LEND Presentation April, 2008

Maternal and Child Health Bureau

LENDPresentation

April, 2008

Health Resources And Services Administration

Maternal And Child Health Bureau

Peter C. Van Dyck, MD, MPH

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MCHB

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The MCH Bureau Authorizing Legislation

MCH Services Block Grant (Title V, Social Security Act)

Traumatic Brain Injury (Section 1252 and 1253 Public Health Service Act)

Healthy Start (Title III, Public Health Service Act, Section 330H)

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The MCH Bureau Authorizing Legislation

Emergency Medical Services Children (Section 1910, Public Health Service Act)

Newborn Hearing Screening (Title III, Public Health Service Act, Section 399M)

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The MCH Bureau Authorizing Legislation

Sickle Cell Service Demonstration Program (Section 712(c) of the American Jobs Creation Act of 2004)

Family to Family Health Information Centers (Section 501(c)(1)(A) of the Social Security Act)

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MCH Formula and Allocation

Whenever the total appropriation exceeds $600 million; 12.75% of the amount is used to fund

the Community Integrated Service System (CISS) set-aside program

Remainder is allocated as 85% to States and 15% retained by the Secretary for SPRANS projects

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MCH Budget for 2007 and 2008 (millions)

MCHBG…$693.0….$693.0….$750.0….$673.0….$666.2 State..….$566.5...$578.9…..$568.9...$566.5…$556.6 SPRANS...$99.9…$102.2…..$100.4..…$79.9.….$78.6 CISS………$10.6…$11.9......$10.1….…$10.6…...

$10.4 Earmark...$16.0…------….….$70.6…...$16.0…...$20.6

FY2007

2008(PB)

1-numbers may not add due to rounding

2008(H)2008(S)2008(APPR)

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MCH Budget for 2007 and 2008 (millions)

Healthy Start...$101.5...$100.5...$120.0...$101.5…$99.7 Hearing…….….....$9.8…...-----.……$11.0.…$12.0….$11.8 EMSC……….…….$19.8.....-----…….$22.3..…$20.0.…$19.5 TBI………….………$8.9…...-----….….$8.9……$10.0…..$8.8 Sickle Cell….…....$2.2…...$2.2………$2.2.….$3.2…….$2.7 Family to Family.$3.0…...$4.0………$4.0…..$4.0…….$4.0 Autism………….….-----…...-----……..$0.0…...$37.0….$36.4

FY2007

2008(PB)

1-numbers may not add due to rounding

2008(H) 2008(S)2008(A)

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MCH Budget for 2007 and 2008 (millions)

SPRANS Earmarks Oral Health…...$4.80…$0.0….$12.0…….$4.8……$4.72 Sickle Cell…..…$3.84…$0.0…...$4.0…….$3.84.…$3.77 Epilepsy…….....$2.88...$0.0……$5.8..….$2.88….$2.83 Genetics….….…$1.92…$0.0..….$3.8..….$1.92….$1.89 Mental Health..$1.54…$0.0…….$0.0…...$0.0……$0.0 Fetal Alcohol.…$0.99…$0.0…….$0.0…...$0.99….$0.97 1rst Mother……..-----….-----……..-----..…$1.54….$1.51 Prepare Birth…..-----….-----…...$15.0….…-----…..$4.9 Autism……………-----…..-----……$30.0…….-----…..$0.0

2007

1-numbers may not add due to rounding

2008(PB)2008(H)2008(S)2008(A)

Healthy People 2010 Focus Area 16:

Maternal, Infant, and Child Health

Progress ReviewSeptember 20, 2007

Overview

• Approximately 6 million pregnancies each year in U.S.

• U.S. infant mortality internationally ranked 29th (2004)

• Birth defects affect 1 in 33 U.S. births annually

• 2005 (preliminary) U.S. cesarean rate is highest ever recorded

• Breastfeeding saves on health care costs: reduced sick care visits, prescriptions, hospitalizations

16-13 Infants put to sleep on their backs16-14c Autism spectrum disorder

Target met or exceeded

Improving16-1c Infant mortality16-1h Sudden infant death syndrome (SIDS)16-6a Prenatal care 16-15 Neural tube defects (NTDs)16-16a Folic acid consumption16-19 Breastfeeding

Highlighted Objectives

Getting worse16-4 Maternal mortality16-9 Cesarean births16-10a Low birthweight16-11a Preterm births

No trend data16-23 Service systems for special health care needs

77 72 67 62 56 57 53 5579

1996 1997 1998 1999 2000 2001

SIDS deathsInfants put to sleep on their

backsPer 100,000 live births Percent

SOURCE: National Vital Statistics System (NVSS), NCHS, CDC and National Infant Sleep Position Study, NICHD, NIH. Obj. 16-1h & 16-13

SIDS deaths 2010 Target: 23

Sleep position 2010 Target: 70

20032002 2004

60

20

80

0

40

60

20

80

0

40

Sudden Infant Death Syndrome and Sleep Position

Obj. 16-14c

0 36 48 60 72 84 96

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

Decrease desired

Age at Identification of Autism Spectrum Disorder, Metropolitan

Atlanta, 2002

62Total

White

Black

Hispanic

Female

Male

2010 Target: 66

24

36

48

60

72

84

96

1996 2000 20020

Median age (months)

n=91

n=71

n=10

n=27

n=153

n=180

Obj. 16-1c

Infant Mortality

Rate per 1,000 live births

1998 1999 2000 2001 2002 2003 2004

2010 Target: 4.5

Decrease desired

American Indian

Black

Total

HispanicAsian

14

12

10

8

6

4

2

0

16

White

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

Obj. 16-1c

Infant Mortality

Rate per 1,000 live births

1998 1999 2000 2001 2002 2003 2004

2010 Target: 4.5

Decrease desired

American Indian

Black

Total

HispanicAsian

14

12

10

8

6

4

2

0

16

White

0

20

40

60

80

1940 2004

BlackWhite

Rate per 1,000 live births

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

4,642

2,246

1,715

1,052

5,622

Congenital anomalies

Short gestation/ low birthweight§

Maternal pregnancy

complications

SIDS

5 Leading Causes of Infant Death*, 2004

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

Unintentional injuries

5

2

6

0

4

1

3

Number (thousands)

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

(20%)

(17%)

(8%)

(6%)

(4%)

Obj. 16-6a

0 40 50 60 70 80 90 100

Percent

Total

American IndianBlack

HispanicAsian

White

< 15 years15-19 years20-24 years25-29 years30-34 years

35+ years

Less than high schoolHigh school

At least some college

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

Increase desired

Prenatal Care Beginning in First Trimester, 2004

2010 Target: 90

84

Obj. 16-6a

0 40 50 60 70 80 90 100

Percent

Total

American IndianBlack

HispanicAsian

White

< 15 years15-19 years20-24 years25-29 years30-34 years

35+ years

Less than high schoolHigh school

At least some college

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

Increase desired

Prenatal Care Beginning in First Trimester, 2004

2010 Target: 90

84

60

70

80

90

100Percent of live births

1990 2003

0

2

4

6

8

10

Spina Bifida and Other NTDs§

Per 10,000 live births

2010 Target: 3

Decrease desired

0

20

40

60

80

100

Baseline data

Recommended Daily Intake of Folic Acid*

Most recent data

Percent

1991-94 19962003-04 2003

2010 Target: 80

Obj. 16-15 & 16-16a

Recommended Daily Intake of Folic Acid

and Neural Tube Defects

Increase desired

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

At 6 months

40

Percent

60

80

Obj. 16-19a, b, c

0

At 12 months

2000 2004 Increase desired

2010 Target: 75

Any Breastfeeding

Ever

20

100

2010 Target: 50

2010 Target: 25

2002

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

Obj. 16-19e

0 20 40 60 80 100

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

Increase desired

Exclusive Breastfeeding Through 6 Months, 2004

11Total

Black

American Indian

Hispanic

White

Native Hawaiian

Asian

Less than high school

High school

Some college

College graduate

2010 Target: 17

Obj. 16-4

0 10 20 30 40 50

Rate per 100,000 live births

Decrease desired

13.1

2010 Target: 4.3

Maternal Mortality, 2004

Total

Hispanic

Asian

White

Black

<20 years

20-24 years

25-29 years

30-34 years

35 years and over

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

Obj. 16-9a

1998 1999 2000 2001 2002 2003 2004

30

20

10

0

Percent

2010 Target: 15

Decrease desired

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

First Cesarean Births Among Low-Risk Pregnancies*

1998 1999 2000 2001 2002 2003 2004

100

90

80

70

60

0

Percent

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

Repeat Cesarean BirthsAmong Low-Risk Pregnancies*

2010 Target: 63

Decrease desired

Obj. 16-9b

WhiteHispanic

0

2

4

6

8

10

12

14Percent of live births

Low birthweight (<2500 grams)

American Indian

Asian Black

Low and Very Low Birthweight Infants, 2004

Obj. 16-10a & b

Decrease desired

2010 Target: 0.9

2010 Target: 5

Very low birthweight (<1500 grams)

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

Total

0

2

4

6

8

10

1998 1999 2000 2001 2002 2003 2004

Low Birthweight (<2500 grams)

Percent of live births

Very low birthweight (<1500 grams)

2.0 1.5 1.6 1.8 2.2 4.1

10.5 10.2 11.59.1 9.9

13.9

0

5

10

15

20

32-36 weeks

Preterm Births, 2004

Percent of live births

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

Obj. 16-11 a, b, & c

2010 TargetTotal preterm births: 7.6

Total Asian White Hispanic American Indian

Black

<32 weeks Decrease desired

0

2

4

6

8

10

12

1998 1999 2000 2001 2002 2003 2004

32-36 weeks

Percent of live births

<32 weeks

0 20 40 60 80 100

Percent

Increase desired

35Total

2 or more races

American Indian

Hispanic

Black

Asian

White

Native Hawaiian

Poor

Near poor

Middle/high income

2010 Target: 100

Children With Special Health Care Needs Who Have Comprehensive Care

Systems*, 2001

Obj. 16-23*Proportion of children under 18 years of age with special health care needs who receive their care in family-centered, comprehensive, and coordinated systems. Note: American Indian includes Alaska Native. Native Hawaiian includes other Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. SOURCE: National Survey of Children with Special Health Care Needs, CDC, NCHS and HRSA, MCHB

Summary

• Improvements in infant mortality have stalled as preterm births and low birth weight have increased.

• Cesarean deliveries have continued to increase over the past decade, and maternal mortality has not improved.

• Major racial and ethnic disparities persist.

• Breastfeeding rates have improved, but long-term and exclusive breastfeeding rates remain low.

• Improvements in rates of sudden infant death syndrome and neural tube defects have corresponded with public health interventions.

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Peter C. van Dyck, M.D., M.P.H.

HRSA/MCHBhttp://mchb.hrsa.gov/

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