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The systematic assessment of the health status of children enables health professionals to determine the impact of past and current health intervention and prevention programs. Program planners and policy-makers identify trends by examining and comparing information from one data collection year to the next. Although indicators are often assessed on an annual basis, some surveillance systems may only collect data every two, three, or five years.
In the following section, mortality, disease, injury, and health behavior indicators are presented by age group. The health status indicators in this section are based on vital statistics and national surveys. Population-based samples are designed to yield data that are representative of the maternal and child population that are affected by, or in need of, specific health services.
Throughout the 1970’s and early 1980’s, the percentage of mothers who began breastfeeding in the hospital increased steadily to 61.9 percent, but then gradually declined to 51.5 percent by 1990. In 2001, breastfeeding rates in the hospital reached 69.5 percent, the highest rate recorded since national breastfeeding data have been collected.
Since 1991, the breastfeeding initiation rates have steadily increased across all racial and ethnic groups. In the past decade, rates of breastfeeding immediately after delivery grew the most among groups of mothers that have traditionally been the least likely to breastfeed, such as Black and Hispanic women. These increases have contributed to a substantial reduction in the gap in breastfeeding rates between White and non-White women. In fact, 2001 is the first year that the highest in-hospital breastfeeding rates were among Hispanic women (73.0 percent), compared to White (72.2 percent) and Black women (52.9 percent). Women were also more likely to initiate breastfeeding with their first child, but women with more than one child were more likely to continue breastfeeding at 6 and 12 months postpartum.
Breastfeeding rates for all women decrease substantially between delivery and 6 months postpartum, the breastfeeding period recommended as most critical for the infant’s health by the Surgeon General of the United States. The percentage of women who report that they are still breastfeeding at 6 months postpartum reached a high of 32.5 percent in 2001. At 6 months postpartum, 34.2 percent, 32.8 percent, and 21.9 percent of White, Hispanic, and Black women, respectively, were still breastfeeding.
Average breastfeeding rates were highest among women who are over 30 years of age, college educated, and not participating in the Women, Infants, and Children (WIC) dietary supplement program. Overall breastfeeding rates were lowest among women under 20 years of age, Black, low-income, those with less than a high school education, and women living in the southeastern United States.
Low Birth Weight
In 2001, 308,747 babies (7.7 percent of all live births) were of low birth weight, weighing less than 2,500 grams, or 5 pounds 8 ounces, at birth. This rate represented a slight increase from the previous year, despite improvements in the use of prenatal care.
The percentage of newborns born at low birth weight has risen steadily from a low of 6.8 percent in 1985 and is currently at the highest level recorded in the past three decades. Mothers younger than 15 years and older than 45 are at the highest risk of delivering a low birth weight infant. Much of the incidence of low birth weight among older mothers (older than 45) is due to an increase in the proportion of multiple births, as the use of assisted reproductive technologies increases. Twins and other multiples are approximately ten times as likely to be born at a low birth weight as singleton newborns (that is, not twins or multiples).
Although the Black low birth weight has declined from a high of 13.6 percent in 1991, it remains considerably higher than the rate for White (6.7 percent) and Hispanic (6.5 percent) births. The rate among infants of White mothers has increased more than 20 percent in the past decade, largely due to the higher prevalence of multiple births among White women.
In 2001, the percentage of low birth weight infants born to smokers (11.9 percent) was substantially higher than among nonsmokers (7.3 percent). This significant differential has been consistantly observed among both Black and White infants. Other factors associated with increased risk of low birth weight include maternal poverty and low levels of educational attainment.
Low birth weight is one of the leading causes of neonatal mortality. Low birth weight infants are more likely to experience long-term disability or to die during the first year of life than are infants of normal weight.
Very Low Birth Weight
In 2001, the rate of very low birth weight newborns remained at 1.4 percent of live births to U.S. women, and has been relatively stable since 1997.
Because chance for survival increases as birth weight increases, infants born at a very low birth weight (less than 1500 grams, or 3 pounds 4 ounces) have the lowest survival rates. Approximately 24 percent of all infants weighing less than 1500 grams die by age one, compared to 2 percent of infants born at 1,500-2,499 grams and 0.3 percent of infants born at 2,500 grams or more. Very low birth weight infants who survive are at a significantly increased risk of severe problems, including physical and visual difficulties, developmental delays and cognitive impairment requiring increased levels of medical, educational and parental care.
The overall rate of very low birth weight among Black babies is two and a half times higher than that among Whites and is more than twice the rate for the total birth population. This is a major contributor to the difference in infant mortality rates between Black and White infants.
Comparison of National Infant Mortality Rates
Differences in the infant mortality rates among industrialized nations reflect differences in the health status of women before and during pregnancy as well as the quality and accessibility of primary care for pregnant women and their infants. Although the United States has greatly reduced its infant mortality rate since 1965, the nation ranked 26th among industrialized nations in 1999.
This graph comparing "national infant mortality rates" includes countries, territories, cities, or geographic areas with a population of at least 1 million that have complete counts of live births and infant deaths as indicated in the United Nations Demographic Yearbook. In 1999, four of these jurisdictions had infant mortality rates less than half that of the United States.
In 2001, 27,801 infants died before their first birthday. The preliminary infant mortality rate was 6.9 deaths per 1,000 live births, representing no change from the previous year.
The rapid decline in infant mortality, which began in the mid 1960s, slowed for both Blacks and Whites during the 1980s. Major advances, including the approval of synthetic surfactants and the recommendation that infants be placed on their backs when sleeping, may have caused a renewed decline during the 1990s. In 2001, the leading causes of infant mortality were congenital malformations, deformations and chromosomal abnormalities, which accounted for 20.2 percent of infant deaths.
Based on preliminary data, mortality among Black infants increased slightly to 14.2 deaths per 1,000 live births in 2001, although this difference was not statistically significant. The preliminary rate of 5.7 for White infants was not different from the reported 2000 rate. The infant mortality rate for Black infants continues to be 2.5 times that of White infants. Although infant mortality rates among Blacks and Whites have been on a continual decline throughout the 20th century, the proportional discrepancy between the Black and White rates remains largely unchanged.
Neonatal and Postneonatal Mortality
In 2001, 18,491 infants younger than 28 days died, resulting in a preliminary neonatal mortality rate of 4.6 deaths per 1,000 live births. This neonatal mortality rate represents no change from the rate recorded in 2000.
In 2001, 9,310 infants between 28 days and 1 year of age died; the preliminary postneonatal mortality rate was 2.3 deaths per 1,000 live births. The 2001 rate is not different from the 2000 rate.
During the past several decades, there has been a dramatic decrease in maternal mortality in the United States. Since 1980, however, the rate of decline has slowed.
In 2000, there were 396 maternal deaths which resulted from complications during pregnancy, childbirth, or the postpartum period up to 42 days. The maternal mortality rate of 9.8 per 100,000 live births was not significantly different from prior years and has remained fairly stable since 1982.
The maternal mortality rate for Black women (22.0 per 100,000 live births) is almost three times the rate for White women (7.5 per 100,000 live births).
According to the National Center for Health Statistics, regardless of race, the risk of maternal death increases for women over age 30. Women ages 35-39 have approximately twice the risk of maternal death of women ages 20-24 years.
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