Download - 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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