Health - Pregnancy And Birth

Prenatal Care

The importance of early prenatal care cannot be overemphasized, as doctors are now better able to detect, and often correct, potential problems early in pregnancy. While every pregnant woman should receive prenatal care, the National Center for Health Statistics (NCHS) believes the United States is capable of guaranteeing that more than 90% of pregnant women receive prenatal care during the first trimester of pregnancy.

FIGURE 6.3 Percent of measures for which Hispanics experience poorer quality of care or have worse access to care compared with non-Hispanic whites, 2000 and 2001 "Figure H.2. Percent of Measures for Which Hispanics Experience Poorer Quality of Care (Left) or Have Worse Access to Care (Right) Compared with Non-Hispanic Whites in 2000 and 2001," in 2004 National Healthcare Disparities Report, U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, December 2004, http://qualitytools.ahrq.gov/disparitiesreport/documents/nhdr2004.pdf (accessed January 25, 2006)

In 2003, 84.1% of all women in the United States received prenatal care during their first trimester of pregnancy, but that percentage was significantly lower among some minority groups. Almost nine out of ten non-Hispanic white women (89%) and Asian and Pacific Islander women (85.4%) received prenatal care during their first trimester. However, only 77.5% of Hispanic women, 75.9% of African-American women, and 70.8% of Native American women did so. It is worthy of note, however, that despite the low rates of first-trimester prenatal care among Hispanic women in general, Cuban women had the highest rate of prenatal care of all racial/ethnic groups, at 92.1%. (See Table 6.5.)

Births and Fertility

Of the 4.1 million births in 2004, 2.3 million were to non-Hispanic white mothers, 944,993 to Hispanic mothers, 576,105 to African-American mothers, 229,352 to Asian and Pacific Islander mothers, and 43,931 to Native American mothers. However, the birth rate (live births per one thousand population in a specified group) was highest among Hispanics (22.9), followed by Asians and Pacific Islanders (16.8), African-Americans (15.1), and Native Americans (14); it was lowest for non-Hispanic whites, at 11.7. (See Table 6.6.)

The fertility rate refers to the number of live births per one thousand women ages fifteen to forty-four in a specified group. In 2004 Hispanic women had the highest fertility rate (97.7), followed by Asian and Pacific Islander women (67.2), African-American women (66.7), Native American women (58.9), and last by non-Hispanic white women (58.5). (See Table 6.6.) Although Hispanic women had the highest fertility rate, it varied among Hispanics from different countries of origin. According to Joyce A. Martin et al. in "Births: Final Data for 2003" (National Vital Statistics Reports, September 8, 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf), in 2003 women of Mexican origin had the highest fertility rate (105.5), while Puerto Rican and Cuban women had the lowest (61.6 and 61.7, respectively).

Low Birth Weight and Infant Mortality

In "Explaining the 2001–02 Infant Mortality Increase: Data from the Linked Birth/Infant Death Data Set" (National Vital Statistics Reports, January 24, 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_12.pdf), Marian F. MacDorman et al. explain that moderately low birth weight is defined as being equal to 1,500 to 2,499 grams (3.3 to 5.5 pounds). Very low birth weight is less than 1,500 grams. Low-birth-weight babies, as well as premature babies (born before thirty-seven weeks of gestation), often suffer serious health problems and encounter developmental problems later in life. In 2002 the infant mortality rate for low-birth-weight infants was twenty-five times that for infants born weighting 2,500 grams or more.

The percentage of babies born with low birth weights increased between 1990 and 2003. According to the Centers for Disease Control and Prevention (CDC), in 1990, 7% of babies born weighed less than 2,500 grams compared with 7.9% of babies born in 2003. In 2003 African-Americans were almost twice as likely as non-Hispanic whites to have low-birth-weight babies. In that year, 13.4% of African-American babies were born with low birth weights, while 7.8% of Asian and Pacific Islander babies, 7.4% of Native American or Alaska Native babies, 7% of non-Hispanic white babies, and 6.7% of Hispanic babies were born with low birth weights. (See Table 6.7.)

The infant mortality rate (rate of deaths before one year of age) increased in 2002 for the first time in more than forty years, from 6.8 infant deaths per one thousand live births in 2001 to seven infant deaths per one thousand live births in 2002. This increase was due primarily TABLE 6.1 Health insurance coverage of people by race and Hispanic origin using 2- and 3-year averages, 2002–04 Carmen DeNavas-Walt, Bernadette D. Proctor, and Cheryl Hill Lee, "Table 8. Health Insurance Coverage of People by Race and Hispanic Origin Using 2- and 3-Year Averages: 2002 to 2004," in Income, Poverty, and Health Insurance Coverage in the United States: 2004, Current Population Reports P60-229, U.S. Census Bureau, August 2005, http://www.census.gov/prod/2005pubs/p60-229.pdf (accessed January 23, 2006)to an increase in the number of births of very low-birth-weight babies. In 2002 non-Hispanic African-Americans suffered the highest rate of infant mortality, with 13.9 deaths per one thousand live births. That rate was more than double the rate of 5.8 deaths per one thousand live births for non-Hispanic whites. Native Americans and Alaska Natives also had a relatively high rate of infant deaths, at 8.6 per one thousand live births. Hispanic women (5.6 deaths per one thousand live births) and Asian and Pacific Islander women (4.8 deaths per one thousand live births) had the lowest infant mortality rates of any racial or ethnic group. (See Table 6.8.)

According to the "Pew Hispanic Center Fact Sheet" (June 2002, http://pewhispanic.org/files/factsheets/1.pdf), the Pew Hispanic Center finds that the connection between low income and educational attainment and high infant mortality seems to be more complicated than previously thought. Hispanics, who suffer higher poverty rates and lower educational attainment than do non-Hispanic whites, have a consistently lower infant mortality rate. Researchers speculate that greater social support, less high-risk behavior, and dietary factors may explain the differences. However, as Hispanic immigrants begin to adopt the lifestyle of the American mainstream, the health of that population will decline and the infant mortality rates will rise.

Other research shows that even professional, middle-class, educated African-American women have a higher risk of having low-birth-weight babies. According to Ziba Kashef in "Persistent Peril: Why African American Babies Have the Highest Infant Mortality Rate in the Developed World" (RaceWire, February 2003, http://www.arc.org/racewire/030210z_kashef.html), "researchers have found that even when they control for such varied factors as poverty, housing, employment, medical risk, abuse, social support and so on, 90 percent of the differences in birth weight between black and white moms remains unaccounted for." As a result, some experts have begun to look at factors such as the health of the mother's mother as well as chronic emotional stress resulting from living in a racist society to explain the poorer birth outcomes of African-American mothers.

TABLE 6.2 Medicaid coverage among persons under 65 years of age, by race/ethnicity and age and percent of poverty level, selected years, 1984–2003 Adapted from "Table 133. Medicaid Coverage among Persons under 65 Years of Age, according to Selected Characteristics: United States, Selected Years 1984–2003," in Health, United States, 2005, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed January 25, 2006)