Series 20

No. 30

Fetal Mortality by Maternal

Education and Prenatal Care,

1990

July 1996

Vital and

Health Statistics

From the CENTERS FOR DISEASE CONTROL AND PREVENTION / National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics
Copyright information

All material appearing in this report is in the public domain and may be

reproduced or copied without permission; citation as to source, however, is

appreciated.

Suggested citation

Hoyert DL. Fetal mortality by maternal education and prenatal care, 1990.

National Center for Health Statistics. Vital Health Stat 20(30). 1996.

Library of Congress Catalog Card Number

Fetal mortality by maternal education and prenatal care, 1990

p. cm. — (Vital and health statistics. Series 20, Data from the national

vital statistics system ; no. 30)

ISBN (invalid) 8040605145

1. Fetal death—United States—Statistics. 2. Prenatal care—United

States—Statistics. 3. Education—United States—Statistics. 4. United

States—Statistics, Medical. I. United States. National Center for Health

Statistics. II. Series.

HB1335, A18 no. 30

[RG632.U6]

304.6'4'0973021 s—dc20 96-14345

[614.5'992] CIP

For sale by the U.S. Government Printing Office

Superintendent of Documents

Mail Stop: SSOP

Washington, DC 20402-9328
Fetal Mortality by Maternal

Education and Prenatal Care,

1990

Series 20:

No. 30

The risk for experiencing a fetal loss differs by both maternal and fetal

characteristics. In this report, data for two maternal factors, education and

use of prenatal care, are presented. Fetal mortality for 1990 varied by the

educational attainment of women, with higher rates for those with less

education. Fetal mortality rates were high for women who received no

prenatal care during pregnancy compared with women who received

some prenatal care.

Hyattsville, Maryland

July 1996

DHHS Publication No. (PHS) 96-1858

Vital and

Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics
National Center for Health Statistics

Edward J. Sondik, Ph.D., Director

Jack R. Anderson, Deputy Director

Jacob J. Feldman, Ph.D., Associate Director for Analysis,

Epidemiology, and Health Promotion

Gail F. Fisher, Ph.D., Associate Director for Planning and

Extramural Programs

Jack R. Anderson, Acting Associate Director for

International Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Monroe G. Sirken, Ph.D., Associate Director for Research

and Methodology

Division of Vital Statistics

Mary Anne Freedman, M.A., Director

James A. Weed, Ph.D., Deputy Director

Harry M. Rosenberg, Ph.D., Chief, Mortality Statistics

Branch

Robert J. Armstrong, Acting Chief, Statistical Resources

Branch

Nicholas F. Pace, Acting Chief, Systems and Programming

Branch
Contents

Highlights .............................................................................................. 1

Introduction............................................................................................. 2

Fetal death reporting system........................................................................... 2

Fetal mortality patterns.................................................................................... 3

Maternal education .................................................................................. 3

Prenatal care ....................................................................................... 4

Prenatal care and maternal education.................................................................... 5

References.............................................................................................. 8

List of detailed tables .................................................................................. 9

Appendix

Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Text figures

1. Fetal mortality rates by maternal education, race, and Hispanic origin, 1990 .................................... 3

2. Fetal mortality rates by prenatal care and period of gestation: Total of 37 States, 1990 ........................... 5

3. Fetal mortality rates by prenatal care, maternal education, and period of gestation: Total of 35 States, 1990 .......... 6

Text tables

A. Fetal mortality rates by educational attainment and age of women: Total of 37 States, 1990 ...................... 4

B. Fetal mortality rates by educational attainment and total-birth order: Total of 37 States, 1990..................... 4

C. Fetal mortality rates by prenatal care total-birth order: Total of 37 States, 1990 ................................ 6

iii
Fetal Mortality by Maternal

Education and Prenatal

Care, 1990

by Donna L. Hoyert, Ph.D., Division of Vital Statistics

Highlights

One of the principal data sets that make up the National

Vital Statistics System of the United States features fetal

deaths. Fetal deaths, involuntary losses of fetuses during

pregnancy, along with infant deaths are two poor outcomes of

pregnancy. In fact, fetal deaths represent close to half of the

deaths that occur during the period between the 20th week of

pregnancy and the first year of life. The risk for experiencing

a fetal loss differs by both maternal and fetal characteristics.

In this report, data for two maternal factors, education and

use of prenatal care, are presented. Both items have routinely

been reported to the data system since 1968; however, neither

item has been published in a National Center for Health

Statistics (NCHS) publication prior to data year 1990.

Fetal mortality for 1990 varied by the educational attainment of women, with higher rates for those with less schooling. This inverse relationship was evident for women aged

20–34 and 35–49 years; and for the white population of all

ages combined. This mortality differential by education persisted when several other characteristics were taken into

account.

Analyses of prenatal care, particularly the timing of

prenatal care, are complicated by factors such as differential

selection into prenatal care and differences in opportunities to

obtain prenatal care. However, this report shows that fetal

mortality rates were high for women who received no prenatal

care during pregnancy as compared with women who received

some prenatal care. This association between prenatal care and

fetal mortality held for all ages, race and ethnic groups, birth

order, length of gestation, and education among women aged

25 years and over.

NOTES: This report was prepared in the Division of Vital Statistics under the

general direction of Harry M. Rosenberg, Ph.D., Chief of the Mortality

Statistics Branch. Marian F. MacDorman, Ph.D., Mortality Statistics Branch,

and staff of the Office of Analysis and Epidemiology, provided peer review for

this report. Sherry L. Murphy provided content review. The Registration

Methods Branch and the Technical Services Branch provided consultation to

State vital statistics offices regarding collection of the vital statistics data on

which this report is based. This report was edited by Demarius V. Miller and

typeset by Annette F. Holman of the Publications Branch, Division of Data

Services.

1
Introduction

One of the principal data sets that make up the National

Vital Statistics System of the United States concerns fetal

deaths. The National Vital Statistics System encompasses

several data bases of statistical information on vital events

such as fetal deaths, births, marriages, divorces, and deaths.

These data sources allow the Federal Government, the research

community, and the public at large to be aware of and to

monitor basic trends occurring within our population. Fetal

deaths, involuntary losses of fetuses during pregnancy, along

with infant deaths are two poor outcomes of pregnancy. In

fact, fetal deaths represent close to half of the deaths that

occur during the period between the 20th week of pregnancy

and the first year of life. The risk for experiencing a fetal loss

differs by both maternal and fetal characteristics.

In this report, two maternal factors, education and use of

prenatal care, are featured. Both items have routinely been

reported in the data system since 1968; however, neither item

has been published in a National Center for Health Statistics

(NCHS) publication prior to data year 1990.

Fetal death reporting system

NCHS adopted the World Health Organization (WHO)

definition of ‘‘fetal death’’ as the recommended standard for

use in the early 1950’s. The following inclusive definition was

developed by the WHO in 1950 in order to end confusion

arising from the use of such terms as stillbirth, spontaneous

abortion, and miscarriage:

Death prior to the complete expulsion or extraction from

its mother of a product of conception, irrespective of the

duration of pregnancy; the death is indicated by the fact

that after such separation, the fetus does not breathe or

show any other evidence of life such as beating of the

heart, pulsation of the umbilical cord, or definite movement of voluntary muscles (1).

The States use a consistent definition of fetal death, but

the registration of a fetal death in most States is required only

for those fetal deaths occurring at 20 or more weeks of

gestation. National fetal-death statistics are compiled from

State fetal death reports received by NCHS every year, and

typically are tabulated for those deaths of 20 or more weeks of

gestation. Statistics on induced terminations of pregnancy

(abortions) are excluded in national fetal-death statistics and

are not included in this report.

The States included in the tables in this report were

chosen on the basis of the completeness of reporting of the

selected variables featured in this report. States were included

in tables 1–5 only if reporting was at least 80 percent complete

for education. Similarly, States were included in tables 6–9

only if reporting was at least 80 percent complete for prenatal

care and in table 10 if reporting was at least 80 percent

complete for both education and prenatal care. For tables 2

and 7, some additional States were dropped because they

either did not have an item identifying Hispanic origin or

reporting was not 90 percent complete for that item. For 1990

data, this selection process resulted in tables 1 and 3–5

including data for 37 States, representing 70 percent of all

fetal deaths of 20 weeks gestation or more in the United

States; tables 6, 8, and 9 including data for a slightly different

group of 37 States, representing 74 percent of fetal deaths in

the United States; table 2 including data for 31 States, representing 64 percent of fetal deaths; table 7 including data for 31

States, representing 68 percent of fetal deaths; and table 10

including data for 35 States, representing 68 percent of fetal

deaths. For details on the specific States included and characteristics of these States, see the Technical notes.

Fetal mortality rates, expressed as the number of fetal

deaths per 1,000 total live births and fetal deaths to women in

the specified group, are shown in the tables. The denominator

for the rates shown in these tables is a proxy estimate of

pregnancies (excluding induced abortions) that are exposed to

the risk of being a fetal death. The rates provide a measure of

the risk of having a fetal death for reported pregnancies (i.e.,

pregnancies ending in a live birth or fetal death of 20 or more

weeks of gestation). In tables 6, 8, and 10, fetal mortality rates

are shown by period of gestation. For example, the denominators of the rates by gestation include all live births for all

periods of gestation, live births of 20 or more weeks of

gestation for the 20–27 weeks period of gestation, and live

births of 28 or more weeks of gestation for the 28 or more

weeks gestational period.

All text tables include ratios of rates to show the relative

risk of fetal mortality for women of differing characteristics or

behavior.

2
Fetal mortality patterns

Maternal education

Fetal mortality varied by educational attainment of women

(table 1). Generally, the risk of fetal loss was greater for

women with less schooling. For example, fetal mortality rates

declined from 7.8 fetal deaths per 1,000 live births and fetal

deaths for women with less than 12 years of schooling to 6.7

for women with 12 or more years of schooling. However, the

relationship was not linear when examined by detailed educational categories (figure 1). Fetal mortality rates for women

with 0–8 and 9–11 years of schooling were not substantially

different from one another; but the rate markedly decreased

from 7.9 for women with 9–11 years of schooling to 5.4 for

women with 16 or more years of schooling, a reduction of

32 percent.

The relationship between fetal mortality and education

differed by maternal age (table A). For women under 20 years

of age, fetal mortality rates did not vary by maternal education. For women aged 20–34 years, rates declined from 7.2 for

less than 12 years of schooling to 6.4 for 12 or more years of

schooling, an 11 percent decrease; and for women aged 35–49

years, from 12.5 to 9.2, a 26-percent decrease.

The association between fetal mortality and maternal

education also differed by race and by Hispanic origin (figure

1). For the white population, rates declined by 14 percent from

6.9 for women with less than 12 years of schooling to 5.9 for

women with 12 or more years of schooling (table 1). For the

black population, the rates were 11.8 and 12.0, respectively.

For Hispanic women (table 2), the rate was 6.5 for those with

less than 12 years of schooling and 6.7 for those with 12 or

more years of schooling.

The analysis in the following three sections was restricted

to women aged 25 years and over in order to exclude women

who were too young to have had the opportunity to complete

16 or more years of schooling. With the exception of some

relationships by marital status, the general patterns evident

with this select group of women were the same as those

evident with women of all ages.

Marital status

The association between fetal mortality and maternal

education varied by marital status for women 25 years of age

and over (table 3). For married women, rates decreased from

6.1 fetal deaths per 1,000 live births and fetal deaths for those

with less than 12 years of schooling to 5.3 for those with 12 or

more years of schooling. For unmarried women, the rate for

those with less than 12 years of schooling was almost the same

as the rate for those with 12 or more years of schooling.

Among married women, the pattern of fetal mortality by

maternal education was different for the white and black

populations. For married white women, rates decreased with

higher educational attainment (6.7 for those with less than 12

years of schooling to 5.1 for those with 12 or more years of

schooling), but rates did not differ by educational attainment

for black married women (9.4 and 9.6). For unmarried women

of either racial group, rates for those with less than 12 years of

schooling did not differ from those with 12 or more years of

schooling.

Metropolitan, nonmetropolitan residence

Among women aged 25 years and over, the general

relationship between fetal mortality and education was the

same regardless of residence (table 4). Fetal mortality was

inversely related to education for women living in metropolitan counties and for women living in nonmetropolitan counties. In metropolitan counties, rates decreased from 8.2 fetal

deaths per 1,000 live births and fetal deaths for women with

less than 12 years of schooling to 6.5 for those women with 12

or more years of schooling, a 21-percent decrease. In nonmet0 8 9 11 12 13 15 16 years

or more

Years of education

0

2

4

6

8

10

12

14

Rate per 1,000 live births and fetal deaths

All races

White

Black

Hispanic

Figure 1. Fetal mortality rates by maternal education, race, and

Hispanic origin, 1990

3
ropolitan counties, rates declined from 9.8 for women with

less than 12 years of schooling to 6.7 for women with 12 or

more years of schooling, a 32-percent decrease.

Fetal mortality patterns by education and residence differ

for white and black women. In metropolitan areas, rates for

white women declined from 7.3 for women with less than 12

years of schooling to 5.7 for those with 12 or more years of

schooling, a 22-percent decrease. For black women in metropolitan areas, the rates were not substantially different by

educational attainment of the women. For nonmetropolitan

areas, the rates for white women were 9.0 for those with less

than 12 years of schooling and 6.2 for those with 12 or more

years of schooling, a decline of 31 percent; and for black

women, the comparable rates did not differ statistically for

those with less than 12 years of schooling compared with

those who had 12 or more years of schooling.

Total-birth order

The association between education and fetal mortality

varies by birth order for women aged 25 years and over. For

women with a total-birth order of 1, the rate for those with less

than 12 years of schooling was 10.0 fetal deaths per 1,000 live

births and fetal deaths compared with 6.1 for those with 12 or

more years of schooling, a 39-percent decrease (tables B and

5). Comparable rates for women with a total-birth order of 2

decreased from 6.9 to 5.4, respectively, or by 22 percent; but

for those with more than two pregnancies, the comparable

rates were not substantially different by maternal education.

The association between fetal mortality and education by

birth order varied by race. Among white women, maternal

education was inversely associated with fetal mortality at birth

orders 1 (decline in rates of 43 percent) and 2 (decline of 25

percent). For black women, rates at all birth orders did not

differ by maternal education.

Prenatal care

Assessing the role of prenatal care in fetal mortality is

complicated by several factors, including differences in the

health and behavior of women who begin prenatal care early

in their pregnancy and those who began prenatal care later in

their pregnancy and differences in opportunities to obtain

prenatal care because the length of pregnancy differs (2,3).

These two factors are discussed to some extent in the following text, and tables 6, 8, and 10 show the association of fetal

mortality and prenatal care by period of gestation. A more

extensive analysis than attempted in this descriptive report

would address potential biases in more detail (2,3). Lastly,

fetal death reports and live birth certificates include limited

information on the content of prenatal care (i.e., obstetric

procedures) but do not include information on the quality of

care (2,4).

Table A. Fetal mortality rates by educational attainment and age of women: Total of 37 States, 1990

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group]

Age of woman

Years of school completed by woman Ratio of rates

for less than

12 years of

education to

12 or more

years of

education

Total Less than 12 years 12 years or more

Rate

Confidence

interval Rate

Confidence

interval Rate

Confidence

interval

All ages . . . . . . . . . . . . . . . . . . 7.0 (6.91, 7.10) 7.8 (7.60, 8.00) 6.7 (6.64, 6.85) 1.16

Under 20 years . . . . . . . . . . . . . 8.2 (7.90, 8.45) 8.1 (7.79, 8.46) 8.3 (7.81, 8.75) 0.98

20–34 years . . . . . . . . . . . . . . . 6.5 (6.42, 6.62) 7.2 (6.97, 7.46) 6.4 (6.25, 6.47) 1.13

35–49 years . . . . . . . . . . . . . . . 9.6 (9.27, 10.01) 12.5 (11.37, 13.63) 9.2 (8.79, 9.57) 1.36

Table B. Fetal mortality rates by educational attainment and total-birth order: Total of 37 States, 1990

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group]

Total-birth order

Years of school completed by woman Ratio of rates

for less than

12 years of

school to rates

for 12 or more

years of school

Total Less than 12 years 12 years or more

Rate

Confidence

interval Rate

Confidence

interval Rate

Confidence

interval

All birth orders . . . . . . . . . . . . . . 6.8 (6.71, 6.94) 8.4 (8.10, 8.80) 6.6 (6.44, 6.69) 1.29

1 . . . . . . . . . . . . . . . . . . . . . . 6.3 (6.09, 6.56) 10.0 (8.79, 11.22) 6.1 (5.86, 6.34) 1.64

2 . . . . . . . . . . . . . . . . . . . . . . 5.5 (5.33, 5.72) 6.9 (6.20, 7.70) 5.4 (5.18, 5.58) 1.29

3 . . . . . . . . . . . . . . . . . . . . . . 6.3 (6.07, 6.55) 6.2 (5.55, 6.80) 6.3 (6.04, 6.55) 0.98

4 . . . . . . . . . . . . . . . . . . . . . . 7.4 (7.10, 7.79) 7.6 (6.80, 8.33) 7.4 (7.03, 7.81) 1.02

5 and over . . . . . . . . . . . . . . . . 11.1 (10.66, 11.50) 11.2 (10.46, 11.93) 11.1 (10.58, 11.61) 1.01

4
Fetal mortality rates varied by prenatal care. For periods

of gestation of 20 or more weeks, women who received no

prenatal care during pregnancy had a relatively high risk of

experiencing a fetal loss, 34.9 fetal deaths per 1,000 live births

and fetal deaths; in contrast, the risk for those who received

prenatal care during pregnancy was 6.7 (table 6 and figure 2).

Regardless of the length of gestation, rates were substantially

lower when prenatal care was obtained than when it was not.

The relationship between fetal mortality and prenatal care

was similar for different age and race groups. Regardless of

maternal age, fetal mortality rates were about 5 times greater

for those who received no prenatal care than for those who

did. Similarly, rates were between 4 and 5 times greater for

those receiving no prenatal care for both white and black

women. For Hispanic women (table 7), fetal mortality was

roughly 3 times greater for those receiving no prenatal care

compared with those who did.

Timing of prenatal care

The trimester in which prenatal care begins, particularly

for pregnancies terminating with a fetal death, can be related

to the length of gestation. For example, initiating prenatal care

in the third trimester is not an option for those women who

experience a fetal death before the third trimester of their

pregnancies. The information on fetal death reports permits

the examination of prenatal care while controlling for gestational period, but it does not indicate why care began when it

did (e.g., if a problem precipitated the care or if a woman was

being vigilant in obtaining routine care). Among women

receiving prenatal care, fetal mortality rates were greater for

those beginning prenatal care during the second trimester of

pregnancy, 7.3 per 1,000, than for those beginning care during

either the first (6.6) or the third trimester (5.5) (table 6 and

figure 2). However, this curvilinear pattern results from the

combination of the patterns for two groups: fetal deaths of

20–27 weeks of gestation and fetal deaths of 28 or more weeks

of gestation.

Fetal mortality rates for pregnancies ending between 20

and 27 weeks declined when prenatal care began later in

pregnancy, with a rate of 2.8 for care initiated in the first

trimester and a rate of 2.5 for care initiated in the second

trimester. In part, higher rates for those beginning prenatal

care in the first trimester may reflect the experience of women

who sought attention early in their pregnancy for medical

problems. Prenatal care beginning in the third trimester is only

possible in a small number of cases for pregnancies ending

between 20 and 27 weeks of gestation.

For pregnancies ending at 28 or more weeks of gestation,

rates increased when prenatal care was delayed until the

second or third trimester. When care was received in the first

trimester, the rate was 3.7 compared with 5.0 when care was

received in the third trimester.

Marital status

Fetal mortality patterns by prenatal care were similar for

married and unmarried women (table 8). For married women,

the fetal mortality rate for those who did not obtain prenatal

care was 21.9 fetal deaths per 1,000 live births and fetal deaths

or nearly 4 times the rate for those who did receive care, 5.7.

For unmarried women, the rate for those who did not receive

prenatal care (42.1) was 4.5 times the rate for those who did

(9.4). Rates were substantially greater for women receiving no

prenatal care than those who did at all gestational periods,

marital statuses, and race groups.

Total-birth order

The relationship between fetal mortality and prenatal care

is affected by total-birth order (tables C and 9). The association of prenatal care with fetal mortality was strongest for

women with birth orders of one, and became weaker as birth

orders increased. For example, the ratio of the rates for those

receiving no prenatal care to those receiving prenatal care was

6.2 for birth order of one compared with 3.8 for birth order of

five or more. The same general pattern held for white women

at all birth orders and black women through birth order four.

Prenatal care and maternal education

Among women 25 years of age and over experiencing a

live birth or fetal death, those women with more education

were more likely to have obtained prenatal care, particularly in

the first trimester, while those with less than 12 years of

schooling were more likely to have received no prenatal care

(data not shown). For the 259,185 women with less than 12

years of schooling, 12,123, or 5 percent, obtained no prenatal

care, 59 percent began care in the first trimester, 28 percent in

the second trimester, and 8 percent in the third trimester. In

comparison, for the women with 13 or more years of schooling, less than 1 percent received no prenatal care, 91 percent

initiated care in the first trimester, 8 percent in the second

trimester, and 1 percent in the third trimester.

The pattern of fetal mortality by prenatal care varied by

educational attainment (figure 3 and table 10). At each level of

educational attainment, fetal mortality rates were greatest

when no prenatal care was received. For women with less than

12 years of schooling, the rate of 29.7 fetal deaths per 1,000

Total 20 27 28 or more

0

10

20

30

40

Rate per 1,000 live births and fetal deaths

If received prenatal care and trimester begun

None Any 1st trimester

2d trimester 3d trimester

Figure 2. Fetal mortality rates by prenatal care and period of

gestation: Total of 37 States, 1990

5
live births and fetal deaths when no prenatal care was received

was almost 4 times the rate of 7.7 when prenatal care was

received. For women with 13 or more years of schooling, the

rate for those receiving no care (43.1) was almost 8 times the

rate for those receiving care (5.6).

The pattern was similar by race with fetal mortality rates

greatest for women receiving no prenatal care. For white

women with less than 12 years of schooling, the rate for

receiving no prenatal care was 3.5 times the rate for those

receiving care. For white women with 12 years of schooling,

the rate for those receiving no care was 5.6 times the rate for

those receiving care and among white women with 13 or more

years of schooling, the rate for those receiving no care was 7.6

times the rate for those receiving care. For black women with

less than 12 years of schooling, the rate for women receiving

no care was 3.5 times the rate for women receiving care. For

black women with 12 years of schooling and for black women

with 13 or more years of schooling, the rate for those

receiving no prenatal care was 5.3 times the rate for those

receiving prenatal care.

Timing of prenatal care

Fetal mortality varies by both the timing of prenatal care

and educational attainment among women aged 25 years and

Less than

12 years

12 years 13 years

or more

Less than

12 years

12 years 13 years

or more Less than

12 years

12 years 13 years

or more

Years of education and period of gestation in weeks

0

10

20

30

40

50

Rate per 1,000 live births and fetal deaths

Prenatal care

None Any 1st 2d 3d

20 weeks or more 20 27 weeks 28 weeks or more

Figure 3. Fetal mortality rates by prenatal care, maternal education, and period of gestation: Total of 35 States, 1990

Table C. Fetal mortality rates by prenatal care and total-birth order: Total of 37 States, 1990

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group]

Total-birth order

Prenatal care

Ratio of

rates for

no care to

rates for

any care

All fetal deaths No prenatal care Any care

Rate

Confidence

interval Rate

Confidence

interval Rate

Confidence

interval

All birth orders . . . . . . . . . . . . . . . . . . . . . . . . 7.5 (7.41, 7.60) 36.5 (34.96, 37.96) 6.9 (6.83, 7.01) 5.29

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 (7.15, 7.48) 41.9 (38.70, 45.05) 6.8 (6.62, 6.94) 6.16

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 (6.23, 6.56) 34.2 (31.15, 37.18) 6.0 (5.79, 6.11) 5.70

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 (6.91, 7.35) 32.2 (28.95, 35.48) 6.6 (6.41, 6.83) 4.88

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.3 (7.95, 8.60) 30.1 (26.32, 33.91) 7.6 (7.33, 7.97) 3.96

5 or more ........................... 12.0 (11.58, 12.40) 40.1 (36.48, 43.64) 10.7 (10.30, 11.10) 3.75

6
over. However, as stated above, the opportunity for and timing

of prenatal care may be influenced by the length of the

pregnancy.

In pregnancies of 20–27 weeks of gestation, fetal mortality rates were greater when prenatal care began in the second

rather than the first trimester regardless of the women’s

educational attainment. For women with less than 12 years of

schooling, the rate for those beginning care in the second

trimester was more than double the rate for those beginning

care in the first trimester; for women with 12 years of

schooling, the rate was more than triple; for women with 13 or

more years of schooling, the rate was quadruple for those

receiving care in the second trimester compared with the first

trimester.

For pregnancies of 28 weeks of gestation or more, fetal

mortality rates were lower when care began in the first

trimester than in the second or third trimester for each

educational attainment level; however, rates were greatest for

those women beginning prenatal care in the second trimester.

For women with less than 12 years of schooling, the fetal

mortality rate was more than double when care began in the

third trimester rather than the first trimester. For women with

12 years of schooling, the fetal mortality rate was nearly

double when care began in the third trimester rather than the

first trimester. For women with 13 or more years of schooling,

the fetal mortality rate for those who began care in the third

trimester was nearly three times the rate for those who began

care in the first trimester.

As stated earlier, one of the limitations the data presents is

a lack of information on why prenatal care was initiated (2).

Further analysis could examine additional characteristics distinguishing women beginning prenatal care during different

trimesters.

7
References

1. National Office of Vital Statistics. International recommendations on definitions of live birth and fetal deaths. Washington:

Public Health Service. 1950.

2. Kleinman JC. Methodological issues in the analysis of vital

statistics. In: Reproductive and perinatal epidemiology, CRC

Press. 1991.

3. Kiely JL, Brett KM, Yu S, Rowley DL. Low birth weight and

intrauterine growth retardation. In: From data to action: CDC’s

public health surveillance for women, infants, and children.

1995.

4. Brett KM, Schoendorf KC, Kiely JL. Differences between black

and white women in the use of prenatal care technologies. Am J

Obstet Gynecol 170: 41–6. 1994.

5. National Center for Health Statistics. Model State Vital Statistics Act and Model State Vital Statistics Regulations. Washington: Public Health Service. 1978.

6. National Center for Health Statistics. Vital statistics of the

United States, 1990, vol II, mortality, part A. Washington:

Public Health Service. 1994.

7. Hoyert DL. Effect on mortality rates of the 1989 change in

tabulating race. National Center for Health Statistics. Vital

Health Stat 20(25). 1994.

8. National Center for Health Statistics. Vital statistics of the

United States, 1990, vol I, natality. Washington: Public Health

Service. 1994.

9. National Center for Health Statistics. Public-use data tape

documentation: 1990 detail natality. Hyattsville, MD: Public

Health Service. 1993.

10. Greb AE, Pauli RM, Kirby RS. Accuracy of fetal death reports:

Comparison with data from an independent stillbirth assessment

program. Am J Public Health 77:1, 202–06. 1987.

8
List of detailed tables

1. Fetal deaths and fetal mortality rates by educational

attainment, age, and race of woman: Total of 37 States,

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

2. Fetal deaths and fetal mortality rates by educational

attainment, age, and Hispanic origin of woman, and by

race of woman for non-Hispanic origin: Total of 31 States,

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

3. Fetal deaths and fetal mortality rates by educational

attainment, race, and marital status of women aged 25

years and over: Total of 37 States, 1990 . . . . . . . . . . . . 13

4. Fetal deaths and fetal mortality rates for women aged 25

years and over by educational attainment of women,

metropolitan and nonmetropolitan counties in selected

States: Total of 37 States, 1990 . . . . . . . . . . . . . . . . . . . 14

5. Fetal deaths and fetal mortality rates for women aged 25

years and over by educational attainment of women, race

of woman, and total-birth order: Total of 37 States, 1990 15

6. Fetal deaths and fetal mortality rates by trimester prenatal

care began, period of gestation, race of woman, and age of

woman: Total of 37 States, 1990 . . . . . . . . . . . . . . . . . . 16

7. Fetal deaths and fetal mortality rates by trimester prenatal

care began, age of women, and Hispanic origin of

woman, and by race of woman for women of nonHispanic origin: Total of 31 States, 1990 ........... 18

8. Fetal deaths and fetal mortality rates by trimester prenatal

care began, period of gestation, marital status, and race of

woman: Total of 37 States, 1990 ................. 20

9. Fetal deaths and fetal mortality rates by total-birth order,

trimester prenatal care began, and race of woman: Total

of 37 States, 1990 ............................ 21

10. Fetal deaths and fetal mortality rates for womans aged 25

years and over by trimester prenatal care began, period of

gestation, educational attainment of women, and race of

woman: Total of 35 States, 1990 ................. 22

9
Table 1. Fetal deaths and fetal mortality rates by educational attainment, age, and race of woman: Total of 37 States, 1990

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group]

Age and race of woman Total

Years of school completed by woman

Less than 12 years 12 years or more

Total 0–8 years 9–11 years Total 12 years 13–15 years

16 years

or more

Number

All races1 .................... 22,098 6,043 1,672 4,371 16,055 9,078 4,115 2,863

Under 20 years ............... 3,424 2,224 386 1,838 1,200 1,063 137 –

20–34 years ................. 16,083 3,347 1,013 2,334 12,736 7,150 3,426 2,159

35–49 years ................. 2,591 467 273 194 2,124 865 553 706

White ...................... 15,775 4,127 1,338 2,789 11,648 6,338 2,969 2,341

Under 20 years . . . . . . . . . . . . . . . 2,115 1,386 256 1,130 729 655 74 –

20–34 years ................. 11,698 2,408 858 1,550 9,290 5,059 2,487 1,744

35–49 years ................. 1,962 334 224 110 1,628 623 407 598

Black ....................... 5,598 1,695 221 1,475 3,903 2,530 1,015 358

Under 20 years ............... 1,232 786 117 670 446 387 59 –

20–34 years ................. 3,872 808 78 730 3,064 1,931 841 292

35–49 years . . . . . . . . . . . . . . . . . 494 87 23 64 407 218 121 68

Rate

All races1 . . . . . . . . . . . . . . . . . . . . 7.0 7.8 7.6 7.9 6.7 7.6 6.3 5.4

Under 20 years . . . . . . . . . . . . . . . 8.2 8.1 7.7 8.2 8.3 8.2 9.0 *

20–34 years . . . . . . . . . . . . . . . . . 6.5 7.2 6.9 7.4 6.4 7.2 6.0 5.0

35–49 years . . . . . . . . . . . . . . . . . 9.6 12.5 12.4 12.7 9.2 12.4 8.9 7.1

White . . . . . . . . . . . . . . . . . . . . . . 6.2 6.9 7.1 6.8 5.9 6.6 5.6 5.0

Under 20 years . . . . . . . . . . . . . . . 7.2 7.2 6.5 7.4 7.2 7.2 7.0 *

20–34 years . . . . . . . . . . . . . . . . . 5.7 6.4 6.5 6.3 5.6 6.2 5.3 4.6

35–49 years . . . . . . . . . . . . . . . . . 8.7 11.5 12.3 10.1 8.3 11.0 7.9 6.8

Black ....................... 12.0 11.8 13.9 11.6 12.0 12.5 11.1 11.5

Under 20 years ............... 10.8 10.6 12.2 10.4 11.2 10.9 14.3 *

20–34 years . . . . . . . . . . . . . . . . . 11.8 12.5 15.0 12.3 11.7 12.3 10.5 11.4

35–49 years ................. 18.5 19.2 21.3 18.5 18.3 22.5 17.1 12.5

– Quantity zero.

* Figure does not meet standard of reliability or precision.

1Includes races other than white and black.

10
Table 2. Fetal deaths and fetal mortality rates by educational attainment, age, and Hispanic origin of woman, and by race of woman for

non-Hispanic origin: Total of 31 States, 1990

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks; see Technical notes. Not stated education values are proportionally

distributed; see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group]

Age and race of woman Total

Years of school completed by woman

Less than 12 years 12 years or more

Total 0–8 years 9–11 years Total 12 years 13–15 years

16 years

or more

Number

All origins1 .......................... 19,966 5,541 1,564 3,977 14,425 8,154 3,718 2,553

Under 20 years ...................... 3,105 2,024 350 1,674 1,081 953 128 –

20–34 years ........................ 14,532 3,073 952 2,121 11,459 6,428 3,099 1,931

35–49 years ........................ 2,329 443 262 181 1,886 773 491 622

Hispanic total ......................... 3,153 1,770 1,000 770 1,383 911 334 138

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 518 384 124 260 134 119 15 –

20–34 years ........................ 2,244 1,140 680 460 1,104 702 290 112

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 391 248 196 52 143 88 28 27

Mexican ............................ 2,339 1,437 835 603 902 618 211 72

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 385 298 100 198 87 76 11 –

20–34 years ........................ 1,681 945 575 370 736 487 185 64

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 273 197 161 37 76 54 14 8

Puerto Rican . . . . . . . . . . . . . . . . . . . . . . . . . 106 34 7 27 72 48 19 5

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 25 14 3 10 11 10 1 –

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 72 17 2 15 55 36 14 4

35–49 years ........................ 9 3 1 1 6 1 4 1

Cuban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 8 1 7 56 24 19 12

Under 20 years ...................... 5 3 – 3 2 2 – —

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 48 2 – 2 46 20 17 9

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 11 2 1 1 9 2 2 4

Central and South American . . . . . . . . . . . . . . . 248 138 87 50 110 65 23 22

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 35 29 8 21 6 5 1 –

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 172 93 67 26 79 48 20 11

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 41 17 13 3 24 12 2 10

Other Hispanic . . . . . . . . . . . . . . . . . . . . . . . . 396 147 67 80 249 157 63 29

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 68 41 14 27 27 26 1 –

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 271 79 35 44 192 112 55 25

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 57 29 19 10 29 19 6 4

Non-Hispanic total2 ..................... 16,219 3,665 566 3,098 12,554 6,985 3,258 2,311

Under 20 years ...................... 2,491 1,580 220 1,360 911 803 108 –

20–34 years ........................ 11,863 1,883 274 1,608 9,980 5,531 2,710 1,739

35–49 years ........................ 1,865 197 71 126 1,668 654 442 573

White ............................. 10,954 2,120 330 1,790 8,834 4,710 2,279 1,846

Under 20 years ...................... 1,397 887 118 770 510 454 56 –

20–34 years ........................ 8,192 1,137 172 965 7,055 3,789 1,901 1,365

35–49 years ........................ 1,365 96 41 56 1,269 465 322 481

Black .............................. 4,632 1,370 153 1,216 3,262 2,095 857 310

Under 20 years ...................... 1,033 652 93 558 381 333 48 –

20–34 years ........................ 3,215 642 46 597 2,573 1,600 719 254

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 384 64 12 52 320 168 95 57

Rate

All origins1 . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 7.8 7.5 8.0 6.9 7.7 6.5 5.5

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 8.3 8.2 7.6 8.4 8.4 8.2 9.5 *

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 6.6 7.2 6.7 7.5 6.5 7.3 6.1 5.1

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 9.8 12.7 12.4 13.2 9.3 12.5 9.0 7.2

Hispanic total . . . . . . . . . . . . . . . . . . . . . . . . . 6.6 6.5 7.0 5.9 6.7 6.9 6.4 6.3

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 6.4 6.0 5.6 6.2 7.9 7.7 * *

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 6.2 6.1 6.5 5.5 6.3 6.5 6.2 6.0

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 11.3 12.6 12.9 11.7 9.5 11.6 6.7 8.1

Mexican . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3 6.3 6.8 5.8 6.3 6.4 6.2 6.1

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 5.9 5.7 5.3 5.9 6.8 6.4 * *

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 6.0 5.9 6.3 5.4 6.1 6.1 6.1 6.3

35–49 years ........................ 10.6 11.8 12.2 10.5 8.3 10.6 * *

Puerto Rican . . . . . . . . . . . . . . . . . . . . . . . . . 5.9 5.0 * 5.1 6.4 7.8 * *

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 6.6 * * * * * * *

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 5.5 * * * 5.8 7.3 * *

35–49 years ........................ * * * * * * * *

11
Table 2. Fetal deaths and fetal mortality rates by educational attainment, age, and Hispanic origin of woman, and by race of woman for

non-Hispanic origin: Total of 31 States, 1990—Con.

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks; see Technical notes. Not stated education values are proportionally

distributed; see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group]

Age and race of woman Total

Years of school completed by woman

Less than 12 years 12 years or more

Total 0–8 years 9–11 years Total 12 years 13–15 years

16 years

or more

Cuban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9 * * * 7.3 7.7 * *

Under 20 years ...................... * * * * * * * *

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 6.3 * * * 7.0 7.3 * *

35–49 years ........................ * * * * * * * *

Central and South American . . . . . . . . . . . . . . . 5.4 5.9 6.0 5.8 4.9 5.2 3.7 5.7

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 7.9 8.1 * 11.0 * * * *

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 4.7 5.3 5.9 4.2 4.1 4.5 3.6 *

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 8.9 * * * 9.9 * * *

Other Hispanic . . . . . . . . . . . . . . . . . . . . . . . . 11.6 12.3 27.0 8.5 11.2 11.6 10.7 10.2

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 9.9 8.3 * 6.7 13.6 14.3 * *

20–34 years ........................ 10.9 12.1 24.9 8.5 10.4 10.3 10.7 10.6

35–49 years ........................ 24.4 55.2 * * 15.7 * * *

Non-Hispanic total2 . . . . . . . . . . . . . . . . . . . . . 7.0 8.5 8.7 8.5 6.7 7.5 6.3 5.2

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 8.5 8.7 9.2 8.7 8.2 8.0 9.1 *

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 6.5 8.0 7.8 8.0 6.3 7.2 5.9 4.9

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 9.2 13.2 12.6 13.6 8.9 12.1 8.8 6.9

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.0 7.4 8.4 7.2 5.8 6.5 5.4 4.8

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 7.5 7.9 8.0 7.9 6.8 6.8 7.0 *

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 5.6 6.8 7.7 6.7 5.4 6.2 5.1 4.4

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 8.3 11.9 16.6 9.9 8.1 10.9 7.8 6.7

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.9 11.7 12.5 11.7 11.9 12.3 11.1 11.8

Under 20 years ...................... 10.8 10.5 12.0 10.3 11.3 11.0 13.9 *

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 11.8 12.5 12.5 12.6 11.6 12.1 10.6 11.6

35–49 years ........................ 17.6 18.0 * 18.9 17.5 21.4 16.1 12.7

– Quantity zero.

*Figure does not meet standard of reliability or precision.

1Figures for origin not stated included in ‘‘All origins’’ but not distributed among origins.

2Includes races other than white and black.

12
Table 3. Fetal deaths and fetal mortality rates by educational attainment, race, and marital status of women aged 25 years and over:

Total of 37 States, 1990

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group]

Race and marital status of women Total

Years of school completed by woman

Less than 12 years 12 years or more

Total 0–8 years 9–11 years Total 12 years 13–15 years

16 years

or more

Number

All races1 .................... 12,892 2,222 909 1,313 10,670 5,047 2,935 2,688

Married .................... 9,581 1,132 613 588 8,301 3,539 2,330 2,443

Unmarried .................. 3,311 1,120 300 747 2,347 1,520 597 219

White ...................... 9,676 1,626 763 863 8,050 3,648 2,197 2,204

Married .................... 8,243 1,079 579 536 7,048 2,996 1,949 2,099

Unmarried .................. 1,433 558 187 335 995 656 245 96

Black ....................... 2,725 472 73 399 2,253 1,280 646 327

Married .................... 1,095 97 24 72 991 478 307 208

Unmarried .................. 1,630 384 50 336 1,254 806 335 111

Rate

All races1 . . . . . . . . . . . . . . . . . . . . 6.8 7.6 7.4 7.7 5.9 6.9 5.6 4.8

Married . . . . . . . . . . . . . . . . . . . . 6.0 6.1 7.2 5.8 5.3 6.0 5.1 4.7

Unmarried . . . . . . . . . . . . . . . . . . 11.4 10.5 8.0 10.8 10.3 10.9 9.4 9.3

White . . . . . . . . . . . . . . . . . . . . . . 6.1 6.9 7.2 6.7 5.3 6.1 5.1 4.6

Married . . . . . . . . . . . . . . . . . . . . 5.8 6.7 7.8 6.1 5.1 5.7 4.9 4.5

Unmarried . . . . . . . . . . . . . . . . . . 8.0 7.5 5.8 8.0 7.8 8.4 7.3 6.3

Black ....................... 13.4 12.4 14.9 12.0 11.4 12.9 9.8 10.1

Married .................... 10.7 9.4 12.6 8.5 9.6 11.5 8.3 8.5

Unmarried .................. 16.3 13.6 16.6 13.3 13.6 14.0 12.0 16.6

1Includes races other than white and black.

13
Table 4. Fetal deaths and fetal mortality rates for women aged 25 years and over by educational attainment of women, metropolitan and

nonmetropolitan counties in selected States: Total of 37 States, 1990

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group]

Area and race of woman1 Total

Years of school completed by woman

Less than 12 years 12 years or more

Total 0–8 years 9–11 years Total 12 years 13–15 years

16 years

or more

Number

Total of States ................. 12,892 2,222 909 1,313 10,670 5,047 2,935 2,688

White ..................... 9,676 1,626 763 863 8,050 3,648 2,197 2,204

Black ..................... 2,725 472 73 399 2,253 1,280 646 327

Metropolitan counties ............. 10,448 1,790 787 1,003 8,658 3,965 2,382 2,311

White ..................... 7,668 1,295 658 637 6,373 2,786 1,717 1,870

Black ..................... 2,366 399 60 339 1,967 1,089 588 290

Nonmetropolitan counties .......... 2,444 432 125 307 2,012 1,074 554 384

White ..................... 2,008 332 107 225 1,676 858 479 339

Black . . . . . . . . . . . . . . . . . . . . . 359 72 13 59 287 189 61 38

Rate

Total of States . . . . . . . . . . . . . . . . . 6.8 8.4 8.2 8.6 6.6 7.7 6.2 5.4

White . . . . . . . . . . . . . . . . . . . . . 6.1 7.6 7.9 7.3 5.8 6.7 5.6 5.0

Black ..................... 13.4 14.4 17.3 14.0 13.2 15.0 11.4 11.8

Metropolitan counties . . . . . . . . . . . . . 6.8 8.2 8.0 8.3 6.5 7.8 6.2 5.4

White . . . . . . . . . . . . . . . . . . . . . 5.9 7.3 7.8 6.9 5.7 6.6 5.4 5.0

Black ..................... 13.3 14.1 15.9 13.8 13.1 14.9 11.4 11.4

Nonmetropolitan counties . . . . . . . . . . 7.1 9.8 10.1 9.7 6.7 7.4 6.5 5.7

White . . . . . . . . . . . . . . . . . . . . . 6.5 9.0 9.5 8.8 6.2 6.7 6.1 5.3

Black ..................... 14.6 16.1 * 14.6 14.3 14.9 11.8 16.4

* Figure does not meet standard of reliability or precision.

1Totals for geographic areas include races other than white and black.

14
Table 5. Fetal deaths and fetal mortality rates for women aged 25 years and over by educational attainment of women, race of woman,

and total-birth order: Total of 37 States, 1990

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group]

Race and total-birth order of women Total

Years of school completed by woman

Less than 12 years 12 years or more

Total 0–8 years 9–11 years Total 12 years 13–15 years

16 years

or more

All races1 Number

Total-birth order ................ 12,892 2,222 909 1,313 10,670 5,047 2,935 2,688

1 ........................ 2,757 262 114 148 2,500 994 669 837

2 ........................ 3,071 331 123 207 2,733 1,226 709 798

3 ........................ 2,657 375 128 247 2,270 1,112 655 504

4 ........................ 1,763 377 157 220 1,388 719 394 276

5 and over .................. 2,645 885 392 494 1,772 993 507 272

White

Total-birth order ................ 9,676 1,626 763 863 8,050 3,648 2,197 2,204

1 ........................ 2,195 213 97 116 1,984 780 518 685

2 ........................ 2,425 267 107 160 2,158 942 545 670

3 ........................ 2,023 278 103 175 1,739 806 510 423

4 ........................ 1,270 279 140 140 992 495 285 213

5 and over .................. 1,763 588 317 272 1,177 624 339 215

Black

Total-birth order ................ 2,725 472 73 399 2,253 1,280 646 327

1 . . . . . . . . . . . . . . . . . . . . . . . . 436 36 9 27 411 189 121 101

2 . . . . . . . . . . . . . . . . . . . . . . . . 530 50 9 40 473 252 140 81

3 . . . . . . . . . . . . . . . . . . . . . . . . 554 82 14 68 464 283 129 53

4 . . . . . . . . . . . . . . . . . . . . . . . . 444 82 11 71 358 211 101 47

5 and over . . . . . . . . . . . . . . . . . . 761 225 30 194 545 342 156 47

All races1 Rate

Total-birth order . . . . . . . . . . . . . . . . 6.8 8.4 8.2 8.6 6.6 7.7 6.2 5.4

1 . . . . . . . . . . . . . . . . . . . . . . . . 6.3 10.0 9.4 10.5 6.1 8.0 5.9 4.9

2 . . . . . . . . . . . . . . . . . . . . . . . . 5.5 6.9 6.7 7.1 5.4 6.3 4.8 4.8

3 . . . . . . . . . . . . . . . . . . . . . . . . 6.3 6.2 5.4 6.7 6.3 6.9 6.2 5.4

4 . . . . . . . . . . . . . . . . . . . . . . . . 7.4 7.6 7.7 7.5 7.4 7.9 7.1 6.7

5 and over . . . . . . . . . . . . . . . . . . 11.1 11.2 10.9 11.5 11.1 11.9 10.5 9.8

White

Total-birth order . . . . . . . . . . . . . . . . 6.1 7.6 7.9 7.3 5.8 6.7 5.6 5.0

1 . . . . . . . . . . . . . . . . . . . . . . . . 5.8 9.7 9.2 10.1 5.5 7.1 5.3 4.5

2 . . . . . . . . . . . . . . . . . . . . . . . . 5.0 6.5 6.6 6.5 4.9 5.6 4.3 4.6

3 . . . . . . . . . . . . . . . . . . . . . . . . 5.6 5.4 4.8 5.8 5.7 6.0 5.8 5.1

4 . . . . . . . . . . . . . . . . . . . . . . . . 6.5 6.8 7.7 6.1 6.4 6.8 6.3 5.9

5 and over . . . . . . . . . . . . . . . . . . 9.8 10.1 10.7 9.6 9.6 10.3 9.1 8.8

Black

Total-birth order ................ 13.4 14.4 17.3 14.0 13.2 15.0 11.4 11.8

1 ........................ 14.7 19.1 * 18.3 14.8 19.2 12.3 12.4

2 ........................ 10.9 12.3 * 11.6 10.6 12.6 8.9 9.1

3 . . . . . . . . . . . . . . . . . . . . . . . . 11.8 13.4 * 12.7 11.4 13.3 9.4 9.4

4 ........................ 13.6 12.9 * 12.6 13.6 14.0 11.9 17.0

5 and over .................. 16.8 15.6 17.4 15.2 17.7 17.8 17.0 20.4

* Figure does not meet standard of reliability or precision.

1Includes races other than white and black.

15
Table 6. Fetal deaths and fetal mortality rates by trimester prenatal care began, period of gestation, race of woman, and age of woman:

Total of 37 States, 1990

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group. Rates by gestation include all live births for rates at all

periods of gestation, live births of 20 or more weeks of gestation for rates at 20–27 weeks of gestation, and live births of 28 or more weeks of gestation for rates at 28

or more weeks of gestation]

Period of gestation, age of women,

and race of woman

All

fetal deaths

Prenatal care

No

prenatal

care

Any

care

Trimester prenatal care began

1st 2nd 3rd

All gestational periods Number

All races1 ...................... 23,361 2,259 21,103 16,016 4,360 727

Under 20 years ................. 3,768 587 3,181 2,026 1,008 147

20–34 years ................... 16,906 1,479 15,427 11,984 2,948 495

35–49 years ................... 2,687 192 2,495 2,006 404 85

White ........................ 16,029 1,076 14,953 11,760 2,748 445

Under 20 years ................. 2,189 261 1,928 1,262 586 80

20–34 years ................... 11,856 695 11,160 8,946 1,903 311

35–49 years ................... 1,984 120 1,864 1,551 259 54

Black ......................... 6,628 1,142 5,486 3,761 1,465 260

Under 20 years ................. 1,507 312 1,195 728 402 65

20–34 years ................... 4,548 759 3,790 2,675 944 171

35–49 years . . . . . . . . . . . . . . . . . . . 573 70 504 362 118 24

20–27 weeks

All races1 ...................... 9,584 1,302 8,365 6,851 1,457 57

Under 20 years ................. 1,707 381 1,340 978 350 12

20–34 years ................... 6,799 833 6,027 5,002 986 39

35–49 years ................... 1,078 86 999 873 120 6

White ........................ 6,125 556 5,619 4,726 860 33

Under 20 years . . . . . . . . . . . . . . . . . 912 154 764 567 191 6

20–34 years ................... 4,436 351 4,123 3,501 598 24

35–49 years . . . . . . . . . . . . . . . . . . . 777 51 731 659 70 2

Black ......................... 3,196 723 2,496 1,930 544 22

Under 20 years . . . . . . . . . . . . . . . . . 762 219 548 392 150 6

20–34 years ................... 2,187 467 1,737 1,369 354 14

35–49 years . . . . . . . . . . . . . . . . . . . 247 35 213 171 40 2

28 weeks or more

All races1 ...................... 13,777 973 12,726 9,177 2,889 660

Under 20 years ................. 2,061 211 1,836 1,049 654 133

20–34 years ................... 10,107 656 9,392 6,990 1,953 449

35–49 years ................... 1,609 106 1,496 1,137 282 77

White ........................ 9,904 526 9,330 7,042 1,881 407

Under 20 years ................. 1,277 109 1,162 696 393 73

20–34 years ................... 7,420 349 7,035 5,452 1,300 283

35–49 years ................... 1,207 69 1,133 894 188 51

Black ......................... 3,432 426 2,984 1,837 913 234

Under 20 years . . . . . . . . . . . . . . . . . 745 95 644 336 250 58

20–34 years ................... 2,361 297 2,049 1,310 585 154

35–49 years . . . . . . . . . . . . . . . . . . . 326 35 290 192 77 21

All gestational periods Rate

All races1 . . . . . . . . . . . . . . . . . . . . . . 7.2 34.9 6.7 6.6 7.3 5.5

Under 20 years . . . . . . . . . . . . . . . . . 8.6 36.0 7.5 8.4 6.9 4.1

20–34 years . . . . . . . . . . . . . . . . . . . 6.7 33.2 6.2 6.1 7.1 5.5

35–49 years . . . . . . . . . . . . . . . . . . . 9.9 47.6 9.4 8.9 11.7 11.8

White . . . . . . . . . . . . . . . . . . . . . . . . 6.2 27.5 5.9 5.8 6.5 4.8

Under 20 years . . . . . . . . . . . . . . . . . 7.3 28.1 6.6 7.3 6.2 3.5

20–34 years . . . . . . . . . . . . . . . . . . . 5.8 25.4 5.5 5.4 6.3 4.8

35–49 years . . . . . . . . . . . . . . . . . . . 8.9 46.0 8.4 8.1 10.2 10.2

Black ......................... 12.6 48.0 10.9 11.8 9.9 7.7

Under 20 years . . . . . . . . . . . . . . . . . 11.7 46.7 9.8 11.7 8.4 5.5

20–34 years ................... 12.4 47.9 10.8 11.3 10.0 8.4

35–49 years ................... 19.3 56.4 17.7 17.4 18.3 19.0

16
Table 6. Fetal deaths and fetal mortality rates by trimester prenatal care began, period of gestation, race of woman, and age of woman:

Total of 37 States, 1990—Con.

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group. Rates by gestation include all live births for rates at all

periods of gestation, live births of 20 or more weeks of gestation for rates at 20–27 weeks of gestation, and live births of 28 or more weeks of gestation for rates at 28

or more weeks of gestation]

Period of gestation, age of women,

and race of woman

All

fetal deaths

Prenatal care

No

prenatal

care

Any

care

Trimester prenatal care began

1st 2nd 3rd

20–27 weeks Rate

All races1 . . . . . . . . . . . . . . . . . . . . . . 3.0 20.4 2.7 2.8 2.5 0.4

Under 20 years . . . . . . . . . . . . . . . . . 3.9 23.7 3.2 4.1 2.4 *

20–34 years . . . . . . . . . . . . . . . . . . . 2.7 19.0 2.5 2.6 2.4 0.4

35–49 years . . . . . . . . . . . . . . . . . . . 4.0 22.0 3.8 3.9 3.5 *

White . . . . . . . . . . . . . . . . . . . . . . . . 2.4 14.4 2.2 2.3 2.1 0.4

Under 20 years . . . . . . . . . . . . . . . . . 3.1 16.8 2.6 3.3 2.0 *

20–34 years . . . . . . . . . . . . . . . . . . . 2.2 13.0 2.0 2.1 2.0 0.4

35–49 years . . . . . . . . . . . . . . . . . . . 3.5 20.1 3.3 3.5 2.8 *

Black . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 31.1 5.0 6.1 3.7 0.7

Under 20 years . . . . . . . . . . . . . . . . . 6.0 33.4 4.5 6.3 3.2 *

20–34 years . . . . . . . . . . . . . . . . . . . 6.0 30.1 5.0 5.8 3.8 *

35–49 years . . . . . . . . . . . . . . . . . . . 8.4 29.2 7.6 8.3 6.3 *

28 weeks or more

All races1 . . . . . . . . . . . . . . . . . . . . . . 4.3 16.1 4.1 3.8 4.9 5.0

Under 20 years . . . . . . . . . . . . . . . . . 4.8 14.0 4.4 4.4 4.6 3.7

20–34 years . . . . . . . . . . . . . . . . . . . 4.1 15.7 3.8 3.6 4.8 5.0

35–49 years . . . . . . . . . . . . . . . . . . . 6.0 28.2 5.7 5.1 8.2 10.8

White . . . . . . . . . . . . . . . . . . . . . . . . 3.9 14.0 3.7 3.5 4.5 4.4

Under 20 years . . . . . . . . . . . . . . . . . 4.3 12.4 4.0 4.0 4.2 3.2

20–34 years . . . . . . . . . . . . . . . . . . . 3.6 13.3 3.5 3.3 4.3 4.4

35–49 years . . . . . . . . . . . . . . . . . . . 5.4 27.9 5.2 4.7 7.5 9.7

Black . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 20.0 6.1 5.9 6.3 7.0

Under 20 years . . . . . . . . . . . . . . . . . 5.9 16.0 5.4 5.5 5.3 4.9

20–34 years . . . . . . . . . . . . . . . . . . . 6.6 20.8 6.0 5.7 6.3 7.6

35–49 years . . . . . . . . . . . . . . . . . . . 11.3 31.3 10.4 9.5 12.2 16.7

* Figure does not meet standard of reliability or precision.

1Includes races other than white and black.

17
Table 7. Fetal deaths and fetal mortality rates by trimester prenatal care began, age of women, and Hispanic origin of woman, and by

race of women of non-Hispanic origin: Total of 31 States, 1990

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated trimester values are proportionally

distributed; see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group]

Age and origin of woman

All

fetal deaths

Prenatal care

No

prenatal

care

Any

care

Trimester prenatal care began

1st 2nd 3rd

Number

All origins1 .......................... 21,229 2,053 19,176 14,479 4,021 676

Under 20 years ...................... 3,449 552 2,897 1,836 929 132

20–34 years ........................ 15,355 1,326 14,028 10,835 2,730 463

35–49 years ........................ 2,425 174 2,251 1,809 361 81

Hispanic total ......................... 3,139 372 2,768 1,776 799 193

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 517 101 416 236 152 28

20–34 years ........................ 2,234 230 2,004 1,310 554 140

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 388 42 345 228 93 24

Mexican ............................ 2,329 294 2,035 1,238 643 154

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 385 85 300 162 115 23

20–34 years ........................ 1,673 176 1,496 926 457 113

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 271 34 237 148 71 18

Puerto Rican . . . . . . . . . . . . . . . . . . . . . . . . . 110 16 94 70 22 2

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 25 2 22 15 6 1

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 76 12 63 48 14 1

35–49 years ........................ 9 1 7 6 1 –

Cuban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 1 60 55 5 –

Under 20 years ...................... 5 1 4 2 2 –

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 46 – 46 45 1 –

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 11 – 11 10 1 –

Central and South American . . . . . . . . . . . . . . . 249 17 233 169 46 18

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 35 4 30 23 6 1

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 172 11 161 120 28 13

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 42 1 41 26 11 4

Other Hispanic . . . . . . . . . . . . . . . . . . . . . . . . 389 41 348 254 77 17

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 67 8 59 34 22 3

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 267 28 239 180 47 12

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 55 5 50 39 8 3

Non-Hispanic total2 ..................... 17,405 1,589 15,816 12,240 3,112 464

Under 20 years ...................... 2,820 429 2,391 1,541 749 101

20–34 years ........................ 12,638 1,033 11,605 9,194 2,102 309

35–49 years ........................ 1,947 125 1,822 1,506 261 55

White ............................. 11,172 599 10,572 8,586 1,753 233

Under 20 years ...................... 1,461 140 1,321 879 393 49

20–34 years ........................ 8,332 392 7,940 6,565 1,220 155

35–49 years ........................ 1,379 67 1,312 1,143 140 29

Black .............................. 5,622 959 4,663 3,207 1,242 214

Under 20 years ...................... 1,303 281 1,023 630 343 50

20–34 years ........................ 3,863 622 3,242 2,296 801 145

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 456 56 400 284 97 19

Rate

All origins1 . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4 34.3 6.8 6.7 7.5 5.5

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 8.7 36.7 7.6 8.5 7.1 4.0

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 6.9 32.2 6.4 6.2 7.3 5.5

35–49 years ........................ 10.1 47.2 9.5 9.1 11.5 12.2

Hispanic total . . . . . . . . . . . . . . . . . . . . . . . . . 6.6 19.8 6.1 6.2 6.1 5.1

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 6.4 22.3 5.5 6.0 5.4 3.2

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 6.2 17.5 5.8 5.8 5.8 5.1

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 11.2 38.7 10.3 9.9 11.1 11.1

Mexican . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3 18.4 5.8 5.8 6.0 4.8

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 5.9 21.8 4.9 5.3 5.0 3.1

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 6.0 15.8 5.6 5.6 5.9 4.9

35–49 years ........................ 10.6 37.6 9.6 9.0 10.7 *

Puerto Rican . . . . . . . . . . . . . . . . . . . . . . . . . 6.0 * 5.3 5.5 5.5 *

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 6.6 * 6.0 * * *

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 5.7 * 4.8 4.9 * *

35–49 years ........................ * * * * * *

18
Table 7. Fetal deaths and fetal mortality rates by trimester prenatal care began, age of women, and Hispanic origin of woman, and by

race of women of non-Hispanic origin: Total of 31 States, 1990—Con.

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated trimester values are proportionally

distributed; see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group]

Age and origin of woman

All

fetal deaths

Prenatal care

No

prenatal

care

Any

care

Trimester prenatal care began

1st 2nd 3rd

Rate

Cuban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 * 6.6 7.0 * *

Under 20 years ...................... * * * * * *

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 6.1 * 6.1 6.9 * *

35–49 years ........................ * * * * * *

Central and South American . . . . . . . . . . . . . . . 5.4 * 5.2 5.8 3.8 *

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 7.9 * 7.2 10.6 * *

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 4.7 * 4.5 5.0 3.0 *

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 9.1 * 9.1 8.2 * *

Other Hispanic . . . . . . . . . . . . . . . . . . . . . . . . 11.4 57.4 10.4 10.8 9.6 *

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 9.8 * 8.9 9.5 8.9 *

20–34 years ........................ 10.7 59.8 9.8 10.0 9.2 *

35–49 years ........................ 23.6 * 21.8 21.6 * *

Non-Hispanic total2 . . . . . . . . . . . . . . . . . . . . . 7.3 39.0 6.7 6.6 7.7 5.5

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 9.0 41.1 7.9 8.8 7.3 4.2

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 6.8 37.1 6.3 6.1 7.5 5.5

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 9.5 48.8 9.0 8.6 11.4 12.3

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 32.0 5.8 5.7 6.9 4.7

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 7.5 32.1 7.0 7.4 6.7 3.8

20–34 years . . . . . . . . . . . . . . . . . . . . . . . . 5.7 30.2 5.4 5.3 6.7 4.5

35–49 years . . . . . . . . . . . . . . . . . . . . . . . . 8.4 48.5 8.1 7.9 9.4 10.3

Black .............................. 12.5 46.8 10.9 11.9 9.7 7.2

Under 20 years . . . . . . . . . . . . . . . . . . . . . . 11.8 48.6 9.8 12.0 8.3 4.8

20–34 years ........................ 12.3 45.4 10.8 11.5 9.8 8.0

35–49 years ........................ 18.4 55.1 16.8 16.4 17.9 *

– Quantity zero.

* Figure does not meet standard of reliability or precision.

1Figures for origin not stated included in ‘‘All origins’’ but not distributed among origins.

2Includes races other than white or black.

19
Table 8. Fetal deaths and fetal mortality rates by trimester prenatal care began, period of gestation, marital status, and race of woman:

Total of 37 States, 1990

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group. Rates by gestation include all live births for rates at all

periods, live births of 20 or more weeks of gestation for rates at 20–27 weeks of gestation, and live births of 28 or more weeks of gestation for rates at 28 or more

weeks of gestation]

Marital status of women, period of

gestation, and race of woman

All

fetal

deaths

Prenatal care

No

prenatal

care

Any

care

Trimester prenatal care began

1st 2nd 3rd

All gestational periods Number

All races1 ........................... 23,361 2,259 21,103 16,016 4,360 727

Married ........................... 13,630 491 13,003 10,893 1,838 272

Unmarried ......................... 9,731 1,789 8,080 5,081 2,540 459

White ............................. 16,029 1,076 14,953 11,760 2,748 445

Married ........................... 11,876 422 11,278 9,456 1,581 241

Unmarried ......................... 4,153 664 3,670 2,284 1,179 207

Black .............................. 6,628 1,142 5,486 3,761 1,465 260

Married ........................... 1,767 112 1,650 1,317 287 46

Unmarried ......................... 4,861 1,031 3,836 2,443 1,179 214

20–27 weeks

All races1 ........................... 9,584 1,302 8,365 6,851 1,457 57

Married ........................... 5,245 259 5,003 4,428 545 30

Unmarried ......................... 4,316 1,030 3,331 2,397 907 27

White ............................. 6,125 556 5,619 4,726 860 33

Married ........................... 4,408 206 4,166 3,699 443 24

Unmarried ......................... 1,702 344 1,422 1,000 414 8

Black .............................. 3,196 723 2,496 1,930 544 22

Married . . . . . . . . . . . . . . . . . . . . . . . . . 849 69 793 681 108 4

Unmarried ......................... 2,344 649 1,706 1,253 435 18

28 weeks or more

All races1 ........................... 13,777 973 12,726 9,177 2,889 660

Married ........................... 8,411 241 8,013 6,487 1,288 238

Unmarried ......................... 5,392 761 4,741 2,680 1,630 431

White ............................. 9,904 526 9,330 7,042 1,881 407

Married ........................... 7,477 220 7,116 5,769 1,134 213

Unmarried ......................... 2,443 321 2,249 1,284 766 199

Black .............................. 3,432 426 2,984 1,837 913 234

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . 918 45 856 640 176 40

Unmarried ......................... 2,517 387 2,126 1,192 740 194

All gestational periods Rate

All races1 . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2 34.9 6.7 6.6 7.3 5.5

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.9 21.9 5.7 5.7 5.8 4.4

Unmarried ......................... 10.8 42.1 9.4 9.9 9.1 6.4

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2 27.5 5.9 5.8 6.5 4.8

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8 22.8 5.6 5.5 6.0 4.7

Unmarried . . . . . . . . . . . . . . . . . . . . . . . . . 7.9 31.9 7.3 7.4 7.6 5.0

Black .............................. 12.6 48.0 10.9 11.8 9.9 7.7

Married ............. ............ 10.2 35.3 9.7 10.2 8.4 7.2

Unmarried ......................... 13.8 50.0 11.5 12.8 10.3 7.9

20–27 weeks

All races1 . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.0 20.4 2.7 2.8 2.5 0.4

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 11.6 2.2 2.3 1.7 0.5

Unmarried . . . . . . . . . . . . . . . . . . . . . . . . . 4.8 24.7 3.9 4.7 3.3 0.4

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 14.4 2.2 2.3 2.1 0.4

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 11.3 2.1 2.2 1.7 0.5

Unmarried . . . . . . . . . . . . . . . . . . . . . . . . . 3.3 16.8 2.8 3.3 2.7 *

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 31.1 5.0 6.1 3.7 0.7

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.9 22.1 4.7 5.3 3.2 *

Unmarried . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 32.2 5.1 6.6 3.8 *

20
Table 8. Fetal deaths and fetal mortality rates by trimester prenatal care began, period of gestation, marital status, and race of woman:

Total of 37 States, 1990—Con.

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group. Rates by gestation include all live births for rates at all

periods, live births of 20 or more weeks of gestation for rates at 20–27 weeks of gestation, and live births of 28 or more weeks of gestation for rates at 28 or more

weeks of gestation]

Marital status of women, period of

gestation, and race of woman

All

fetal

deaths

Prenatal care

No

prenatal

care

Any

care

Trimester prenatal care began

1st 2nd 3rd

28 weeks or more Rate

All races1 . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3 16.0 4.1 3.8 4.9 5.0

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7 11.2 3.5 3.4 4.1 3.9

Unmarried . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 19.4 5.6 5.3 5.9 6.1

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9 14.0 3.7 3.5 4.5 4.4

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7 12.3 3.5 3.4 4.3 4.2

Unmarried . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 16.2 4.5 4.2 5.0 4.8

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 20.0 6.1 5.9 6.3 7.0

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4 15.6 5.1 5.1 5.2 6.4

Unmarried . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 20.9 6.5 6.4 6.6 7.2

* Figure does not meet standard of reliability or precision.

1Includes races other than white and black.

21
Table 9. Fetal deaths and fetal mortality rates by total-birth order, trimester prenatal care began, and race of woman: Total of 37 States,

1990

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group]

Race of woman and total-birth order

All

fetal

deaths

Prenatal care

No

prenatal

care

Any

care

Trimester prenatal care began

1st 2nd 3rd

Number

All races1 ........................... 23,361 2,259 21,103 16,016 4,360 727

Total-birth order:

1 ............................... 7,596 668 6,934 5,271 1,445 218

2 ............................... 5,868 492 5,375 4,197 1,029 149

3 ............................... 4,179 374 3,802 2,970 713 119

4 ............................... 2,474 242 2,225 1,630 504 91

5 or more ......................... 3,244 481 2,768 1,949 669 150

White ............................. 16,029 1,076 14,953 11,760 2,748 445

1 ............................... 5,441 368 5,081 3,967 971 143

2 ............................... 4,135 226 3,914 3,164 655 95

3 ............................... 2,853 170 2,678 2,173 440 65

4 ............................... 1,614 110 1,499 1,136 303 60

5 or more ......................... 1,987 202 1,781 1,321 378 82

Black .............................. 6,628 1,142 5,486 3,761 1,465 260

1 ............................... 1,923 286 1,635 1,123 443 69

2 ............................... 1,565 259 1,301 915 334 52

3 ............................... 1,217 197 1,023 716 255 52

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 794 125 666 452 185 29

5 or more ......................... 1,130 274 861 555 247 59

Rate

All races1 . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.5 36.5 6.9 6.8 7.6 5.7

Total-birth order:

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 41.9 6.8 6.6 7.7 5.6

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 34.2 6.0 5.8 6.8 4.5

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 32.2 6.6 6.7 6.7 5.0

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.3 30.1 7.6 7.6 8.2 6.2

5 or more ......................... 12.0 40.1 10.7 11.1 10.2 8.2

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 28.1 6.1 6.0 6.7 4.9

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 33.0 6.0 5.9 7.0 5.0

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.5 24.6 5.3 5.2 5.9 4.1

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 24.4 5.8 5.9 5.8 4.0

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9 24.0 6.6 6.5 7.1 6.0

5 or more ......................... 10.1 31.7 9.4 9.8 8.8 6.8

Black .............................. 13.7 52.1 11.8 12.7 10.7 8.3

1 ............................... 13.4 66.8 11.7 12.5 10.7 8.4

2 ............................... 12.0 53.4 10.4 11.1 9.6 6.4

3 ............................... 12.8 45.7 11.3 12.3 9.7 8.5

4 ............................... 14.3 38.6 12.7 14.0 11.5 7.4

5 or more ......................... 18.7 52.4 15.6 17.2 13.6 12.0

1Includes races other than white and black.

22
Table 10. Fetal deaths and fetal mortality rates for women aged 25 years and over by trimester prenatal care began, period of gestation,

educational attainment of women, and race of woman: Total of 35 States, 1990

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group. Rates by gestation include all live births for rates at all

periods of gestation, live births of 20 or more weeks of gestation for rates at 20–27 weeks of gestation, and live births of 28 or more weeks of gestation for rates at 28

weeks or more gestation]

Maternal education, period of

gestation, educational attainment,

and race of woman

All

fetal deaths

Prenatal care

No

prenatal

care

Any

care

Trimester prenatal care began

1st 2nd 3rd

All gestational periods, all races1 Number

Total .............................. 12,501 865 11,635 7,108 4,182 345

Less than 12 years .................... 2,188 360 1,892 755 978 159

12 years .......................... 4,904 431 4,496 2,655 1,733 108

13 years or more ..................... 5,409 173 5,175 3,620 1,470 85

White ............................. 9,331 448 8,883 5,662 2,988 233

Less than 12 years .................... 1,602 212 1,426 587 725 114

12 years .......................... 3,522 183 3,341 2,092 1,181 68

13 years or more ..................... 4,207 92 4,086 2,941 1,087 58

Black .............................. 2,701 403 2,298 1,191 1,009 98

Less than 12 years . . . . . . . . . . . . . . . . . . . . 470 132 360 132 194 34

12 years .......................... 1,271 258 1,036 494 502 40

13 years or more . . . . . . . . . . . . . . . . . . . . . 961 80 857 528 305 24

20–27 weeks

Total .............................. 4,877 448 4,475 2,988 1,458 29

Less than 12 years . . . . . . . . . . . . . . . . . . . . 707 171 570 271 292 7

12 years .......................... 1,968 220 1,777 1,117 652 8

13 years or more ..................... 2,214 105 2,093 1,558 522 13

White ............................. 3,467 203 3,296 2,284 996 16

Less than 12 years . . . . . . . . . . . . . . . . . . . . 489 96 415 202 209 4

12 years .......................... 1,346 84 1,279 845 429 5

13 years or more ..................... 1,637 41 1,591 1,217 367 7

Black .............................. 1,243 240 1,012 609 391 12

Less than 12 years . . . . . . . . . . . . . . . . . . . . 190 68 133 60 70 3

12 years . . . . . . . . . . . . . . . . . . . . . . . . . . 572 140 447 247 197 3

13 years or more . . . . . . . . . . . . . . . . . . . . . 485 65 411 278 128 5

28 weeks or more

Total .............................. 7,624 422 7,158 4,130 2,717 311

Less than 12 years .................... 1,476 190 1,314 483 682 149

12 years .......................... 2,938 212 2,721 1,541 1,082 98

13 years or more ..................... 3,199 67 3,086 2,068 947 71

White ............................. 5,864 247 5,586 3,386 1,986 214

Less than 12 years . . . . . . . . . . . . . . . . . . . . 1,110 117 1,007 385 514 108

12 years .......................... 2,177 99 2,065 1,251 753 61

13 years or more ..................... 2,572 51 2,497 1,728 720 49

Black .............................. 1,458 165 1,284 584 616 84

Less than 12 years . . . . . . . . . . . . . . . . . . . . 278 65 226 72 124 30

12 years . . . . . . . . . . . . . . . . . . . . . . . . . . 698 120 589 248 305 36

13 years or more . . . . . . . . . . . . . . . . . . . . . 478 13 447 250 178 19

All gestational periods, all races1 Rate

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8 34.5 6.5 4.7 17.6 7.2

Less than 12 years . . . . . . . . . . . . . . . . . . . . 8.4 29.7 7.7 4.9 13.4 7.7

12 years . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7 46.8 7.2 5.1 18.7 6.3

13 years or more . . . . . . . . . . . . . . . . . . . . . 5.8 43.1 5.6 4.3 20.2 7.9

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 28.2 5.8 4.3 16.7 6.5

Less than 12 years . . . . . . . . . . . . . . . . . . . . 7.6 24.7 7.1 4.6 12.3 6.7

12 years . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 36.0 6.4 4.7 17.6 5.8

13 years or more . . . . . . . . . . . . . . . . . . . . . 5.2 38.9 5.1 4.0 20.1 7.9

Black .............................. 13.4 48.9 11.9 8.6 22.6 10.8

Less than 12 years .................... 14.4 42.6 12.2 7.7 19.7 13.7

12 years .......................... 15.0 67.3 12.8 9.0 23.4 9.2

13 years or more . . . . . . . . . . . . . . . . . . . . . 11.5 55.6 10.4 7.9 22.8 10.5

23
Table 10. Fetal deaths and fetal mortality rates for women aged 25 years and over by trimester prenatal care began, period of gestation,

educational attainment of women, and race of woman: Total of 35 States, 1990—Con.

[Fetal deaths include only those with stated or presumed period of gestation of 20 weeks or more; see Technical notes. Not stated values are proportionally distributed;

see Technical notes. Rates are number of fetal deaths per 1,000 live births and fetal deaths in specified group. Rates by gestation include all live births for rates at all

periods of gestation, live births of 20 or more weeks of gestation for rates at 20–27 weeks of gestation, and live births of 28 or more weeks of gestation for rates at 28

weeks or more gestation]

Maternal education, period of

gestation, educational attainment,

and race of woman

All

fetal deaths

Prenatal care

No

prenatal

care

Any

care

Trimester prenatal care began

1st 2nd 3rd

20–27 weeks Rate

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 18.2 2.5 2.0 6.2 0.6

Less than 12 years . . . . . . . . . . . . . . . . . . . . 2.7 14.4 2.3 1.8 4.0 *

12 years . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 24.5 2.9 2.2 7.1 *

13 years or more . . . . . . . . . . . . . . . . . . . . . 2.4 26.7 2.3 1.8 7.3 *

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 13.0 2.2 1.7 5.6 *

Less than 12 years . . . . . . . . . . . . . . . . . . . . 2.3 11.4 2.1 1.6 3.6 *

12 years . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 16.9 2.5 1.9 6.5 *

13 years or more . . . . . . . . . . . . . . . . . . . . . 2.0 17.7 2.0 1.7 6.9 *

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2 29.9 5.3 4.4 8.9 *

Less than 12 years . . . . . . . . . . . . . . . . . . . . 5.9 22.5 4.6 3.5 7.2 *

12 years . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8 37.8 5.6 4.5 9.3 *

13 years or more . . . . . . . . . . . . . . . . . . . . . 5.8 45.8 5.0 4.2 9.7 *

28 weeks or more

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 17.9 4.0 2.7 11.6 6.5

Less than 12 years . . . . . . . . . . . . . . . . . . . . 5.8 16.5 5.4 3.2 9.4 7.2

12 years . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 24.8 4.4 3.0 11.8 5.8

13 years or more . . . . . . . . . . . . . . . . . . . . . 3.5 18.1 3.3 2.5 13.2 6.6

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.8 16.2 3.7 2.6 11.2 6.0

Less than 12 years . . . . . . . . . . . . . . . . . . . . 5.3 14.1 5.0 3.1 8.8 6.4

12 years . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 20.4 4.0 2.8 11.3 5.2

13 years or more . . . . . . . . . . . . . . . . . . . . . 3.2 22.6 3.1 2.4 13.5 6.7

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4 22.4 6.8 4.3 14.1 9.4

Less than 12 years . . . . . . . . . . . . . . . . . . . . 8.8 23.2 7.8 4.3 12.9 12.3

12 years . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5 35.1 7.5 4.6 14.6 8.4

13 years or more . . . . . . . . . . . . . . . . . . . . . 5.8 * 5.5 3.8 13.6 *

* Figure does not meet standard of reliability or precision.

1Includes races other than white or black.

24
Appendix

Contents

Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Source of data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Classification of data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Quality of data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Random variation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Appendix table

I. Percent distribution of characteristics of fetal deaths in selected States and in the United States, 1990 . . . . . . . . . . . . . . 26

25
Appendix

Technical notes

Source of data

Fetal deaths

Each year fetal-death statistics are based on all reports of

fetal death received by the National Center for Health Statistics (NCHS), but a reporting criteria was used to limit the

number of States included in the tables of this report. States

were included only if reporting was at least 80 percent complete for education and prenatal care variables in 1990. Results

for a subset of States are believed to be reasonably representative of all States based on comparison of characteristics for

the subsets of States to all States (see table I). The largest

differences are that the States in tables 6, 8, and 9 have 13

percent more nonmetropolitan residents than the total United

States (23.1 percent compared with 20.5 percent). Each

Table I. Percent distribution of characteristics of fetal deaths in selected States and in the United States, 1990

Characteristic

States

included in

tables 1, 3–5

States

included in

tables 6, 8, 9

States

included in

table 10

United

States

Maternal age .................. 100.0 100.0 100.0 100.0

Under 20 years ............... 15.5 16.1 15.6 15.2

20–34 years ................. 72.8 72.4 72.7 72.7

35 years and over . . . . . . . . . . . . . 11.7 11.5 11.7 12.2

Maternal race ................. 100.0 100.0 100.0 100.0

White ..................... 71.4 68.6 71.1 67.2

Black ..................... 25.3 28.4 25.7 29.3

American Indian . . . . . . . . . . . . . . 0.9 0.8 0.8 0.9

Chinese . . . . . . . . . . . . . . . . . . . . 0.2 0.2 0.2 0.2

Japanese . . . . . . . . . . . . . . . . . . . * * * 0.1

Hawaiian . . . . . . . . . . . . . . . . . . . * * * 0.1

Filipino . . . . . . . . . . . . . . . . . . . . 0.5 0.4 0.5 0.5

Other Asian or Pacific Islander . . . . . . . 1.4 1.3 1.3 1.5

Other . . . . . . . . . . . . . . . . . . . . . 0.2 0.2 0.2 0.2

Total-birth order ............... 100.0 100.0 100.0 100.0

1 ........................ 30.9 31.1 31.1 29.7

2 ........................ 23.9 24.0 24.0 23.4

3 ........................ 17.1 17.1 17.0 16.9

4 ........................ 10.1 10.1 10.1 10.1

5 or more .................. 13.3 13.3 13.3 13.8

Not stated . . . . . . . . . . . . . . . . . . 4.6 4.4 4.5 6.1

Place of residence .............. 100.0 100.0 100.0 100.0

Metropolitan ................. 78.7 76.9 78.8 79.5

Nonmetropolitan .............. 21.3 23.1 21.2 20.5

Period of gestation .............. 100.0 100.0 100.0 100.0

20–23 weeks ................ 22.7 23.7 22.8 24.8

24–27 weeks ................ 15.1 15.4 15.2 15.2

28 weeks and over ............. 57.1 56.3 57.1 53.5

Unknown . . . . . . . . . . . . . . . . . . . 5.1 4.6 4.9 6.5

Fetal birthweight ................ 100.0 100.0 100.0 100.0

1,499 grams or less ............ 53.2 53.9 53.7 52.1

1,500–2,499 grams ............. 17.2 17.1 17.4 16.1

2,500 grams or more ........... 22.1 21.6 22.1 20.4

Not stated . . . . . . . . . . . . . . . . . . 7.4 7.4 6.9 11.4

Fetal sex .................... 100.0 100.0 100.0 100.0

Male ...................... 53.2 53.2 53.2 53.8

Female .................... 46.8 46.8 46.8 46.2

Number .................... 22,098 23,361 21,497 31,386

* Figure does not meet standard of reliability or precision.

NOTE: Due to rounding, percents may not add to total.

26
of the three groups of selected States have substantially less

reporting of unknown or not stated period of gestation or

birthweight.

Fetal mortality data are shown for a total of 37 States

except for the Hispanic population where data are shown for

31 States and for data by both prenatal care and education,

which are shown for 35 States. The States included in this

report for maternal education are Alabama, Alaska, Arizona,

Arkansas, California, Colorado, Delaware, Florida, Idaho,

Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska,

Nevada, New Hampshire, North Carolina, North Dakota,

Ohio, Oregon, Pennsylvania, South Carolina, South Dakota,

Tennessee, Texas, Utah, Vermont, West Virginia, Wisconsin,

and Wyoming. The States included for trimester prenatal care

began are Alabama, Alaska, Arizona, Arkansas, California,

Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana,

Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Michigan,

Mississippi, Missouri, Montana, Nebraska, New Hampshire,

North Carolina, North Dakota, Ohio, Oregon, Pennsylvania,

South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, West Virginia, Wisconsin, and Wyoming.

Month prenatal care began and maternal education was

not reported for approximately 10 percent of the records for

the selected States. Deaths and live births for which either

month prenatal care began or maternal education were not

known were proportionally allocated according to the proportion of deaths with known values. The allocated numbers do

not necessarily add to the totals.

The data are provided to the National Center for Health

Statistics (NCHS) through the Vital Statistics Cooperative

Program (VSCP). Beginning with 1989, most States provided

NCHS, through the VSCP, computer tapes of data coded

according to NCHS specifications. The State-coded demographic data are not used in tabulating fetal deaths in data year

1990.

Tabulations of fetal deaths were based solely on information obtained by NCHS from copies of original reports of fetal

deaths from State registration offices, except registration

offices in New York State (excluding New York City), which

only submitted State-coded data in 1990. The information

from these copies was edited, coded, and tabulated. All

mortality information taken from these records was transferred

by NCHS to magnetic tape for computer processing.

Standard certificates and reports

The U.S. Standard Report of Fetal Death is used as a

model to attain uniformity in the contents of forms used to

collect fetal mortality information. Although States may make

modifications, the reports or certificates of most States conform closely in content and arrangement to the standard.

The standard report is revised periodically by the national

vital statistics agency through consultation with State health

officers and registrars; Federal agencies concerned with vital

statistics; national, State, and county medical societies; and

others working in such fields as public health, social welfare,

demography, and insurance. This revision procedure has ensured

careful evaluation of each item in terms of its current and

future usefulness for legal, medical and health, demographic,

and research purposes. New items have been added when

necessary, and old items have been modified to ensure better

reporting; or in some cases, items have been dropped when

their usefulness appeared to be limited. A new revision of the

U.S. Standard Report of Fetal Death was recommended for

State use beginning January 1, 1989.

The fetal-death reporting system of the United States

encompasses the 50 States, the District of Columbia, Puerto

Rico, the Virgin Islands, and Guam.

The 1977 revision of the Model State Vital Statistics Act

and Model State Vital Statistics Regulations (5) recommended

that spontaneous fetal deaths at a gestation of 20 weeks or

more or a weight of 350 grams or more be reported. The forms

used to collect fetal death data are to be considered legally

required statistical reports rather than legal documents.

Beginning with 1970 fetal deaths, procedures were implemented to separate reports of spontaneous fetal deaths from

those of induced terminations of pregnancy. These procedures

are still in use.

Classification of data

The principal value of vital statistics data is realized

through the presentation of rates; fetal mortality rates are

computed by relating the fetal deaths of a class to the live

births and fetal deaths of a similarly defined class. Vital

statistics of fetal deaths and live births must therefore be

classified according to similarly defined systems and tabulated

in comparable groups. Even when the variables common to

both, such as age and race, have been similarly classified and

tabulated, inconsistencies in reporting between the fetal death

report and birth certificate may result in significant

discrepancies.

Race

For vital statistics in the United States for 1990, fetal

deaths are classified by race—white, black, American Indian,

Chinese, Hawaiian, Japanese, Filipino, Other Asian or Pacific

Islander, and Other.

The white category includes, in addition to persons reported

as white, those reported as Mexican, Puerto Rican, Cuban, and

all other Caucasians. The American Indian category includes

American, Alaskan, Canadian, Eskimo, and Aleut.

The tables in this report, however, do not present data for

this detailed classification by race. In all the tables that show

data by race, the divisions are all races combined, white, and

black.

Beginning with data year 1989, NCHS changed the

method of tabulating live birth and fetal death data by race

from race of child to race of mother. In previous years, birth

and fetal death tabulations were by race of child, as determined statistically by an algorithm based on information

reported for the mother and father. (See Vital Statistics of the

United States, 1990, Volume II, Mortality, Part A, Technical

27
Appendix, (6) and the Vital and Health Statistics series report

‘‘Effect on Mortality Rates of the 1989 Change in Tabulating

Race’’ (7) for further details.)

When the race of the mother is unknown, the mother is

assigned to the father’s race; when information for both

parents is missing, the race of the mother is assigned to the

specific race of the mother of the preceding record with known

race.

Period of gestation

The period of gestation is the number of completed weeks

elapsed between the first day of the last normal menstrual

period (LMP) and the date of delivery. (See Vital Statistics of

the United States, 1990, Volume II, Mortality, Part A, Technical Appendix, (6) for further details.)

Age of woman

Beginning with data for 1989, the U.S. Standard Report of

Fetal Death asks for the mother’s date of birth. Age of woman

is computed from the woman’s date of birth and the date of the

termination of the pregnancy. For those States whose reports

do not contain an item on the woman’s date of birth, reported

age of the woman (in years) is used. The age of the woman is

edited by NCHS for upper and lower limits. When women are

reported to be under 10 years of age or 50 years of age and

over, the age of the woman is considered not stated and is

assigned as follows: Age on all fetal-death records with age of

woman not stated is assigned according to the age appearing

on the record previously processed for a woman of identical

race and having the same total-birth order (total of live births

and other terminations).

Marital status

In Vital Statistics of the United States, 1990, Volume I,

Natality (8) and the 1990 Detail Natality Public-Use Documentation (9), not stated marital status for live birth data is

assigned. In 1990 marital status was reported directly on the

birth certificates of 44 States and the District of Columbia. In

the remaining six States, which lack such an item (California,

Connecticut, Michigan, Nevada, New York, and Texas), marital status is inferred from a comparison of the child’s and

parents’ surnames. A birth in a nonreporting State is classified

as occurring to a married woman if the parents’ surnames are

the same, or if the child’s and father’s surnames are the same

and the mother’s current surname cannot be obtained from the

informant item on the birth certificate. A birth in a nonreporting State is classified as occurring to an unmarried woman if

the father’s name is missing, if the parents’ surnames are

different, or if the father’s and child’s surnames are different

and the mother’s current surname is missing. When marital

status is not stated on the birth certificate of a reporting area,

the woman is considered married. For this report, not stated

marital status for live birth data (0.01 percent of records in the

selected areas) was not assigned to married among reporting

States so that not stated marital status was allocated with

identical procedures for the live birth and fetal death records

(8).

Instead, fetal deaths and live births with unknown or

not-stated values are distributed according to the proportions

with known values. Not stated marital status is distributed

before not stated education or prenatal care. Allocated numbers do not necessarily add to the totals.

Total-birth order

Total-birth order is the sum of the number of live births,

number of other terminations including both spontaneous and

induced terminations, and the current delivery. Not stated

total-birth order is distributed according to the proportions

with known values. This distribution is done before distributing not stated education or prenatal care. The allocated

numbers do not necessarily add to the totals.

Quality of data

Completeness of registration

All States have adopted laws that require the registration

of births and the reporting of fetal deaths. It is believed that

more than 99 percent of the births occurring in this country are

registered.

Reporting requirements for fetal deaths vary somewhat

from State to State (see ‘‘Comparability and completeness of

data’’). Overall reporting is not as complete for fetal deaths as

for births, but it is believed to be relatively complete for fetal

deaths at a gestation of 28 weeks or more. Tabulated national

statistical data on fetal deaths include only fetal deaths occurring at a stated or presumed gestation of 20 weeks or more.

Comparability and completeness of data—Registration

area requirements for reporting fetal deaths vary. Most of

these areas require reporting of fetal deaths at gestations of 20

weeks or more (see Vital Statistics of the United States, 1990,

Volume II, Mortality, Part A, Technical Appendix (6). There is

substantial evidence that not all fetal deaths for which reporting is required are reported (10).

Underreporting of fetal deaths is most likely to occur in

the earlier part of the required reporting period for each State.

Thus, for States requiring reporting of all periods of gestation,

fetal deaths occurring at younger gestational ages are less

completely reported. The reporting of fetal deaths at 20–23

weeks of gestation may be more complete for those States that

report fetal deaths at all periods of gestation than for others.

The tables in this report are based on fetal deaths occurring at gestations of 20 weeks or more. These tables also

include fetal deaths for which gestation is not stated for those

States requiring reporting at 20 weeks or more of gestation

only. Fetal deaths of not stated gestation were excluded for

Georgia, which required reporting of all products of conception except for those with a stated birthweight of 500 grams or

more.

28
Computation of rates

Fetal deaths with unknown or not-stated values are distributed according to the proportions with known values

before rates are computed. An asterisk is shown in place of

any derived statistic based on fewer than 20 cases in the

numerator or denominator.

Random variation

Although the fetal death data in this report are not subject

to sampling error, they may be affected by random variation in

the number of fetal deaths involved. When the number of

events is small, perhaps less than 100, and the probability of

such an event is small, considerable caution must be observed

in interpreting the data.

If the rate R1 corresponding to N1 events is compared with

the rate R2 corresponding to N2 events, the difference between

the two rates may be regarded as statistically significant at the

0.05 level of significance if it exceeds

2 ŒR1

2

N1

+

R2

2

N2

Additional information on random variation may be found

in the Technical Appendix from Vital Statistics of the United

States, 1990, Volume II, Mortality, Part A (6).

29
Vital and Health Statistics

series descriptions

SERIES 1. Programs and Collection Procedures—These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the methods

used to collect and process the data, definitions, and other

material necessary for understanding the data.

SERIES 2. Data Evaluation and Methods Research—These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. These studies also

include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

SERIES 3. Analytical and Epidemiological Studies—These reports

present analytical or interpretive studies based on vital and

health statistics. These reports carry the analyses further than

the expository types of reports in the other series.

SERIES 4. Documents and Committee Reports—These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

SERIES 5. International Vital and Health Statistics Reports—These

reports are analytical or descriptive reports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

SERIES 6. Cognition and Survey Measurement—These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

SERIES 10. Data From the National Health Interview Survey—These

reports contain statistics on illness; unintentional injuries;

disability; use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

SERIES 11. Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributions of the population with respect to

physical, physiological, and psychological characteristics, and

(2) analyses of trends and relationships among various

measurements and between survey periods.

SERIES 12. Data From the Institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

included in Series 13.

SERIES 13. Data From the National Health Care Survey—These

reports contain statistics on health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14. Data on Health Resources: Manpower and Facilities—

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

SERIES 15. Data From Special Surveys—These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

SERIES 16. Compilations of Advance Data From Vital and Health

Statistics—Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reports in Series 10–13.

SERIES 20. Data on Mortality—These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

SERIES 21. Data on Natality, Marriage, and Divorce—These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

SERIES 22. Data From the National Mortality and Natality Surveys—

Discontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

SERIES 23. Data From the National Survey of Family Growth—

These reports contain statistics on factors that affect birth

rates, including contraception, infertility, cohabitation,

marriage, divorce, and remarriage; adoption; use of medical

care for family planning and infertility; and related maternal

and infant health topics. These statistics are based on

national surveys of childbearing age.

SERIES 24. Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

Monthly Vital Statistics Report (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact:

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and Prevention

Public Health Service

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782

(301) 436–8500

E-mail: nchsquery@nch10a.em.cdc.gov

Internet: http://www.cdc.gov/nchswww/nchshome.htm
Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

6525 Belcrest Road

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

DHHS Publication No. (PHS) 96-1859, Series 20, No. 30

6-0242 (7/96)

BULK RATE

POSTAGE & FEES PAID

PHS/NCHS

PERMIT NO. G-281