescriptions, hospitalizations

**Approximately 6 million pregnancies each year in U.S.**
**U.S. infant mortality internationally ranked 29****th**** (2004)**
**Birth defects affect 1 in 33 U.S. births annually**
**2005 (preliminary) U.S. cesarean rate is highest ever recorded **
**Breastfeeding saves on health care costs: reduced sick care visits, prescriptions, hospitalizations**

## Maternal, Infant, and Child Health

**Focus Area**

**Fetal, Infant, Child, and Adolescent Deaths**
**Maternal Deaths and Illnesses**
**Prenatal Care**
**Obstetrical Care**
**Risk Factors**
**Developmental Disabilities and Neural Tube Defects**
**Prenatal Substance Exposure**
**Breastfeeding, Newborn Screening, and Service Systems**

## Highlighted Objectives

**16-14c           Autism spectrum disorder**

**Target met or exceeded**

**Improving**

**16-1c             Infant mortality**
**16-1h             Sudden infant death syndrome (SIDS)**
**16-6a             Prenatal care **
**16-15****	****       Neural tube defects (NTDs)**
**16-16a ****	****       Folic acid consumption**
**16-19             Breastfeeding**

**Highlighted Objectives**

**Getting worse**

**16-4               Maternal mortality**
**16-9               Cesarean births**
**16-10a           Low birthweight**
**16-11a           Preterm births**** **

**No trend data**

**16-23             Service systems for special health care needs**

## Infant Mortality

**Obj. 16-1c**

**Infant Mortality**

**Rate per 1,000 live births **

**	****    ****1998        1999        2000       2001        2002        2003        2004**

**2010 Target: 4.5**

**American Indian**

**Black**

**Total**

**Hispanic**

**Asian**

**14**

**12**

**10**

**8**

**6**

**4**

**2**

**0**

**16**

**White**

- Note:  Includes all deaths <1 year.  American Indian includes Alaska Native.  Asian includes Pacific Islander.  The categories black and white exclude persons of Hispanic origin.  Persons of Hispanic origin may be any race. For 1940-79, infant deaths are classified by their race as reported on the death certificate. For 1980-2004, infant deaths are classified by race of mother.
- SOURCE:  National Vital Statistics System (NVSS), NCHS, CDC.

## Infant Mortality

**Obj. 16-1c**

**Infant Mortality**

**Rate per 1,000 live births **

**	****    ****1998        1999        2000       2001        2002        2003        2004**

**2010 Target: 4.5**

**American Indian**

**Black**

**Total**

**Hispanic**

**Asian**

**14**

**12**

**10**

**8**

**6**

**4**

**2**

**0**

**16**

**White**

- Note:  Includes all deaths <1 year.  American Indian includes Alaska Native.  Asian includes Pacific Islander.  The categories black and white exclude persons of Hispanic origin.  Persons of Hispanic origin may be any race. For 1940-79, infant deaths are classified by their race as reported on the death certificate. For 1980-2004, infant deaths are classified by race of mother.
- SOURCE:  National Vital Statistics System (NVSS), NCHS, CDC.

## 5 Leading Causes of Infant Death*, 2004

**Congenital **
**anomalies**

**Short gestation/ **
**low birthweight****§**

**Maternal **
**pregnancy **
**complications**

**SIDS**

**5 Leading Causes of Infant Death*, 2004**

- *Includes all deaths <1 year.  §Not elsewhere classified.  Note: SIDS represents “Sudden Infant Death Syndrome.”
- SOURCE:  National Vital Statistics System (NVSS), NCHS, CDC.

**Unintentional **
**injuries**

**5**

**2**

**6**

**0**

**4**

**1**

**3**

**Number (thousands)**

**A re-analysis of cause of death data indicates that 37% of infant deaths are due to preterm-related causes of death.**

**(20%)**

**(17%)**

**(8%)**

**(6%)**

**(4%)**

## Recommended Daily Intake of Folic Acid

**Baseline data**

**Recommended Daily **
**Intake of Folic Acid*******

**Most recent data**

**Percent**

- 1991-94

- 1996

- 2003-04

- 2003

**2010 Target: 80**

**Obj. 16-15 & 16-16a**

**Recommended Daily Intake of Folic Acid**
**and Neural Tube Defects**

- *Proportion of non pregnant women aged 15-44 years getting ≥400μg of folic acid per day from supplements and fortified foods.  § New cases among live births and fetal deaths at greater than 20 weeks gestation.
- SOURCE: National Health and Nutrition Examination Survey, NCHS, CDC and National Birth Defects Prevention Network, NCBDDD, CDC.

## Preterm Births, 2004

**32-36 weeks**

**Preterm Births, 2004**

**Percent of live births**

- Note:  American Indian includes Alaska Native.  Asian includes Pacific Islander.  The categories black and white exclude persons of Hispanic origin.  Persons of Hispanic origin may be any race.
- SOURCE: National Vital Statistics System (NVSS), NCHS, CDC.

**Obj. 16-11 a, b, & c**

**2010 Target**
**Total preterm births: 7.6**

**Total**

**Asian**

**White**

**Hispanic**

**American**
** ****Indian**

**Black**

**<32 weeks**

## Low and Very Low Birthweight Infants, 2004

**Hispanic**

**Percent of live births**

**Low birthweight **
**(<2500 grams)**

**American**
** ****Indian**

**Asian**

**Black**

**Low and Very Low Birthweight Infants, 2004**

**Obj. 16-10a & b**

**Very low birthweight **
**(<1500 grams)**

-     = 95% confidence interval.  Note: American Indian includes Alaska Native.  Asian includes Pacific Islander.  The categories black and white exclude persons of Hispanic origin.  Persons of Hispanic origin may be any race.
- SOURCE: National Vital Statistics System (NVSS), CDC, NCHS.

**Total**

## Sudden Infant Death Syndrome 

**1996**

**1997**

**1998**

**1999**

**2000**

**2001**

**SIDS deaths**

**Infants put to sleep on their backs**

**Per 100,000 live births**

**Percent**

- SOURCE: National Vital Statistics System (NVSS), NCHS, CDC and National Infant Sleep Position Study, NICHD, NIH.

**Obj. 16-1h & 16-13**

**SIDS deaths 2010 Target: 23**

**Sleep position 2010 Target: 70**

**2003**

**2002**

**2004**

**60**

**20**

**80**

**0**

**40**

**60**

**20**

**80**

**0**

**40**

**Sudden Infant Death Syndrome **
**and Sleep Position**

## Maternal Mortality, 2004 

**Obj. 16-4**

**0               10               20               30               40               50**
**Rate per 100,000 live births**

**13.1**

**2010 Target: 4.3**

**Maternal Mortality, 2004 **

**Total**
**Hispanic**
**Asian**
**White **
**Black**
**<20 years**
**20-24 years**
**25-29 years**
**30-34 years**
**35 years and over**

-      = 95% confidence interval. Note:  Data for the American Indian and Alaska Native population are statistically unreliable and are suppressed.  Asian includes Pacific Islander.  The categories black and white exclude persons of Hispanic origin.  Persons of Hispanic origin may be any race.
- SOURCE: National Vital Statistics System (NVSS), CDC, NCHS.

## First Cesarean Births 

**Obj. 16-9a**

**	****    ****1998        1999       2000        2001        2002        2003        2004**

**30**
**20**
**10**
**0**

**Percent**

**2010 Target: 15**

- * Among women with no prior cesarean birth, a low-risk pregnancy is defined as one with a full-term (at least 37 weeks gestation) singleton (not a multiple pregnancy), with vertex presentation (head facing in a downward position in the birth canal).
- SOURCE:  National Vital Statistics System (NVSS), NCHS, CDC.

**First Cesarean Births **
**Among Low-Risk Pregnancies***

## Repeat Cesarean Births

**	****    ****1998        1999       2000        2001        2002        2003        2004**

**100**
**90**
**80**
**70**
**60**
**0**

**Percent**

- * Among women with a prior cesarean birth, a low-risk pregnancy is defined as one with a full-term (at least 37 weeks gestation) singleton (not a multiple pregnancy), with vertex presentation (head facing in a downward position in the birth canal).
- SOURCE:  National Vital Statistics System (NVSS), NCHS, CDC.

**Repeat Cesarean Births**
**Among Low-Risk Pregnancies***

**2010 Target: 63**

**Obj. 16-9b**

## Prenatal Care 

**Obj. 16-6a**

**0 ****	****      40          50         60         70          80         90        100  **
**Percent          **

**Total**
**American Indian**
**Black**
**Hispanic**
**Asian**
**White **
**< 15 years**
**15-19 years**
**20-24 years**
**25-29 years**
**30-34 years**
**35+ years**
**Less than high school**
**High school**
**At least some college**

-       = 95% confidence interval. Note: American Indian includes Alaska Native.  Asian includes Pacific Islander.  The categories black and white exclude persons of Hispanic origin.  Persons of Hispanic origin may be any race.  Excludes estimates for ID, FL, KY, NH, NY (not inc. NYC), PA, SC, TN, and WA.  Data by education level are for mothers aged 20 years and over.  Data for 2003 exclude PA and WA. SOURCE: National Vital Statistics System (NVSS), CDC, NCHS.

**Prenatal Care **
**Beginning in First Trimester, 2004**

**2010 Target: 90 **

**84**

## Prenatal Care 

**Obj. 16-6a**

**0 ****	****      40          50         60         70          80         90        100  **
**Percent          **

**Total**
**American Indian**
**Black**
**Hispanic**
**Asian**
**White **
**< 15 years**
**15-19 years**
**20-24 years**
**25-29 years**
**30-34 years**
**35+ years**
**Less than high school**
**High school**
**At least some college**

-       = 95% confidence interval. Note: American Indian includes Alaska Native.  Asian includes Pacific Islander.  The categories black and white exclude persons of Hispanic origin.  Persons of Hispanic origin may be any race.  Excludes estimates for ID, FL, KY, NH, NY (not inc. NYC), PA, SC, TN, and WA.  Data by education level are for mothers aged 20 years and over.  Data for 2003 exclude PA and WA. SOURCE: National Vital Statistics System (NVSS), CDC, NCHS.

**Prenatal Care **
**Beginning in First Trimester, 2004**

**2010 Target: 90 **

**84**

## Any Breastfeeding

**At 6 months**

**40**

**Percent**

**60**

**80**

**Obj. 16-19a, b, c**

**0**

**At 12 months **

**2000**

**2004**

**2010 Target: 75**

**Any Breastfeeding**

**Ever**

**20**

**100**

**2010 Target: 50**

**2010 Target: 25**

**2002**

-     = 95% confidence interval.  Note: Any breastfeeding is defined by breastmilk as at least one of the types of milk
- an infant was fed.  Data are presented by birth year.
- SOURCE:  National Immunization Survey (NIS), CDC, NCIRD and NCHS.

## Exclusive Breastfeeding 

**Obj. 16-19e**

**0               20               40               60               80            100**
**Percent**

-      = 95% confidence interval.  Note:  Exclusive breastfeeding is defined as no food or drink other than breastmilk.  Data are presented by birth year.  Native Hawaiian includes other Pacific Islander.  American Indian includes Alaska Native. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. Data for races shown are not mutually exclusive.
- SOURCE:  National Immunization Survey (NIS), CDC, NCIRD and NCHS.

**Exclusive Breastfeeding **
**Through 6 Months, 2004**

**11**

**Total**
**Black**
**American Indian**
**Hispanic**
**White **
**Native Hawaiian **
**Asian**
**Less than high school**
**High school**
**Some college**
**College graduate **

**2010 Target: 17**

## Age at Identification of Autism Spectrum Disorder, Metropolitan Atlanta, 2002

**Obj. 16-14c**

**0            36           48            60   ****	**** 72            84           96**
**Median Age (Months)**

- Note: The data are for children aged 8 years of age in metropolitan Atlanta, Georgia.  The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race.
- SOURCE: Metropolitan Atlanta Development Disabilities Surveillance Program (MADDSP), CDC, NCBDDD.

**Age at Identification of Autism Spectrum Disorder, Metropolitan Atlanta, 2002**

**62**

**Total**
**White**
**Black**
**Hispanic**
**Female**
**Male**

**2010 Target: 66**

**n=91**

**n=71**

**n=10**

**n=27**

**n=153**

**n=180**

## Children With Special Health Care Needs Who Have Comprehensive Care Systems*, 2001

**0               20               40               60               80            100**
**Percent**

**35**

**Total**
**2 or more races**
**American Indian **
**Hispanic**
**Black**
**Asian**
**White**
**Native Hawaiian**
**Poor**
**Near poor**
**Middle/high income **

**2010 Target: 100**

**Children With Special Health Care Needs Who Have Comprehensive Care Systems*, 2001**

**Obj. 16-23**

- *Proportion of children under 18 years of age with special health care needs who receive their care in family-centered, comprehensive, and coordinated systems.  Note: American Indian includes Alaska Native.  Native Hawaiian includes other Pacific Islander.  The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race.
- SOURCE: National Survey of Children with Special Health Care Needs, CDC, NCHS and HRSA, MCHB

## Target met or exceeded
Improving
Little or no change*
Getting worse
No trend data (baseline only)
Dropped at midcourse
Retained as developmental

- Target met or exceeded
- Improving
- Little or no change*
- Getting worse
- No trend data (baseline only)
- Dropped at midcourse
- Retained as developmental

- 3
- 21
- 8
- 10
- 4
- 4
- 3

- * Percent of targeted change achieved is between -10% and 10%.

## Improvements in infant mortality have stalled as preterm births and low birth weight have increased.
Cesarean deliveries have continued to increase over the past decade, and maternal mortality has not improved.
Major racial and ethnic disparities persist.
Breastfeeding rates have improved, but long-term and exclusive breastfeeding rates remain low.
Improvements in rates of sudden infant death syndrome and neural tube defects have corresponded with public health interventions.

**Improvements in infant mortality have stalled as preterm births and low birth weight have increased.**
**Cesarean deliveries have continued to increase over the past decade, and maternal mortality has not improved.**
**Major racial and ethnic disparities persist.**
**Breastfeeding rates have improved, but long-term and exclusive breastfeeding rates remain low.**
**Improvements in rates of sudden infant death syndrome and neural tube defects have corresponded with public health interventions.**

## http://www.cdc.gov/nchs/hphome.htm

**Progress review data and slides**
**are available on the web at:**

**http://www.cdc.gov/nchs/hphome.htm**