1. Maternal and Child Health Bureau LEND Presentation April, 2008 Health Resources And Services Administration Maternal And Child Health Bureau Peter C. Van Dyck, MD, MPH This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation In Slide Show, click on the right mouse button Select “Meeting Minder” Select the “Action Items” tab Type in action items as they come up Click OK to dismiss this box This will automatically create an Action Item slide at the end of your presentation with your points entered.

2. APRIL 2008 2 MCHB

3. APRIL 2008 3 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)

4. APRIL 2008 4 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)

5. APRIL 2008 5 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)

6. APRIL 2008 6 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

7. APRIL 2008 7 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 FY20072008(PB) 1-numbers may not add due to rounding 2008(H)2008(S)2008(APPR)

8. APRIL 2008 8 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 FY20072008(PB) 1-numbers may not add due to rounding 2008(H)2008(S)2008(A)

9. APRIL 2008 9 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)

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

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

12. 16-13 Infants put to sleep on their backs 16-14c Autism spectrum disorder Target met or exceeded Improving 16-1c Infant mortality 16-1h Sudden infant death syndrome (SIDS) 16-6a Prenatal care 16-15 Neural tube defects (NTDs) 16-16a Folic acid consumption 16-19 Breastfeeding Highlighted Objectives Getting worse 16-4 Maternal mortality 16-9 Cesarean births 16-10a Low birthweight 16-11a Preterm births No trend data 16-23 Service systems for special health care needs

13. 19961997 1998 199920002001 SIDS deaths Infants put to sleep on their backs Per 100,000 live births Percent SOURCE: National Vital Statistics System (NVSS), NCHS, CDC and National Infant Sleep Position Study, NICHD, NIH. Obj. 16-1h & 16-13 SIDS deaths 2010 Target: 23 Sleep position 2010 Target: 70 2003 20022004 60 20 80 0 40 60 20 80 0 40 Sudden Infant Death Syndrome and Sleep Position

14. 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 62 Total White Black Hispanic Female Male 2010 Target: 66 0 Median age (months) n=91 n=71 n=10 n=27 n=153 n=180

15. 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 Hispanic Asian 14 12 10 8 6 4 2 0 16 White Note: Includes all deaths <1 year. American Indian includes Alaska Native. Asian includes Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. For 1940-79, infant deaths are classified by their race as reported on the death certificate. For 1980-2004, infant deaths are classified by race of mother. SOURCE: National Vital Statistics System (NVSS), NCHS, CDC.

16. 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 Hispanic Asian 14 12 10 8 6 4 2 0 16 White 19402004 Black White 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.

17. 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%)

18. Obj. 16-6a 0 40 50 60 70 80 90 100 Percent Total American Indian Black Hispanic Asian White < 15 years 15-19 years 20-24 years 25-29 years 30-34 years 35+ years Less than high school High school At least some college = 95% confidence interval. Note: American Indian includes Alaska Native. Asian includes Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Excludes estimates for ID, FL, KY, NH, NY (not inc. NYC), PA, SC, TN, and WA. Data by education level are for mothers aged 20 years and over. Data for 2003 exclude PA and WA. SOURCE: National Vital Statistics System (NVSS), CDC, NCHS. Increase desired Prenatal Care Beginning in First Trimester, 2004 2010 Target: 90 84

19. Obj. 16-6a 0 40 50 60 70 80 90 100 Percent Total American Indian Black Hispanic Asian White < 15 years 15-19 years 20-24 years 25-29 years 30-34 years 35+ years Less than high school High school At least some college = 95% confidence interval. Note: American Indian includes Alaska Native. Asian includes Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Excludes estimates for ID, FL, KY, NH, NY (not inc. NYC), PA, SC, TN, and WA. Data by education level are for mothers aged 20 years and over. Data for 2003 exclude PA and WA. SOURCE: National Vital Statistics System (NVSS), CDC, NCHS. Increase desired Prenatal Care Beginning in First Trimester, 2004 2010 Target: 90 84 Percent of live births 19902003

20. Spina Bifida and Other NTDs § Per 10,000 live births 2010 Target: 3 Decrease desired 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.

21. 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.

22. 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 11 Total Black American Indian Hispanic White Native Hawaiian Asian Less than high school High school Some college College graduate 2010 Target: 17

23. 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.

24. 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*

25. 1998 1999 2000 2001 2002 2003 2004 100 90 80 70 60 0 Percent * Among women with a prior cesarean birth, a low-risk pregnancy is defined as one with a full-term (at least 37 weeks gestation) singleton (not a multiple pregnancy), with vertex presentation (head facing in a downward position in the birth canal). SOURCE: National Vital Statistics System (NVSS), NCHS, CDC. Repeat Cesarean Births Among Low-Risk Pregnancies* 2010 Target: 63 Decrease desired Obj. 16-9b

26. White Hispanic Percent of live births Low birthweight (<2500 grams) American Indian AsianBlack 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 Low Birthweight (<2500 grams) Percent of live births Very low birthweight (<1500 grams)

27. 32-36 weeks Preterm Births, 2004 Percent of live births Note: American Indian includes Alaska Native. Asian includes Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. SOURCE: National Vital Statistics System (NVSS), NCHS, CDC. Obj. 16-11 a, b, & c 2010 Target Total preterm births: 7.6 TotalAsianWhiteHispanicAmerican Indian Black <32 weeks Decrease desired 32-36 weeks Percent of live births <32 weeks

28. 0 20 40 60 80 100 Percent Increase desired 35 Total 2 or more races American Indian Hispanic Black Asian White Native Hawaiian Poor Near poor Middle/high income 2010 Target: 100 Children With Special Health Care Needs Who Have Comprehensive Care Systems*, 2001 Obj. 16-23 *Proportion of children under 18 years of age with special health care needs who receive their care in family-centered, comprehensive, and coordinated systems. Note: American Indian includes Alaska Native. Native Hawaiian includes other Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. SOURCE: National Survey of Children with Special Health Care Needs, CDC, NCHS and HRSA, MCHB

29. 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.

30. APRIL 2008 30

31. APRIL 2008 31 Peter C. van Dyck, M.D., M.P.H. HRSA/MCHB http://mchb.hrsa.gov/ Contact