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Maternal and Child Health Community Health Data Sheets Klickitat County Health Department ---PAGE BREAK--- Maternal and Child Health Community Health Data Sheets – 2008 The Mission of Klickitat County Health Department is to work to promote and protect the health of Washington citizens. This is accomplished by: • Improve health through disease and injury prevention, immunization, and newborn screening for prenatal disease programs. • Prevent illness and death caused by behavior choices • Provide education to help people make good health decisions • Control communicable diseases • Strengthen families Community Health Data Sheets The Klickitat County Health Department developed one page data sheets in an effort to share information about different aspects of the health status of Klickitat County. These data sheets will be used to assist our public, researchers, and policy makers to engage in on-going discussions that establish priorities and actions on these issues. Each data sheet contains status information, including data tables and graphs, with the county’s statistical trend on the issue compared with Washington State rates and national targets (if available). Most of the sheets also contain additional topic sections: Why we should care: summarizes the importance of the topic; What we can do: recommends action based on the latest literature and best practices, regarding the topic Maternal and Child Health Data Summary The health of mothers and babies is one of the most sensitive indicators of overall community health. Problems such as infant death, low birth weight, and lack of access to prenatal care are interrelated and are seriously aggravated by poverty and social disruption. The health of very young children and their mothers strongly influences later health and development. If all children get the best possible start, society as a whole benefits through improved learning, adult productivity and reduction of the costs associated with chronic health conditions and dependence on social programs. Many issues relating to childbirth and infant health can be studied to provide insight into the health of mothers and babies. The maternal and child population addressed here includes women of childbearing age (15-44 years) and newborn infants. These following aspects of maternal and child health are examined: Pregnancy, birth, and abortion rates among all ages including adolescents; Births to single women; Births with Medicaid-paid maternity care Entry into prenatal care; Low and very low birth weight births; and Births to smoking mothers. ---PAGE BREAK--- Key Highlights Maternal smoking in Klickitat County remains above the Washington state level. Teen pregnancy rates have declined from 57.4 per 1,000 in 1993, to 23.8 per 1,000 in 2003 and an even lower 16.8% in 2006. In the past twenty years, Klickitat County has not met the national target that “90% of all pregnant women receive early and adequate prenatal care commencing in the first trimester of their pregnancy”. The need for maternal and child health services continues in Klickitat County. Pregnancy, Birth, and Abortion Rates Pregnancy outcomes include live births, fetal deaths, and abortions. Because fetal deaths are irregularly reported and the numbers are very low they are excluded from our rate calculations. Rates are calculated for birth, abortion, and pregnancy (which combine birth and abortion) by dividing the number of events to women of a certain age-group in a given year by the total number of women in that age-group in the same year and multiplying by a constant (1,000). Klickitat County birth rates have remained relatively constant since 1999. There has not been a large increase in the number of births and there was actually a slight decrease in the number of women of child bearing age (15-44 years) in Klickitat County. In 1999 there were 3,517 women of child bearing age, in 2003 that number was 3,431 women, and for 2006 there were 3,409 women of child bearing age. Abortion represents a truly unwanted pregnancy. In Klickitat County, the abortion rate (per 1,000) declined from 11.9 in 1999, to a low of 5.9 in 2004, while increasing somewhat to 10.0 in 2006. It should be noted that the 2006 rate increase was probably a statistical anomaly due to Klickitat County’s low population, but nonetheless is well below the Washington State rate of 18.5 per 1,000 in 2006. Teen Pregnancy Teen pregnancy is a complex issue influenced by many factors including individual, family and community characteristics. Its consequences negatively affect the health, social and economic well being of the teen, child and society. Klickitat County’s teen pregnancy rate declined over the past six years. In 2001, Klickitat County’s rate of 40.4 pregnancies per 1,000 for 15-17 year old females was higher than Washington State’s rate of 32.8. The rate per 1,000 declined significantly for 2006: 16.8 in Klickitat County, while that Washington State rate was 27.5. These rates are all well below the national Healthy People 2010 target of 46 per 1,000. Although teen pregnancy rates have declined in Klickitat County as well as Washington State, US rates remain higher than in other developed countries. No single approach for preventing teen pregnancies is appropriate for all teens in all circumstances. Some approaches, such as youth development programs, show promise in reducing pregnancy rates. Coordinated and sustained interventions from all sectors of society will be needed to ensure the declining trend of teen pregnancy rates continues. ---PAGE BREAK--- Births to Single Mothers The percentage of births to single women in Klickitat County increased from 30.8% in 2001 to 37.6% in 2006, while Washington State’s percentages underwent a more modest increase: 28.6% in 2001 to 31.7% in 2006. Births to single women are a critical indicator of a community’s well being in that single parent families are a major factor associated with children living in poverty. New studies indicate that the absence of the father’s name on the birth certificate is more indicative of health risk for the infant than mother’s single marital status. Prenatal Care Access Prenatal care (PNC) is comprehensive medical care provided for the mother and fetus. First trimester is the first three months of pregnancy. Early and continuous prenatal care is considered the best strategy for improving the long-term health of the mother and preventing adverse birth outcomes of the baby. In 2006, 79.6% of women in Klickitat County obtained first trimester PNC while 78.5% of women statewide obtained first trimester PNC. This fell short of the national target that 90% of all pregnant women have ongoing PNC commencing in the first trimester of their pregnancy. In 2006, 2.9% of women in Klickitat County and 5.1% of women statewide obtained late or no PNC. Low Birth Weight/Very Low Birth Weight Low birth weight (LBW) is a weight of less than 5 pounds, 8 ounces (2,500 grams) at birth. Very low birth weight (VLBW) is a weight of less than 3 pounds, 5 ounces (1,500 grams). Because of the small number of LBW and VLBW deliveries in Klickitat County, rates are rolled into three-year averages. The percent of LBW births in Klickitat County generally increased over the past ten years. From the 1997-1999 period to the 2000-2002 period, Klickitat County’s percent of LBW infants has been lower than that of the state. But during the 2001-2003 period Klickitat County’s percent of LBW was 6.7%, while Washington State’s rate was 5.9% and both exceeded the national target that no more than 5% of all births are LBW. The 2004-2006 average was 7.0% for Klickitat County and 6.3% for Washington State. The extremely low numbers for VLBW meant that even the three year averaging technique resulted in erratic rate changes for Klickitat County over the last ten years. The percent of VLBW births in Klickitat County was at a low of 0.58 for 1997-1999 and then a high of 1.23% for 2002-2004 before dropping again to 0.62 for 2004-2006. Washington State’s rates were quite steady for that ten-year period, varying no more than 0.13% (0.89 to 1.02%). Since the national target rate is 0.9%, the state rates were consistently above the target, and Klickitat County’s rates were generally higher over this entire period. Maternal Smoking Smoking during pregnancy is defined as the mother smoking at any time during her pregnancy. Tobacco smoking during pregnancy is the most important preventable cause of low birth weight. Since 2001, Klickitat County’s percent of women who gave birth and did smoke has remained higher than both the state and national targets. ---PAGE BREAK--- Smoking during pregnancy in Klickitat County was 16.4% in 2001, compared to 12.7% for Washington State. Percentages for 2006 were 27.4% for Klickitat County and 10.3% statewide. Both Klickitat County and Washington State are far from meeting the national target that no more than 2% of pregnant women smoke cigarettes. Smoking is higher among the poorest women who gave birth in Klickitat County. When comparing Klickitat County births paid by Medicaid to non-Medicaid paid births, an average of 17% of women on Medicaid smoked during pregnancy compared to about 4% of non-Medicaid women during the 2003-2006 period. Continued efforts directed towards smoking cessation programs for pregnant women as well as their partners, is crucial if Klickitat County hopes to achieve and maintain the national target. Programs that encourage women to stop smoking before, during, and after pregnancy (and not to take up smoking again) deserve high priority. For Additional Information More detailed information about the Maternal and Child Health indicators discussed here can be found on the following data sheets. Technical notes and data sources are provided for each data sheet. Please send any comments, questions and/or suggestions regarding this information to: Larry Gourley Assessment Coordinator Klickitat County Health Department 228 West Main Goldendale, WA 98620 Email: [EMAIL REDACTED] Phone: (509) 773-4565 ---PAGE BREAK--- Klickitat County Health Department 2008 Pregnancy, Birth, and Abortion Rates Age 15-44 Klickitat County, 2001 through 2006 Status: The pregnancy, birth, and abortion rates* in Klickitat County remain relatively constant. (1,2) At 72.2 births per 1,000 in 2006, Klickitat County’s birth rate is lower than Washington State’s rate of 83.8 births per 1,000.(1,2) There has been a slight decrease in the number of births in Klickitat County from 263 in 2001, to 246 in 2006, but this relatively constant number points to the continued need for prenatal and pediatric services. Not all pregnancies result in live birth. Abortion rates in Klickitat County declined from a high of 11.9 per 1000 pregnancies in 2001, to 6.2 in 2005. And while the rate jumped to 10.0 in 2006 (probably a statistical anomaly due to Klickitat County’s small population) it remained well below the state rate of 18.5 for that year, and as it has historically since at least 1990. (1,2) Klickitat County Rates Washington State Rates Year Pregnancies Births Abortions Pregnancies Births Abortions 2001 74.6 62.7 11.9 80.9 61.0 19.8 2002 72.4 64.6 7.8 80.0 60.6 19.4 2003 77.2 67.3 9.9 80.9 61.8 19.2 2004 71.7 65.8 5.9 81.3 62.6 18.7 2005 67.6 61.4 6.2 81.2 62.9 18.3 2006 72.2 62.2 10.0 83.8 65.3 18.5 *A pregnancy rate is calculated by dividing the number of pregnancies among women aged 15-44 by the total number of women aged 15-44 in a given year and multiplying by 1,000 (constant). Similarly, birth and abortion rates are calculated using numbers of births and abortions. Sources: Abortion Report Records: Washington State Department of Health, Center for Health Statistics. Birth Certificate Data: Washington State Department of Health, Center for Health Statistics. 1990-2007 Population Estimates for Public Health Assessment, Washington State Vista Partnership, and Krupski Consulting. December 2007. Klickitat County *Rate per 1000 females age 15-44 0 10 20 30 40 50 60 70 80 90 Pregnancies Births Abortions 2001 2006 2005 2004 2003 2002 ---PAGE BREAK--- Klickitat County Health Department 2008 Teen Pregnancy, Birth, and Abortion Rates Aged 15-17 Klickitat County, 2001 through 2006 Why we should care: Teen pregnancy has serious consequences for the teen mother, the child, and to society in general. Future prospects for teenagers decline significantly if they have a baby. Teen mothers are less likely to complete school and are closely linked to poverty and single parenthood. Children of teens suffer from higher rates of low birth weight and related health problems as well as poor school performance. Teen pregnancy costs society billions of dollars a year. Each year the federal government alone spends about $7 billion to help families that began with a teenage birth. The U.S. still leads the fully industrialized world in teen pregnancy and birth rates – by a large margin. For these reasons we focus public health efforts on preventing teen pregnancies. Status: Klickitat County teen pregnancy rate has declined from 40.4 per 1,000 in 2001 to 16.8 per 1,000 in 2006 period. This rate is below Washington State’s rate of 27.5 in 2006. 3) The Klickitat County 2006 rate of 16.8 pregnancies per 1,000 adolescent females aged 15-17 is well below the national target of no more than 43 per 1,000 pregnancies. 3, 4) What we can do: • Promote and support sex and HIV education programs for teens, parents and families. • Support increased access to effective teen reproductive health services through clinic or school-based programs. - Encouraging abstinence and improve access to condoms and other contraceptives. • Support teen involvement in service learning, youth development, vocational education and employment programs. Klickitat County *Rate per 1000 females age 15-17 0 5 10 15 20 25 30 35 40 45 Pregnancies Births Abortions 2001 2002 2003 2004 2005 2006 Klickitat County Rates Number of Events Year Pregnancies Births Abortions Pregnancies Births Abortions 2001 40.4 27.7 12.8 19 13 6 2002 15.0 12.8 2.1 7 6 1 2003 25.8 19.4 6.5 12 9 3 2004 23.9 15.2 8.7 11 7 4 2005 19.2 12.8 6.4 9 6 3 2006 16.8 8.4 8.4 8 4 4 *The teen pregnancy rate is calculated by dividing the number of pregnancies among adolescent females aged 15-17 by the total number of adolescent females aged 15-17 and multiplying by 1,000 (constant). Similarly, teen birth and abortion rates are calculated using numbers of teen births and abortions. Sources: Teen Pregnancy So What? February 2004. The National Campaign to Prevent Teen Pregnancy. September 12, 2006. Abortion Report Records: Washington State Department of Health, Center for Health Statistics. Birth Certificate Data: Washington State Department of Health, Center for Health Statistics. 1990-2007 Population Estimates for Public Health Assessment, Washington State Vista Partnership, and Krupski Consulting. December 2007. National Target, U.S. Department of Health and Human Services, Healthy People 2010 Target Objective 9-7: Reduce pregnancies among adolescents aged 15-17 to no more than 43 per 1,000. Kirby, Douglas, Ph.D. “Emerging Answers, Research Findings on Programs to Reduce Teen Pregnancy (Summary).” May 2001. Washington DC: The National Campaign to Prevent Teen Pregnancy. September 12, 2006. . ---PAGE BREAK--- Klickitat County Health Department 2008 Teen Pregnancy Rates Aged 15-17 Klickitat County and Washington State 2001 through 2006 Why we should care: Teen pregnancy has serious consequences for the teen mother, the child, and society in general. Future prospects for teenagers decline significantly if they have a baby. Teen mothers are less likely to complete school and are closely linked to poverty and single parenthood. Children of teens suffer from higher rates of low birth weight and related health problems as well as poor school performance. Teen pregnancy costs society billions of dollars a year. Each year the federal government alone spends about $7 billion to help families that began with a teenage birth. The U.S. still leads the industrialized world in teen pregnancy and birth rates – by a large margin. For these reasons we focus public health efforts on preventing teen pregnancies. Status: Klickitat County teen pregnancy rate has declined from 40.4 per 1,000 in 2001, to 16.8 per 1,000 in 2006 and the county’s rates were below Washington State’s rates in each of those six years including 2006: 16.8 as compared to 27.5 per 1,000. 3) This 2006 county rate is also well below the national target of no more than 43 pregnancies per 1,000 females aged 15-17. 4) What we can do: • Promote and support sex and HIV education programs for teens, parents and families. • Support increased access to effective teen reproductive health services through clinic or school-based programs. • Encouraging abstinence and improve access to condoms or other contraceptives. • Support teen involvement in service learning, youth development, vocational education and employment programs *Rate per 1000 females age 15-17 0 5 10 15 20 25 30 35 40 45 50 2001 2002 2003 2004 2005 2006 Klickitat County Washington State National Target: <43 *The teen pregnancy rate is calculated by dividing the number of pregnancies among adolescent females aged 15-17 by the total number of adolescent females aged 15-17 and multiplying by 1,000 (constant). Source: Teen Pregnancy So What? February 2004. The National Campaign to Prevent Teen Pregnancy. September 12, 2006. Abortion Report Records: Washington State Department of Health, Center for Health Statistics. Birth Certificate Data: Washington State Department of Health, Center for Health Statistics. 1990-2007 Population Estimates for Public Health Assessment, Washington State Vista Partnership, and Krupski Consulting. December 2007. National Target, U.S. Department of Health and Human Services, Healthy People 2010 Target Objective 9-7: Reduce pregnancies among adolescents aged 15-17 to no more than 43 per 1,000. Kirby, Douglas, Ph.D. “Emerging Answers, Research Findings on Programs to Reduce Teen Pregnancy (Summary).” May 2001. Washington DC: The National Campaign to Prevent Teen Pregnancy. September 12, 2006. . Klickitat County Washington State Year Pregnancy Rate # of Pregnancies Pregnancy Rate # of Pregnancies 2001 40.4 19 32.8 4166 2002 15.0 7 30.8 3944 2003 25.8 19 28.7 3693 2004 23.9 11 28.4 3669 2005 19.2 9 27.4 3614 2006 16.8 8 27.5 3716 ---PAGE BREAK--- Klickitat County Health Department 2008 Births to Unmarried Mothers 15-44 Klickitat County, 2001 through 2006 Why we should care: Unmarried mothers generally have lower incomes, lower education levels, and greater dependence on welfare assistance than do married mothers. Children born to unmarried mothers are more likely to grow up in a single-parent household, experience instability in living arrangements, live in poverty, and have socio-emotional problems. As these children reach adolescence, they are more likely to have low educational attainment, engage in sex at younger ages, and have a premarital birth. Status: The percent of births to unmarried mothers aged 15- 44 in Klickitat County has remained relatively consistent from 1993 to 2006 with a high of 40.6% in 2005.(1) The percent of births to unmarried mothers aged 15- 44 in Klickitat County has remained above the percent in Washington state since 1993. What we can do: • Promote and support policies and legislation that reduce the economic insecurity of children living in single-parent families. • Target absence of father’s name on birth certificate as another risk factor to reach at-risk families. • Support efforts that promote shared parenting and financial responsibilities between mothers and fathers. • Support policies and legislation that increase the availability of quality programs for child care, health care, and income security for all children and all parents.(4) Percentage of births to unmarried mothers age 15-44 0 5 10 15 20 25 30 35 40 45 2001 2002 2003 2004 2005 2006 Klickitat County Washington State Percentage of Births to Unmarried Mothers Age 15-44 Klickitat County Washington State Year % Number % Number 2001 30.8 68 28.6 22,676 2002 30.8 69 28.8 22,658 2003 35.8 82 28.7 22,897 2004 37.4 83 30.2 24,470 2005 40.6 84 30.8 25,243 2006 37.6 79 31.7 27,322 Source: Birth Certificate Data: Washington State Department of Health, Center for Health Statistics. 1990-2007 Population Estimates for Public Health Assessment, Washington State Vista Partnership, and Krupski Consulting. December 2007. Child Trends Data Bank. Percentage of Births to Unmarried Women. 2003. September 14, 2006 < http://www.childtrendsdatabank.org/indicators/75UnmarriedBirths.cfm>. McLanahan, S. (1994, June 23). “The consequences of Single Motherhood,” The American Prospect, 5, No. 18. James A. Gaudino Jr., Bill Jenkins, and Roger W. Rochat (1999). “No father’s names: a risk factor for infant mortality in the State of Georgia, USA” Social Science & Medicine, 48, 253-265. ---PAGE BREAK--- Klickitat County Health Department 2008 First Trimester Prenatal Care Utilization Klickitat County, 2001 through 2006 Why we should care: Early and continuous prenatal care is considered the best strategy for improving the long-term health of the mother and preventing adverse health outcomes. Status: • In 2006, 79.6% of pregnant women in Klickitat County (ages 15-44) obtained first trimester prenatal care which is higher than the Washington State rate of 78.5%. 3) • Both Klickitat County and Washington State fell short of the national target that 90% of all pregnant women receive early and adequate prenatal care commencing in the first trimester of their pregnancy. What we can do: • Reduce barriers to receiving early prenatal care such as: removing financial obstacles; support culturally appropriate prenatal care services; support adequate supply and distribution of healthcare providers; and provide information about available resources. • Encourage and support participation in Family Planning Clinics, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs, and Maternity Support Services (MSS). • Continue and enhance public education campaigns and referral Assistance that promote early initiation of prenatal care Percent of 1st trimester prenatal care utilization 72 74 76 78 80 82 84 86 88 90 92 2001 2002 2003 2004 2005 2006 Klickitat County Washington State National Target > 90% Percent of First Trimester Prenatal Care Utilization Klickitat County Washington State Year % Number % Number 2001 80.1 173 83.2 60,624 2002 80.8 173 83.4 59,952 2003 78.8 178 81.1 52,752 2004 78.6 173 79.6 53,224 2005 81.6 168 79.2 54,528 2006 79.6 164 78.5 59,363 Source: MCH Data Report. January 2006. Prenatal Care. Washington State Department of Health. November 7, 2006. [retrieval date] Birth Certificate Data: Washington State Department of Health, Center for Health Statistics. 1990-2007 Population Estimates for Public Health Assessment, Washington State Vista Partnership, and Krupski Consulting. December 2007. National Target: US Dept of Health and Human Services, Healthy People 2010, Objective 16-6: Increase to 90% the proportion of pregnant women receiving early (beginning in the first trimester) and adequate prenatal care. The Health of Washington State. Prenatal Care. [chapter pages 4-5]. Washington State Department of Health. July 23, 2002. ---PAGE BREAK--- Klickitat County Health Department 2008 Late or No Prenatal Care Utilization Klickitat County, 2001 through 2006 Why we should care: Early and continuous prenatal care is considered the best strategy for improving the long-term health of the mother and preventing adverse health outcomes. Women who begin prenatal care late in pregnancy, e.g., after the sixth month are at greater risk for poor pregnancy outcomes. Status: • In Klickitat County 2.9% of women age 15-44 giving birth received late or no prenatal care in 2006. 3) • This percent has dropped from a high of 6% in 2001. • Klickitat County has remained lower than Washington State rate from 2002 to 2006. What we can do: • Reduce barriers to receiving early prenatal care such as: removing financial obstacles; support culturally appropriate prenatal care services; support adequate supply and distribution of providers; and provide information about available resources. • Encourage and support participation in Family Planning Clinics, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs, and Maternity Support Services (MSS). • - Public information and education campaigns and referral assistance have promoted early initiation of prenatal care. Percent of late or no prenatal care utilization 0 1 2 3 4 5 6 7 2001 2002 2003 2004 2005 2006 Klickitat County Washington State Source: MCH Data Report. January 2006. Prenatal Care. Washington State Department of Health. November 7 2006. Birth Certificate Data: Washington State Department of Health, Center for Health Statistics. 1990-2007 Population Estimates for Public Health Assessment, Washington State Vista Partnership, and Krupski Consulting. December 2007 The Health of Washington State. Prenatal Care. [Chapter pages 4-5]. Washington State Department of Health. July 23, 2002. Late or no prenatal care utilization Klickitat County Washington State Year % Number % Number 2001 6.0 13 3.0 2,185 2002 1.9 4 3.1 2,197 2003 2.2 5 4.2 2,708 2004 1.8 4 4.5 3,017 2005 3.9 8 4.7 3,247 2006 2.9 6 5.1 3,834 ---PAGE BREAK--- Klickitat County Health Department 2008 Low Birth Weight Klickitat County and Washington State Three year periods, 1997-1999 through 2004-2006 Why We Should Care: Low birth weight (LBW) is a major contributor to infant mortality and morbidity, and care of LBW infants is costly. Children born LBW are at increased risk for health, development, behavioral, and social problems. Status: • In the 2001-2003 period in Klickitat County, 6.7% of all births were to infants with LBW compared to 5.9% for Washington State. From the 1994-1996 to 2000-2002 period, Klickitat County’s percent of LBW births were lower than the state’s percent. 3) • In the 2001-2006 period, Klickitat County was above the national target that no more than 5% of all births are LBW. (2,3) What we can do: • The high rate of low birth weight would be most effectively addressed through a dedicated, national commitment to assuring adequate support to individuals and families, including ample income and health care. • More obvious ways to lower rates of LBW and preterm birth: o Stop cigarette smoking, drinking alcohol and/or using illicit drugs during pregnancy; o Get early, regular prenatal care; o Eat a balanced diet with enough calories. Percent of Low Birth Rate (LBW) 0 1 2 3 4 5 6 7 8 1997- 1999 1998- 2000 1999- 2001 2000- 2002 2001- 2003 2002- 2004 2003- 2005 2004- 2006 Klickitat County Washington State National Target < 5% Technical Notes: Low Birth Weight (LBW) infants are newborns who weigh less than 2500 grams (5lbs., 8 oz) and include those born too early and those whose intrauterine growth is retarded. Very Low Birth Weight (VLBW) infants weigh less than 1500 grams (3lbs, 5 oz). Source: MCH Data Report. January 2006. Low Birth Weight for Singleton Births. Washington State Department of Health. November 7, 2006. Birth Certificate Data: Washington State Department of Health, Center for Health Statistics. 1990-2007 Population Estimates for Public Health Assessment, Washington State Vista Partnership, and Krupski Consulting. December 2007 March of Dimes. April 2003. Medical References. November 14 2006 < http://www.marchofdimes.com/professionals/681_1153.asp> The Future of Children. Spring 1995. The Role of Social Change in Preventing Low Birth Weight. Princeton University and The Brookings Institution. November 14, 2006. http://www.futureofchildren.org/information2826/information_show.htm?doc_id=79885 Percent of Low Birth Weight (LBW) Births Klickitat County Washington State Years % Number % Number 1997-1999 4.0 27 5.7 13,461 1998-2000 3.3 23 5.7 13,586 1999-2001 3.7 25 5.7 13,630 2000-2002 4.5 30 5.7 13,533 2001-2003 6.7 43 5.9 13,874 2002-2004 6.1 40 6.0 14,331 2003-2005 5.6 37 6.1 14,835 2004-2006 7.0 45 6.3 15,648 ---PAGE BREAK--- Klickitat County Health Department 2008 Very Low Birth Weight Klickitat County and Washington State Three year periods, 1997-1999 through 2004-2006 Why we should care: Very low birth weight (VLBW) infants are at particularly high risk for lifelong physical, cognitive and behavioral disabilities compared to normal birth weight babies. These infants are more likely to face major challenges from mental retardation, cerebral palsy, long-term cognitive problems and impairments in lung function, sight and hearing. Costs and use of medical services endures into childhood and, in many cases, well into adulthood. Status: • The percent of VLBW has increased in both Klickitat County and Washington State. 2) In Klickitat County, 1.7% of all births in the 2001-2003 period were VLBW. In Washington State, 1.0% of all births in the same period were VLBW. (1,2) • Klickitat County and Washington State are above the national target rate of no more than 0.9% of all births are VLBW. What we can do: • Broad strategies, addressing a wide range of risk factors, are essential to reduce the rate of VLBW. • Specific strategies include: Promote and support research on the causes of VLBW; Expand access to health care; Focus intensively on smoking prevention and cessation; and Ensure that pregnant women get adequate nutrition; address social and demographic risk factors. Percent of Very Low Birth Rate (VLBW) 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 1997- 1999 1998- 2000 1999- 2001 2000- 2002 2001- 2003 2002- 2004 2003- 2005 2004- 2006 Klickitat County Washington State National Target: 0.9% Source: Birth Certificate Data: Washington State Department of Health, Center for Health Statistics. 1990-2007 Population Estimates for Public Health Assessment, Washington State Vista Partnership, and Krupski Consulting, December 2007. National Target, Healthy People 2010 Objective 16-10b: no more than 0.9% of births are Very Low Birth Weight (VLBW). The Annie E. Casey Foundation. July 2005. Kids Count Preventing Low Birth Weight. November 14 2006. Percent of Very Low Birth Weight (VLBW) Births Klickitat County Washington State Years % Number % Number 1997-1999 0.58 4 0.89 2,402 1998-2000 0.71 5 1.01 2,411 1999-2001 1.17 8 1.00 2,377 2000-2002 0.90 6 0.99 2,352 2001-2003 1.7 11 1.01 2,391 2002-2004 1.23 8 1.02 2,433 2003-2005 1.21 8 0.99 2,412 2004-2006 0.62 4 0.99 2,471 ---PAGE BREAK--- Klickitat County Health Department 2008 Percent of Births to Women Who Smoke Klickitat County, 2001 through 2006 Why we should care: Smoking during pregnancy is the single most preventable cause of illness and death among mothers and infants. Women who smoke during pregnancy are more likely than nonsmokers to have a miscarriage or ectopic pregnancy. Babies born to smokers are more likely to have low birth weight, SIDS (sudden infant death and lower respiratory infections than babies born to nonsmoking mothers. Status: • The percent of women who gave birth and did smoke is higher in Klickitat County than in Washington State, 12.1% compared to 10.9% for the year 2003. 2) • Both Klickitat County and Washington State are far from meeting the national target that no more than 2% of pregnant women smoke cigarettes. What we can do: • Support and promote effective smoking cessation programs for pregnant women as well as their partners. • All pregnant women need to be screened for smoking at their first prenatal care visit and throughout their pregnancy. • Encourage health care providers to reinforce knowledge that quitting smoking will reduce health risks to the fetus, and review the important postpartum benefits for both mother and child. • Maintain smoke-free environments- homes, businesses, and cars. Percent of Births to Women Who Smoke 0 5 10 15 20 25 30 2001 2002 2003 2004 2005 2006 Klickitat County Washington State National Target: Source: Birth Certificate Data: Washington State Department of Health, Center for Health Statistics. 1990-2007 Population Estimates for Public Health Assessment, Washington State Vista Partnership, and Krupski Consulting. December 2007 National Target, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Healthy People 2010 Objective 16-17c. Center for Disease Control and Prevention, Preventing Smoking During Pregnancy. November 28 2005. National Center for Chronic Disease Prevention and Health Promotion. November 14 2006. Center for Disease Control and Prevention, Health & Economic Impact: Smoking Cessation for Pregnant Women. July 2002. Smoke Free Families. November 14, 2006. Percent of Births to Women Who Smoke Klickitat County Washington State Year % Number % Number 2001 16.4 36 12.7 9,790 2002 13.4 30 12.0 9,185 2003 12.1 28 10.9 8,608 2004 22.8 28 10.2 8,056 2005 26.5 35 10.2 8,158 2006 27.4 29 10.3 8,697 ---PAGE BREAK--- Klickitat County Health Department 2008 Births to Medicaid and Non-Medicaid Women Who Smoke Klickitat County, 2003 through 2006 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 2003 2004 2005 2006 Percent of Births to Medicaid & Non-Medicaid Women Who Smoke Klickitat County Non-Medicaid Klickitat County Medicaid Washington State Non-Medicaid Washington State Medicaid Klickitat County Washington State Year Non-Medicaid Medicaid Non-Medicaid Medicaid 2003 4.2% 18.4% 3.4% 17.9 % 2004 3.9% 16.8% 3.1% 21.1% 2005 4.8% 16.5% 1.4% 25.6% 2006 4.0% 16.7% 3.6% 21.1% Technical Note: Yes to questions “Did mother smoke”. Excludes unknown or blank responses. Sources: County Profiles 2006. Department of Social and Health Services, Research and Data Analysis Division. ---PAGE BREAK--- Klickitat County Health Department 2008 Births with Medicaid-Paid Maternity Care Klickitat County and Washington State 2001 through 2006 Status: There was no clear trend from 2001 through 2006 in the number of births in Klickitat County with Medicaid-paid maternity care. Medicaid births in Washington State remained relatively constant, with a small overall increase over the six years. In each of these years percentages in Klickitat County were higher than statewide. 0 10 20 30 40 50 60 70 2001 2002 2003 2004 2005 2006 Percent of Births with Medicaid-Paid Maternity Care Klickitat County Washington State Source: County Profiles 2004 and 2006. Department of Social and Health Services, Research and Data Analysis Division. Percent of Births with Medicaid-Paid Care Year Klickitat County Washington State 2001 62.1 43.5 2002 57.0 43.3 2003 62.1 45.5 2004 55.8 45.8 2005 64.8 47.9 2006 59.0 47.1 ---PAGE BREAK--- Klickitat County Health Department 2008 Abortion Rates for Females of Different Age Groups – Klickitat County and Washington State (Ages 15-44) 2003 through 2006 Status: There were no clear trends in abortion rates in any of the six Klickitat County age groups in this four year period though county rates have generally drifted lower from 2003 to 2006 for all women of childbearing age (15-44). Washington State’s abortion rates for all women (ages 15-44) also saw a slight decrease in this period. Abortion rates have been significantly lower overall in Klickitat County than rates statewide. Among women of childbearing age (15-44) Klickitat County’s rates have been lower for every year since at least 1990, though because of Klickitat County’s small population there have been statistical anomalies where the rate within a certain age group has been higher than Washington State for certain years. The average rate (ages 15-44) from 1993 to 2006 was 9.8 per 1,000 women in Klickitat County, or less than half the average rate of 20.1 per 1,000 women statewide in those years. Abortions for Females of Different Age Groups in Klickitat County – Rate (number of abortions per 1,000 females) and Count (number of events) 15-19 20-24 25-29 30-34 35-39 40-44 Abortions in Washington State – Ages: 15-44 Year Rate Count Rate Count Rate Count Rate Count Rate Count Rate Count Rate Count 2003 12.1 8 33.8 14 17.9 8 6.0 3 1.6 1 0.0 0 19.2 24,903 2004 9.1 6 11.9 5 11.1 5 2.1 1 5.0 3 0.0 0 18.7 24,342 2005 9.0 6 11.7 5 8.7 4 6.4 3 3.3 2 1.3 1 18.3 23,966 2006 11.8 8 27.5 12 12.5 6 6.5 3 8.2 5 0.0 0 18.5 24,585 0 5 10 15 20 25 30 35 15-19 20-24 25-29 30-34 35-39 40-44 Washington State Age Groups Abortion Rates per 1,000 Females of Different Age Groups in Klickitat County 2003 2004 2005 2006 Sources: Abortion Report Records: Washington State Department of Health, Center for Health Statistics. 1990-2007 Population Estimates for Public Health Assessment, Washington State Vista Partnership, and Krupski Consulting. December 2007 ---PAGE BREAK--- Klickitat County Health Department 2008 Pregnancy Rates for Females of Different Age Groups – Klickitat County and Washington State (Ages 15-44) 2003 through 2006 Status: Pregnancy rates for Klickitat County teens (15-19) trended lower over this four year period, as was also the case for the 25-29 age group. There were no clear tendencies in the other age brackets and also no real trend for all county women of childbearing age (15-44). Washington State pregnancies in this period rose modestly, and the average statewide rate for these four years was nearly 10 points higher than Klickitat County (81.8 versus 72.2 per 1,000 women). Pregnancies for Females of Different Ages in Klickitat County – Rate (number of pregnancies minus fetal deaths, per 1,000 females) and Count (number of events) 15-19 20-24 25-29 30-34 35-39 40-44 Pregnancies in Washington State – Ages: 15-44 Year Rate Count Rate Count Rate Count Rate Count Rate Count Rate Count Rate Count 2003 66.3 44 207.5 86 159.0 71 72.0 36 32.2 20 10.2 8 80.9 105,093 2004 53.0 35 188.2 79 129.3 58 90.8 44 38.1 23 5.2 4 81.2 105,766 2005 52.4 35 161.9 69 128.5 59 70.2 33 31.5 19 18.4 14 81.2 106,333 2006 41.4 28 167.3 73 127.2 61 113.0 52 39.2 24 10.7 8 83.8 111,145 0 50 100 150 200 250 15-19 20-24 25-29 30-34 35-39 40-44 Washington State (Ages 15-44) Age Groups Pregnancy Rates for Females of Different Age Groups in Klickitat County 2003 2004 2005 2006 Sources: Birth Certificate Data and Abortion Report Records: Washington State Department of Health, Center for Health Statistics. 1990-2007 Population Estimates for Public Health Assessment, Washington State Vista Partnership, and Krupski Consulting. December 2007 ---PAGE BREAK--- Klickitat County Health Department 2008 Estimated Unintended Pregnancies Klickitat County and Washington State 1995 through 2006 Status: The percentage of estimated unintended pregnancies for both Klickitat County and Washington State remained remarkably steady from 1995 through 2003. Then in the 2004 through 2006 period both the county and statewide numbers dropped several percentage points. In each of the four periods Klickitat County estimates were lower than state estimates by an average of 20 25 30 35 40 45 50 55 1995-1997 1998-2000 2001-2003 2004-2006 Estimated Unintended Pregnancies Klickitat County Washington State Source: County Profiles 2006. Department of Social and Health Services, Research and Data Analysis Division. Estimated Pregnancies that were Unintended Year Klickitat County Washington State 1995-1997 52.4 54.3 1998-2000 53.0 53.9 2001-2003 52.9 54.4 2004-2006 47.3 50.8