Defining Health and Wellness - Birthrates And Fertility Rates

The birthrate is the number of live births per one thousand women. The fertility rate, however, is the number of live births per one thousand women between fifteen and forty-four years of age, generally considered a woman's prime childbearing years.

In Health, United States, 2005 (2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf), the National Center for Health Statistics (NCHS) reported that there were more than four million live births (4,089,950) in the United States in 2003, which basically did not change from 2002. This number translated to a birthrate of 14.1 births per one thousand women—among the lowest rates recorded for the United States and comparable to the U.S. birthrate in 1999. (See Table 1.1.) Between the most recent high point, 16.7 in 1990, and the most recent low point, 13.9 in 2002, the crude birthrate declined 16.8%. Although the NCHS reports that the number of live births has increased steadily since 1970, the birthrate and fertility rate have remained relatively stable since 1999.

Birthrates have continued to decline for teenagers ages fifteen to nineteen. In 2003 the number of live births per one thousand teens ages fifteen to seventeen was 22.4, down from the last most recent peak of 37.5 in 1990, a decrease of 40.3%. The number of live births per one thousand young women ages eighteen to nineteen in 2003 was 70.7, down from 88.6 in 1990, a decrease of 20.2%. (See Table 1.1.)

In contrast, the birthrates for women ages twenty-five to forty-four increased in 2003. The birthrates for women ages thirty-five to thirty-nine, which has been increasing dramatically since 1980, increased by another 5.8% in 2003—43.8 births per one thousand women (up from 41.4 births per one thousand women in 2002). (See Table 1.1.) The birthrate for this age group increased by more than 38% between 1990 and 2003, with an average increase of about 3% per year.

Women ages twenty to twenty-nine continued to have the highest birthrates, although the proportion of births to these women has declined in recent years.

Fertility rates focus on live births to mothers in the primary childbearing age group, fifteen to forty-four. In 2003 the fertility rate for American women was 66.1 births per one thousand women, which is a slight increase from 2002 (64.8) but a decline of 6.8% from 1990 (70.9). Total fertility rates, which offer an index of lifetime fertility among women, not only varied by age but also TABLE 1.1 Crude birth rates, fertility rates, and birth rates by age of mother, according to race and Hispanic origin, selected years 1950–2003by race and ethnic origin. In 2003 the fertility rate for Hispanic women (96.9 births per one thousand Hispanic women ages fifteen to forty-four) was two-thirds (65.6%) higher than for non-Hispanic white women (58.5 births per one thousand). (See Table 1.1.)

TABLE 1.1
Crude birth rates, fertility rates, and birth rates by age of mother, according to race and Hispanic origin, selected years 1950–2003
[Data are based on birth certificates]
Race, Hispanic origin, and year	Crude birth ratea	Fertility rateb	Age of mother
			15-19 years				20-24 years	25-29 years	30-34 years	35-39 years	40-44 years	45-54 yearsc
			10-14 years	Total	15-17 years	18-19 years
All races	Live births per 1,000 women
1950	24.1	106.2	1.0	81.6	40.7	132.7	196.6	166.1	103.7	52.9	15.1	1.2
1960	23.7	118.0	0.8	89.1	43.9	166.7	258.1	197.4	112.7	56.2	15.5	0.9
1970	18.4	87.9	1.2	68.3	38.8	114.7	167.8	145.1	73.3	31.7	8.1	0.5
1980	15.9	68.4	1.1	53.0	32.5	82.1	115.1	112.9	61.9	19.8	3.9	0.2
1985	15.8	66.3	1.2	51.0	31.0	79.6	108.3	111.0	69.1	24.0	4.0	0.2
1990	16.7	70.9	1.4	59.9	37.5	88.6	116.5	120.2	80.8	31.7	5.5	0.2
1995	14.6	64.6	1.3	56.0	35.5	87.7	107.5	108.8	81.1	34.0	6.6	0.3
1999	14.2	64.4	0.9	48.8	28.2	79.0	107.9	111.2	87.1	37.8	7.4	0.4
2000	14.4	65.9	0.9	47.7	26.9	78.1	109.7	113.5	91.2	39.7	8.0	0.5
2001	14.1	65.3	0.8	45.3	24.7	76.1	106.2	113.4	91.9	40.6	8.1	0.5
2002	13.9	64.8	0.7	43.0	23.2	72.8	103.6	113.6	91.5	41.4	8.3	0.5
2003	14.1	66.1	0.6	41.6	22.4	70.7	102.6	115.6	95.1	43.8	8.7	0.5
Race of child: whited
1950	23.0	102.3	0.4	70.0	31.3	120.5	190.4	165.1	102.6	51.4	14.5	1.0
1960	22.7	113.2	0.4	79.4	35.5	154.6	252.8	194.9	109.6	54.0	14.7	0.8
1970	17.4	84.1	0.5	57.4	29.2	101.5	163.4	145.9	71.9	30.0	7.5	0.4
1980	14.9	64.7	0.6	44.7	25.2	72.1	109.5	112.4	60.4	18.5	3.4	0.2
Race of mother: whitee
1980	15.1	65.6	0.6	45.4	25.5	73.2	111.1	113.8	61.2	18.8	3.5	0.2
1985	15.0	64.1	0.6	43.3	24.4	70.4	104.1	112.3	69.9	23.3	3.7	0.2
1990	15.8	68.3	0.7	50.8	29.5	78.0	109.8	120.7	81.7	31.5	5.2	0.2
1995	14.1	63.6	0.8	49.5	29.6	80.2	104.7	111.7	83.3	34.2	6.4	0.3
1999	13.7	64.0	0.6	44.0	24.4	73.0	105.0	114.9	90.7	38.5	7.4	0.4
2000	13.9	65.3	0.6	43.2	23.3	72.3	106.6	116.7	94.6	40.2	7.9	0.4
2001	13.7	65.0	0.5	41.2	21.4	70.8	103.7	117.0	95.8	41.3	8.0	0.5
2002	13.5	64.8	0.5	39.4	20.5	68.0	101.6	117.4	95.5	42.4	8.2	0.5
2003	13.6	66.1	0.5	38.3	19.8	66.2	100.6	119.5	99.3	44.8	8.7	0.5
Race of child: black or African Americand
1960	31.9	153.5	4.3	156.1	—	—	295.4	218.6	137.1	73.9	21.9	1.1
1970	25.3	115.4	5.2	140.7	101.4	204.9	202.7	136.3	79.6	41.9	12.5	1.0
1980	22.1	88.1	4.3	100.0	73.6	138.8	146.3	109.1	62.9	24.5	5.8	0.3
Race of mother: black or African Americane
1980	21.3	84.9	4.3	97.8	72.5	135.1	140.0	103.9	59.9	23.5	5.6	0.3
1985	20.4	78.8	4.5	95.4	69.3	132.4	135.0	100.2	57.9	23.9	4.6	0.3
1990	22.4	86.8	4.9	112.8	82.3	152.9	160.2	115.5	68.7	28.1	5.5	0.3
1995	17.8	71.0	4.1	94.4	68.5	135.0	133.7	95.6	63.0	28.4	6.0	0.3
1999	16.8	68.5	2.5	79.1	50.5	120.6	137.9	97.3	62.7	30.2	6.5	0.3
2000	17.0	70.0	2.3	77.4	49.0	118.8	141.3	100.3	65.4	31.5	7.2	0.4
2001	16.3	67.6	2.0	71.8	43.9	114.0	133.2	99.2	64.8	31.6	7.2	0.4
2002	15.7	65.8	1.8	66.6	40.0	107.6	127.1	99.0	64.4	31.5	7.4	0.4
2003	15.7	66.3	1.6	63.8	38.2	103.7	126.1	100.4	66.5	33.2	7.7	0.5
American Indian or Alaska Native motherse
1980	20.7	82.7	1.9	82.2	51.5	129.5	143.7	106.6	61.8	28.1	8.2	*
1985	19.8	78.6	1.7	79.2	47.7	124.1	139.1	109.6	62.6	27.4	6.0	*
1990	18.9	76.2	1.6	81.1	48.5	129.3	148.7	110.3	61.5	27.5	5.9	*
1995	15.3	63.0	1.6	72.9	44.6	122.2	123.1	91.6	56.5	24.3	5.5	*
1999	14.2	59.0	1.4	59.9	36.5	98.0	120.7	90.6	53.8	24.3	5.7	0.3
2000	14.0	58.7	1.1	58.3	34.1	97.1	117.2	91.8	55.5	24.6	5.7	0.3
2001	13.7	58.1	1.0	56.3	31.4	94.8	115.0	90.4	55.9	24.7	5.7	0.3
2002	13.8	58.0	0.9	53.8	30.7	89.2	112.6	91.8	56.4	25.4	5.8	0.3
2003	13.8	58.4	1.0	53.1	30.6	87.3	110.0	93.5	57.4	25.4	5.5	0.4

Factors other than age, race, and ethnicity can have dramatic effects on fertility and birthrates. For example, although women who are currently married and living with their husbands have much higher fertility rates than those women who have never married or are separated, TABLE 1.1 Crude birth rates, fertility rates, and birth rates by age of mother, according to race and Hispanic origin, selected years 1950–2003 [CONTINUED] "Table 3. Crude Birth Rates, Fertility Rates, and Birth Rates by Age of Mother, according to Race and Hispanic Origin: United States, Selected Years 1950–2003" in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed December 8, 2005)widowed, or divorced, the NCHS in Health, United States, 2005 reports that in 2003 the birthrate for unmarried women has been increasing steadily over the years, to nearly forty-five births per one thousand unmarried women ages fourteen to forty-four. This increase has occurred in spite of the decrease in the birthrate among

TABLE 1.1
Crude birth rates, fertility rates, and birth rates by age of mother, according to race and Hispanic origin, selected years 1950–2003 [CONTINUED]
[Data are based on birth certificates]
Race, Hispanic origin, and year	Crude birth ratea	Fertility rateb	Age of mother
			15-19 years				20-24 years	25-29 years	30-34 years	35-39 years	40-44 years	45-54 yearsc
			10-14 years	Total	15-17 years	18-19 years
*Rates based on fewer than 20 births are considered unreliable and are not shown.
aLive births per 1,000 population.
bTotal number of live births regardless of age of mother per 1,000 women 15-44 years of age.
cPrior to 1997 data are for live births to mothers 45-49 years of age per 1,000 women 45-49 years of age. Starting in 1997 data are for live births to mothers 45-54 years of age per 1,000 women 45-49 years of age.
dLive births are tabulated by race of child.
eLive births are tabulated by race and/or Hispanic origin of mother.
fPrior to 1993, data from states lacking an Hispanic-origin item on the birth certificate were excluded.
gRates in 1985 were not calculated because estimates for the Hispanic and non-Hispanic populations were not available.
Notes: "—" = Data not available. Data are based on births adjusted for underregistration for 1950 and on registered births for all other years. Beginning in 1970, births to persons who were not residents of the 50 states and the District of Columbia are excluded. The race groups, white, black, American Indian or Alaska Native, and Asian or Pacific Islander, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Interpretation of trend data should take into consideration expansion of reporting areas and immigration.
SOURCE: "Table 3. Crude Birth Rates, Fertility Rates, and Birth Rates by Age of Mother, according to Race and Hispanic Origin: United States, Selected Years 1950–2003" in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed December 8, 2005)
Asian or Pacific Islander motherse
1980	19.9	73.2	0.3	26.2	12.0	46.2	93.3	127.4	96.0	38.3	8.5	0.7
1985	18.7	68.4	0.4	23.8	12.5	40.8	83.6	123.0	93.6	42.7	8.7	1.2
1990	19.0	69.6	0.7	26.4	16.0	40.2	79.2	126.3	106.5	49.6	10.7	1.1
1995	16.7	62.6	0.7	25.5	15.6	40.1	64.2	103.7	102.3	50.1	11.8	0.8
1999	15.9	60.9	0.4	21.4	12.4	33.9	58.9	100.8	104.3	52.9	11.3	0.9
2000	17.1	65.8	0.3	20.5	11.6	32.6	60.3	108.4	116.5	59.0	12.6	0.8
2001	16.4	64.2	0.2	19.8	10.3	32.8	59.1	106.4	112.6	56.7	12.3	0.9
2002	16.5	64.1	0.3	18.3	9.0	31.5	60.4	105.4	109.6	56.5	12.5	0.9
2003	16.8	66.3	0.2	17.4	8.8	29.8	59.6	108.5	114.6	59.9	13.5	0.9
Hispanic or Latino motherse, f, g
1980	23.5	95.4	1.7	82.2	52.1	126.9	156.4	132.1	83.2	39.9	10.6	0.7
1990	26.7	107.7	2.4	100.3	65.9	147.7	181.0	153.0	98.3	45.3	10.9	0.7
1995	24.1	98.8	2.6	99.3	68.3	145.4	171.9	140.4	90.5	43.7	10.7	0.6
1999	22.5	93.0	1.9	86.8	56.9	129.5	157.3	135.8	92.3	44.5	10.6	0.6
2000	23.1	95.9	1.7	87.3	55.5	132.6	161.3	139.9	97.1	46.6	11.5	0.6
2001	23.0	96.0	1.6	86.4	52.8	135.5	163.5	140.4	97.6	47.9	11.6	0.7
2002	22.6	94.4	1.4	83.4	50.7	133.0	164.3	139.4	95.1	47.8	11.5	0.7
2003	22.9	96.9	1.3	82.3	49.7	132.0	163.4	144.4	102.0	50.8	12.2	0.7
White, not Hispanic or Latino motherse, f, g
1980	14.2	62.4	0.4	41.2	22.4	67.7	105.5	110.6	59.9	17.7	3.0	0.1
1990	14.4	62.8	0.5	42.5	23.2	66.6	97.5	115.3	79.4	30.0	4.7	0.2
1995	12.5	57.5	0.4	39.3	22.0	66.2	90.2	105.1	81.5	32.8	5.9	0.3
1999	12.1	57.7	0.3	34.1	17.1	59.4	90.6	108.6	89.5	37.3	6.9	0.4
2000	12.2	58.5	0.3	32.6	15.8	57.5	91.2	109.4	93.2	38.8	7.3	0.4
2001	11.8	57.7	0.3	30.3	14.0	54.8	87.1	108.9	94.3	39.8	7.5	0.4
2002	11.7	57.4	0.2	28.5	13.1	51.9	84.3	109.3	94.4	40.9	7.6	0.5
2003	11.8	58.5	0.2	27.4	12.4	50.0	83.5	110.8	97.6	43.2	8.1	0.5
Black or African American, not Hispanic or Latino motherse, f, g
1980	22.9	90.7	4.6	105.1	77.2	146.5	152.2	111.7	65.2	25.8	5.8	0.3
1990	23.0	89.0	5.0	116.2	84.9	157.5	165.1	118.4	70.2	28.7	5.6	0.3
1995	18.2	72.8	4.2	97.2	70.4	139.2	137.8	98.5	64.4	28.8	6.1	0.3
1999	17.1	69.9	2.6	81.0	51.7	123.9	142.1	99.8	63.9	30.6	6.5	0.3
2000	17.3	71.4	2.4	79.2	50.1	121.9	145.4	102.8	66.5	31.8	7.2	0.4
2001	16.6	69.1	2.1	73.5	44.9	116.7	137.2	102.1	66.2	32.1	7.3	0.4
2002	16.1	67.4	1.9	68.3	41.0	110.3	131.0	102.1	66.1	32.1	7.5	0.4
2003	15.9	67.1	1.6	64.7	38.7	105.3	128.1	102.1	67.4	33.4	7.7	0.5

teenagers. The Centers for Disease Control and Prevention (CDC) cites successful health prevention programs that include education emphasizing prevention of pregnancy through abstinence (avoiding sexual contact) and contraception (measures to prevent pregnancy) as one factor that has contributed to the decline in teen birthrates along with a leveling-off of sexual activity among teens.

Prenatal Care, Prematurity, and Low Birth Weight

Early prenatal care, defined as pregnancy-related care started in the first trimester (one to three months), can detect and often correct many potential health problems early in pregnancy. Regular visits to a physician or clinic usually give the mother-to-be information and encouragement about eating properly, exercising regularly, taking prenatal vitamins, and avoiding harmful substances such as alcohol, drugs, and tobacco. The benefits of these preventive measures can make literally a lifetime of difference for a newborn.

Sophisticated diagnostic medical procedures, such as obstetric ultrasound scans and amniocentesis, can be performed to detect possible birth defects and other prenatal problems. Ultrasound uses high-frequency sound waves to compose a picture of the fetus and is used to detect and assess fetal development and malformations in the fetus. During amniocentesis, a physician inserts a needle through the abdominal wall into the uterus to obtain a small sample of the amniotic fluid surrounding the fetus. When tested in a laboratory, this fluid can reveal chromosomal abnormalities, metabolic disorders, and physical abnormalities.

Pregnant women older than age thirty-five are generally advised to undergo amniocentesis and other diagnostic testing, because they are at greater risk than younger women of giving birth to babies with chromosomal abnormalities such as Down syndrome (also called Down's syndrome). Instead of the normal forty-six chromosomes, newborns with Down syndrome have an extra copy of chromosome twenty-one, giving them a total of forty-seven chromosomes. These children have varying degrees of mental retardation, and, according to the Cincinnati Children's Hospital Medical Center (http://www.cincinnatichildrens.org/health/heart-encyclopedia/disease/syndrome/down.htm), up to 50% have congenital heart diseases. The center notes that the incidence of Down syndrome is one in every seven hundred to eight hundred live births. And, according to a January 6, 2006, report by the CDC ("Improved National Prevalence Estimates for 18 Selected Major Birth Defects—United States, 1999–2001," http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5451a2.htm), the average prevalence of children born with Down syndrome in an eleven-state study was 12.9 per ten thousand live births.

Ideally, every woman should receive prenatal care, and according to the NCHS, the United States is capable of delivering prenatal care to nearly all pregnant women during the first trimester of pregnancy. Not all mothers-to-be, however, seek or receive early or adequate prenatal care. Adequate/adequate plus prenatal care is defined as pregnancy-related care beginning in the first four months of pregnancy with the appropriate number of visits for gestational age, according to the Adequacy of Prenatal Care Utilization Index. According to the March of Dimes Birth Defects Foundation, a national voluntary organization that seeks to improve infant health by preventing birth defects, in 2002 nearly 75% of expectant mothers received adequate/adequate plus prenatal care, while 14% received intermediate care (less than optimal but not inadequate) and almost 12% received inadequate care (http://www.marchofdimes.com/peristats/level1.aspx?reg=99&top=5&stop=33&lev=1&slev=1&obj=3).

The percentage of expectant mothers receiving prenatal care beginning in the first trimester steadily increased from 68% in 1970 to 84.1% in 2003. (See Table 1.2.) More white (85.7%) and Asian or Pacific Islander (85.4%) women received early prenatal care than did Hispanic or Latino (77.5%), African-American (75.9%), or American Indian or Alaska Native (70.8%) women. During the same period the percentage of expectant mothers that received inadequate prenatal care—care beginning during the third trimester or no prenatal care at all—declined by more than half, from 7.9% to 3.5%. More American Indian or Alaska Natives (7.6%) and African-American women (6%) failed to receive adequate prenatal care than white (3%) or Asian or Pacific Islander (3.1%) women.

Overall, the percentage of women of all races and ethnicity that received early prenatal care increased from the period of 1995–97 to the period of 2001–03. (See Table 1.3.) There was, however, a wide geographic variation in the percentage of women obtaining early prenatal care during the 2001–03 period, from a low of 75.7% of women in the District of Columbia to a high of 89.8% of women in Massachusetts. Within states, the percentage of women that received prenatal care varied widely. For example, in New Jersey less than two-thirds of African-American women (63.5%) received early prenatal care, compared with 89% of white women.

The March of Dimes cited lack of health insurance, transportation, and child care; inconvenient health care provider service hours; unplanned pregnancies; and cultural and personal factors as obstacles preventing expectant mothers from receiving prenatal care.

Early prenatal care can prevent or reduce the risk of low birth weight (LBW). Infants who weigh less than twenty-five hundred grams (five pounds, eight ounces) at birth are considered to be of LBW. Those born weighing TABLE 1.2 Prenatal care for live births, by race and Hispanic origin of mother, selected years 1970–2003 "Table 7. Prenatal Care for Live Births, according to Detailed Race and Hispanic Origin of Mother: United States, Selected Years 1970–2003," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed December 8, 2005)less than fifteen hundred grams (three pounds, four ounces) are termed very low birth weight (VLBW). LBW may result from premature birth (infants born before thirty-seven weeks of pregnancy are considered premature), poor maternal nutrition, teen pregnancy, drug and alcohol use, smoking, or sexually transmitted diseases.

TABLE 1.2
Prenatal care for live births, by race and Hispanic origin of mother, selected years 1970–2003
[Data are based on birth certificates]
Prenatal care, race, and Hispanic origin of mother	1970	1975	1980	1985	1990	1995	1997	1999	2000	2001	2002	2003
aExcludes live births for whom trimester when prenatal care began is unknown.
bFor 2003, data are not shown for Asian or Pacific Islander subgroups during the transition from single race to multiple race reporting.
cPrior to 1993, data from states lacking an Hispanic-origin item on the birth certificate were excluded. Data for non-Hispanic white and non-Hispanic black women for years prior to 1989 are not nationally representative and are provided for comparison with Hispanic data.
Notes: "—" = Data not available. Data for 2003 exclude Pennsylvania and Washington that implemented the 2003 revision to the U.S. Standard Certificate of Live Birth. Prenatal care data based on the 2003 revision are not comparable with data based on the 1989 revision to the U.S. Standard Certificate of Live Birth. Data for 1970 and 1975 exclude births that occurred in states not reporting prenatal care. The race groups, white, black, American Indian or Alaska Native, and Asian or Pacific Islander, include persons of Hispanic and non-Hispanic origin Persons of Hispanic origin may be of any race. Interpretation of trend data should take into consideration expansion of reporting areas and immigration.
SOURCE: "Table 7. Prenatal Care for Live Births, according to Detailed Race and Hispanic Origin of Mother: United States, Selected Years 1970–2003," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed December 8, 2005)
Prenatal care began during 1st trimester	Percent of live birthsa
All races	68.0	72.4	76.3	76.2	75.8	81.3	82.5	83.2	83.2	83.4	83.7	84.1
White	72.3	75.8	79.2	79.3	79.2	83.6	84.7	85.1	85.0	85.2	85.4	85.7
Black or African American	44.2	55.5	62.4	61.5	60.6	70.4	72.3	74.1	74.3	74.5	75.2	75.9
American Indian or Alaska Native	38.2	45.4	55.8	57.5	57.9	66.7	68.1	69.5	69.3	69.3	69.8	70.8
Asian or Pacific Islanderb	—	—	73.7	74.1	75.1	79.9	82.1	83.7	84.0	84.0	84.8	85.4
Chinese	71.8	76.7	82.6	82.0	81.3	85.7	87.4	88.5	87.6	87.0	87.2	—
Japanese	78.1	82.7	86.1	84.7	87.0	89.7	89.3	90.7	91.0	90.1	90.5	—
Filipino	60.6	70.6	77.3	76.5	77.1	80.9	83.3	84.2	84.9	85.0	85.4	—
Hawaiian	—	—	68.8	67.7	65.8	75.9	78.0	79.6	79.9	79.1	78.1	—
Other Asian or Pacific Islander	—	—	67.4	69.9	71.9	77.0	79.7	81.8	82.5	82.7	83.9	—
Hispanic or Latinoc	—	—	60.2	61.2	60.2	70.8	73.7	74.4	74.4	75.7	76.7	77.5
Mexican	—	—	59.6	60.0	57.8	69.1	72.1	73.1	72.9	74.6	75.7	76.5
Puerto Rican	—	—	55.1	58.3	63.5	74.0	76.5	77.7	78.5	79.1	79.9	81.2
Cuban	—	—	82.7	82.5	84.8	89.2	90.4	91.4	91.7	91.8	92.0	92.1
Central and South American	—	—	58.8	60.6	61.5	73.2	76.9	77.6	77.6	77.4	78.7	79.2
Other and unknown Hispanic or Latino	—	—	66.4	65.8	66.4	74.3	76.0	74.8	75.8	77.3	76.7	77.0
Not Hispanic or Latino:c
White	—	—	81.2	81.4	83.3	87.1	87.9	88.4	88.5	88.5	88.6	89.0
Black or African American	—	—	60.8	60.2	60.7	70.4	72.3	74.1	74.3	74.5	75.2	75.9
Prenatal care began during 3rd trimester or no prenatal care
All races	7.9	6.0	5.1	5.7	6.1	4.2	3.9	3.8	3.9	3.7	3.6	3.5
White	6.3	5.0	4.3	4.8	4.9	3.5	3.2	3.2	3.3	3.2	3.1	3.0
Black or African American	16.6	10.5	8.9	10.2	11.3	7.6	7.3	6.6	6.7	6.5	6.2	6.0
American Indian or Alaska Native	28.9	22.4	15.2	12.9	12.9	9.5	8.6	8.2	8.6	8.2	8.0	7.6
Asian or Pacific Islanderb	—	—	6.5	6.5	5.8	4.3	3.8	3.5	3.3	3.4	3.1	3.1
Chinese	6.5	4.4	3.7	4.4	3.4	3.0	2.4	2.0	2.2	2.4	2.1	—
Japanese	4.1	2.7	2.1	3.1	2.9	2.3	2.7	2.1	1.8	2.0	2.1	—
Filipino	7.2	4.1	4.0	4.8	4.5	4.1	3.3	2.8	3.0	3.0	2.8	—
Hawaiian	—	—	6.7	7.4	8.7	5.1	5.4	4.0	4.2	4.8	4.7	—
Other Asian or Pacific Islander	—	—	9.3	8.2	7.1	5.0	4.4	4.1	3.8	3.8	3.5	—
Hispanic or Latinoc	—	—	12.0	12.4	12.0	7.4	6.2	6.3	6.3	5.9	5.5	5.3
Mexican	—	—	11.8	12.9	13.2	8.1	6.7	6.7	6.9	6.2	5.8	5.6
Puerto Rican	—	—	16.2	15.5	10.6	5.5	5.4	5.0	4.5	4.6	4.1	3.7
Cuban	—	—	3.9	3.7	2.8	2.1	1.5	1.4	1.4	1.3	1.3	1.3
Central and South American	—	—	13.1	12.5	10.9	6.1	5.0	5.2	5.4	5.7	4.9	4.7
Other and unknown Hispanic or Latino	—	—	9.2	9.4	8.5	6.0	5.3	6.3	5.9	5.4	5.3	5.4
Not Hispanic or Latino:c
White	—	—	3.5	4.0	3.4	2.5	2.4	2.3	2.3	2.2	2.2	2.1
Black or African American	—	—	9.7	10.9	11.2	7.6	7.3	6.6	6.7	6.5	6.2	6.0

Infants who are premature or have LBVs are at greater risk of death and disability than infants of normal weight. About 80% of women at risk for delivering a LBW infant can be identified in the first prenatal visit, and interventions can be made to try to prevent problems. Between 1995 and 2003 the proportion of newborn babies weighing less than twenty-five hundred grams increased from 7.4% to 7.8%. (See Table 1.4.)

As with access to prenatal care, the percent of LBW live births varies by geography, race, and ethnicity. Among non-Hispanic African-Americans, 13.3% of live TABLE 1.3 Early prenatal care, 1995–97, 1998–2000, and 2001–03births weighed less than twenty-five hundred grams, compared with 6.9% of white births, 6.6% of Hispanic or Latino births, 7.3% of American Indian or Alaska native births, and 7.7% of Asian or Pacific Islander births. Nearly 15% of live births to African-American mothers in Colorado were LBW, compared with 5.4% of LBW live births to Hispanic or Latino mothers in Washington. (See Table 1.4.)

TABLE 1.3
Early prenatal care, 1995–97, 1998–2000, and 2001–03
[Data are based on birth certificates]
Geographic division and state	All races			Not Hispanic or Latino
				White			Black or African American
	1995–97	1998–2000	2001–2003	1995–97	1998–2000	2001–2003	1995–97	1998–2000	2001–2003
	Percent of live births with early prenatal care (beginning in the 1st trimester)
United Statesa	81.9	83.1	83.7	87.4	88.3	88.8	71.4	73.9	75.2
New England	88.1	89.4	89.6	90.7	91.8	92.0	77.0	80.5	80.5
Connecticut	88.4	88.9	88.5	92.1	92.5	92.4	78.5	81.2	81.9
Maine	89.3	88.9	87.8	89.8	89.3	88.2	82.0	81.3	76.1
Massachusetts	87.3	89.4	89.8	90.4	92.3	92.6	75.6	79.7	79.3
New Hampshire	89.6	90.5	91.6	90.0	91.1	92.4	78.3	75.5	81.3
Rhode Island	89.6	90.6	90.6	92.1	92.9	93.2	79.3	83.3	82.1
Vermont	87.6	87.9	89.6	87.8	88.1	89.9	74.6	75.6	73.3
Middle Atlantica	81.2	82.2	81.0	87.9	88.5	88.5	67.3	69.7	69.3
New Jersey	82.0	81.2	80.1	89.7	89.5	89.0	65.3	64.4	63.5
New York	79.2	81.0	81.5	87.2	88.2	88.2	68.3	71.2	71.6
Pennsylvaniaa	83.8	85.1	—	87.6	88.4	—	66.8	71.7	—
East North Central	83.1	83.7	85.0	87.3	87.9	88.8	69.3	71.0	73.6
Illinois	81.6	82.5	84.8	88.9	89.7	90.7	68.5	70.4	73.7
Indiana	80.4	80.4	81.2	82.8	83.2	84.3	65.9	67.0	69.3
Michigan	84.0	84.1	85.4	88.1	88.6	89.4	70.5	70.3	71.0
Ohio	85.1	86.2	87.6	87.7	88.5	89.7	71.4	75.0	78.3
Wisconsin	84.0	84.2	84.4	87.9	87.9	88.1	66.8	68.8	71.5
West North Central	85.0	85.8	86.4	87.8	88.7	89.4	71.6	74.5	76.8
Iowa	87.2	87.7	88.7	88.5	89.2	90.3	73.4	75.6	78.0
Kansas	85.6	86.2	87.1	89.0	89.6	90.3	75.7	77.4	79.8
Minnesota	83.7	84.6	85.5	87.0	88.2	89.8	63.6	66.8	69.7
Missouri	85.6	87.0	88.0	88.2	89.3	90.0	72.5	76.6	79.8
Nebraska	84.2	83.8	83.3	87.0	87.0	87.0	71.9	70.9	70.5
North Dakota	84.5	86.1	86.4	86.3	88.5	89.2	76.0	76.5	81.9
South Dakota	81.9	81.6	78.1	85.6	85.7	82.8	69.4	73.3	62.2
South Atlantic	83.8	84.7	84.3	89.2	89.9	89.8	73.1	75.8	76.4
Delaware	83.8	84.1	86.2	88.8	88.8	90.5	73.1	75.8	81.1
District of Columbia	63.4	73.1	75.7	87.4	90.8	90.4	58.3	68.0	70.1
Florida	83.3	83.8	85.1	88.3	88.9	89.7	72.1	73.3	76.6
Georgia	85.1	86.9	85.0	90.5	91.7	90.8	77.3	80.4	79.5
Maryland	88.3	87.0	83.8	93.2	92.3	90.5	78.8	78.7	76.1
North Carolina	83.6	84.7	84.4	89.7	90.8	90.9	72.1	75.7	76.0
South Carolina	79.5	80.5	78.3	86.8	87.0	84.8	67.4	70.9	70.1
Virginia	84.5	85.2	85.2	89.7	90.2	90.5	72.4	75.0	76.8
West Virginia	82.0	84.9	86.0	82.6	85.6	86.5	66.0	70.4	75.2
East South Central	82.4	83.7	84.1	87.4	88.4	88.7	69.8	72.5	74.7
Alabama	81.9	82.8	83.2	88.4	89.5	89.8	69.5	71.2	73.6
Kentucky	84.9	86.6	86.8	86.3	87.7	88.1	73.6	78.3	80.3
Mississippi	78.6	81.1	83.8	88.2	89.4	90.5	67.9	71.8	76.3
Tennessee	83.3	83.8	83.0	87.2	87.9	87.8	71.5	73.1	72.5
West South Central	78.3	79.6	80.6	85.5	86.6	87.0	71.2	74.1	75.1
Arkansas	75.7	78.8	80.3	80.6	83.0	84.1	61.9	68.7	71.3
Louisiana	81.0	82.8	83.7	88.7	90.0	90.5	70.5	73.0	74.5
Oklahoma	78.5	79.4	77.3	81.8	82.8	81.4	66.9	71.2	69.5
Texas	78.0	79.1	80.6	86.4	87.3	88.1	74.1	76.3	76.9
Mountain	77.9	77.7	77.8	84.6	84.9	85.3	70.5	71.8	72.4
Arizona	73.7	75.9	76.6	83.3	86.0	87.5	69.8	74.0	77.6
Colorado	81.6	81.5	79.4	86.8	88.0	86.5	75.4	75.6	71.3
Idaho	79.1	80.0	81.8	81.9	82.7	84.0	75.6	71.7	83.3
Montana	82.2	83.1	83.6	84.5	85.8	86.5	79.3	82.7	81.5
Nevada	76.5	74.7	75.8	83.3	83.3	85.3	66.7	67.2	69.6
New Mexico	69.8	67.7	68.9	79.0	75.2	76.8	62.7	62.4	67.9
Utah	83.9	80.6	79.7	86.9	84.2	83.7	68.5	60.5	60.6
Wyoming	82.5	82.3	84.8	84.3	84.0	86.2	71.3	73.1	86.3

TABLE 1.3 Early prenatal care, 1995–97, 1998–2000, and 2001–03 [CONTINUED]

TABLE 1.3
Early prenatal care, 1995–97, 1998–2000, and 2001–03 [CONTINUED]
[Data are based on birth certificates]
Geographic division and state	Hispanic or Latinob			American Indian or Alaska Nativec			Asian or Pacific Islanderc
	1995–97	1998–2000	2001–2003	1995–97	1998–2000	2001–2003	1995–97	1998–2000	2001–2003
	Percent of live births with early prenatal care (beginning in the 1st trimester)
Pacifica	80.7	83.2	85.8	86.1	87.6	89.3	77.9	80.5	83.1
Alaska	81.5	80.3	80.2	84.2	83.4	83.6	82.9	82.9	83.0
California	80.3	83.5	86.4	86.7	89.1	90.4	77.9	80.8	83.2
Hawaii	83.8	85.5	83.5	89.7	90.8	88.0	89.6	91.1	92.0
Oregon	79.9	80.8	81.5	82.6	83.6	84.5	76.2	77.3	76.8
Washingtona	83.1	82.8	—	86.0	85.9	—	76.6	75.9	—
United Statesa	72.2	74.4	76.7	67.5	69.2	69.8	81.1	83.6	84.8
New England	76.9	79.8	81.5	75.2	79.0	84.6	81.7	85.0	86.0
Connecticut	77.1	78.8	77.9	74.9	79.0	85.0	85.6	87.2	88.3
Maine	79.3	81.0	80.4	74.4	73.8	79.3	79.6	84.6	82.8
Massachusetts	75.7	79.3	82.8	71.9	78.3	89.4	80.7	84.3	85.4
New Hampshire	78.8	79.4	83.5	78.9	84.2	86.9	84.3	86.9	87.6
Rhode Island	82.8	85.2	86.8	79.2	82.3	81.3	80.0	82.6	83.5
Vermont	82.6	83.3	81.5	d	83.0d	87.5d	75.0	83.0	87.6
Middle Atlantica	69.0	71.7	72.7	73.4	76.7	75.6	76.7	78.8	79.8
New Jersey	70.9	69.8	68.3	75.3	74.1	68.7	82.9	83.5	84.3
New York	67.9	72.3	74.8	71.9	75.0	77.3	73.7	76.0	77.5
Pennsylvaniaa	70.6	73.3	—	75.2	81.1	—	77.9	80.8	—
East North Central	71.5	72.1	76.0	71.8	74.5	75.8	80.4	83.1	85.1
Illinois	71.4	72.9	78.4	73.7	75.2	81.1	83.2	85.5	86.9
Indiana	66.6	63.5	64.8	69.7	71.8	72.4	80.8	82.0	81.6
Michigan	72.8	72.1	75.4	73.9	75.0	79.5	85.1	86.0	88.2
Ohio	76.2	76.7	78.1	78.7	81.1	80.8	86.2	87.8	90.1
Wisconsin	70.6	70.3	70.0	67.5	72.2	71.4	59.6	64.7	68.5
West North Central	67.1	69.5	72.4	66.4	66.7	66.0	72.1	76.9	80.4
Iowa	71.0	72.6	74.8	70.0	74.8	75.5	81.9	82.9	86.6
Kansas	64.7	68.3	73.6	79.9	77.0	82.0	81.3	85.5	85.6
Minnesota	60.8	63.6	67.3	60.5	62.2	63.5	59.3	66.8	73.4
Missouri	76.8	78.1	79.1	77.1	77.0	80.2	83.6	87.3	88.0
Nebraska	66.7	68.3	69.2	66.7	68.9	67.6	81.4	82.0	81.9
North Dakota	76.4	75.8	80.4	69.9	68.8	66.2	77.4	85.5	87.2
South Dakota	73.2	71.1	65.0	63.5	62.9	59.3	74.3	78.9	75.6
South Atlantic	77.5	77.9	76.8	74.3	73.5	76.0	84.5	86.8	86.2
Delaware	68.6	71.3	73.4	80.4d	76.4	82.4	84.5	86.7	91.6
District of Columbia	60.6	70.3	71.3	d	d	d	67.1	76.8	82.2
Florida	80.7	81.4	83.2	71.8	65.2	68.1	86.6	87.8	88.7
Georgia	74.4	78.6	72.8	83.2	83.7	80.7	85.7	89.6	89.3
Maryland	81.3	80.8	71.0	85.4	81.8	81.5	89.3	89.9	83.7
North Carolina	68.4	68.5	69.9	72.2	74.4	79.5	80.9	83.2	84.6
South Carolina	66.2	61.4	60.2	73.1	79.1	75.3	76.6	79.2	76.3
Virginia	71.3	72.9	70.4	81.0	80.8	81.5	82.5	85.3	85.4
West Virginia	74.3	74.9	69.2	78.0d	77.4d	66.7d	81.4	80.7	83.6
East South Central	67.3	63.3	61.2	75.0	78.4	76.8	82.2	84.9	84.4
Alabama	63.0	59.3	52.7	79.7	76.5	83.3	82.2	86.4	87.6
Kentucky	74.7	70.7	71.6	77.9	83.7	84.7	84.0	87.4	84.7
Mississippi	78.1	74.6	74.7	72.1	78.0	70.9	78.8	82.0	85.3
Tennessee	64.9	60.9	60.1	73.1	77.9	75.1	82.7	84.0	82.8
West South Central	70.2	72.0	74.6	69.7	71.3	71.5	84.8	87.0	87.5
Arkansas	59.0	64.3	69.2	68.7	73.1	75.1	73.2	77.7	80.6
Louisiana	82.4	85.4	83.5	80.1	80.0	82.4	81.6	85.3	87.3
Oklahoma	68.6	67.9	64.8	68.5	70.0	69.5	81.1	81.7	79.4
Texas	70.2	72.0	75.0	72.8	74.8	77.7	85.8	87.9	88.5

The usual length of pregnancy is forty weeks from the first day of the woman's last menstrual period. Infants born prematurely do not have fully formed organ systems. If, however, the premature infant is born with a birth weight comparable to a full-term baby and has organ systems only slightly undeveloped, the chances of survival are great. Premature infants of VLBW are susceptible to numerous risks and are less likely to survive than full-term infants. If they survive, they may suffer from mental retardation, developmental disabilities, and other abnormalities of the nervous system.

A severe medical condition called hyaline membrane disease, or respiratory distress syndrome (RDS), commonly affects premature infants. It is caused by the inability of immature lungs to function properly. TABLE 1.3 Early prenatal care, 1995–97, 1998–2000, and 2001–03 [CONTINUED] "Table 8. Early Prenatal Care according to Race and Hispanic Origin of Mother, Geographic Division, and State: United States, Average Annual 1995–97, 1998–2000, and 2001–2003," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed December 8, 2005)Occurring immediately after birth, the disease may cause infant death within hours. Intensive care of affected infants includes the use of a mechanical ventilator to facilitate breathing. Also, premature infants' immature gastrointestinal systems preclude them from taking in nourishment properly. Unable to suck and swallow, they must be fed through a nasogastric feeding tube (nutrient-rich formula enters through a tube inserted into the stomach via the nose).

TABLE 1.3
Early prenatal care, 1995–97, 1998–2000, and 2001–03 [CONTINUED]
[Data are based on birth certificates]
Geographic division and state	Hispanic or Latinob			American Indian or Alaska Nativec			Asian or Pacific Islanderc
	1995–97	1998–2000	2001–2003	1995–97	1998–2000	2001–2003	1995–97	1998–2000	2001–2003
aData for 2003 exclude Pennsylvania and Washington that implemented the 2003 revision to the U.S. Standard Certificate of Live Birth. Prenatal care data based on the 2003 revision are not comparable with data based on the 1989 revision to the U.S. Standard Certificate of Live Birth.
bPersons of Hispanic origin may be of any race.
cIncludes persons of Hispanic and non-Hispanic origin.
dPercents are based on fewer than 50 births. Percents not shown are based on fewer than 20 births.
Note: "—" = Data not available.
SOURCE: "Table 8. Early Prenatal Care according to Race and Hispanic Origin of Mother, Geographic Division, and State: United States, Average Annual 1995–97, 1998–2000, and 2001–2003," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed December 8, 2005)
	Percent of live births with early prenatal care (beginning in the 1st trimester)
Mountain	64.8	64.9	66.0	60.0	63.1	64.6	77.4	78.7	79.0
Arizona	62.8	65.0	66.7	59.5	64.8	66.9	80.7	84.7	84.3
Colorado	67.6	66.5	66.0	70.4	71.6	65.3	78.9	82.1	80.6
Idaho	61.3	64.2	69.3	60.5	62.7	69.5	80.0	78.5	82.8
Montana	75.7	78.9	79.9	67.2	65.2	65.9	75.2	81.6	82.8
Nevada	64.0	61.5	63.4	69.4	66.2	70.5	78.9	78.9	80.3
New Mexico	66.6	65.0	66.3	54.9	58.1	59.5	73.4	75.6	75.6
Utah	64.9	62.6	62.8	58.4	56.7	56.8	70.1	65.6	65.3
Wyoming	71.6	73.0	77.2	65.6	69.5	72.7	84.3	82.5	84.3
Pacifica	75.0	79.0	83.5	72.0	72.6	73.1	82.4	85.0	86.7
Alaska	78.8	80.5	79.4	75.7	72.9	70.7	77.1	76.3	76.5
California	75.3	79.5	83.9	70.0	73.4	75.4	83.0	85.8	87.9
Hawaii	82.0	83.8	82.1	83.1	83.2	81.5	81.5	83.8	81.9
Oregon	65.4	68.3	70.4	66.2	67.5	70.5	78.8	81.5	81.9
Washingtona	70.1	71.0	—	71.9	71.9	—	79.4	81.1	—

While ideal birth weight varies based on the expectant mother's ethnicity, the NCHS reports that for women in the United States the average ideal birth weight is approximately 7.5 pounds, which was the average weight of singletons (babies born singly) born in 2002. The percent of babies born with LBW has risen steadily since the mid-1980s, reaching the highest level reported in more than three decades in the 2001–03 period. In Health, United States, 2005 the NCHS also reports that the percent of VLBW infants rose from 1.44% in 2001 to 1.46% in 2002.

LBW and VLBW are major predictors of infant morbidity (illness or disease) and mortality. For LBW infants, the risk of dying during the first year of life is more than five times that of normal-birth-weight infants; the risk for VLBW infants is nearly one hundred times higher. The risk of delivering an LBW infant is greatest among the youngest and oldest mothers; however, many of the LBW births among older mothers are attributable to their higher rates of multiple births. According to the NCHS, in 2002 multiples accounted for nearly two-thirds of all LBW infants delivered to mothers age forty-five and older. Less than 10% of singletons born to mothers age forty-five or older were LBW, compared with 8.7% of births to mothers less than twenty years old. Health, United States, 2005 reports the rate of triplet and higher order multiple births in 2003—187.4 per one hundred thousand live births—has remained relatively stable since 1998, with the greatest increase in multiple births among women age thirty and older.

Birth Weight Influences Risk of Disease

Although the relationship between birth weight and development of disease in adulthood is an emerging field of research, and scientists cannot yet fully explain how and why birth weight is a predictor of health and illness in later life, mounting evidence indicates that both LBW and higher-than-average birth weight are linked to future health problems. Research reveals that LBW infants are more likely than normal-weight infants to develop disease in later life. Male infants with LBW who gain weight rapidly before their first birthdays appear to be at the highest risk. Investigators hypothesize that LBW infants have fewer muscle cells at birth and that rapid weight gain during the first year of life may lead to disproportionate amounts of fat to muscle and above-average TABLE 1.4 Low-birth-weight live births, 1995–97, 1998–2000, and 2001–03body mass. Persons with LBW who later develop aboveaverage body mass are at increased risk for developing diseases such as Type 2 diabetes, hypertension (high blood pressure), cardiovascular disease, and stroke. A 1997 study published in the British journal Lancet examined the medical records of 13,249 men and found the risk of dying from stroke or heart disease was highest for those who weighed 5.5 pounds at birth or less. Those who

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TABLE 1.4
Low-birth-weight live births, 1995–97, 1998–2000, and 2001–03
[Data are based on birth certificates]
Geographic division and state	All races			Not Hispanic or Latino
				White			Black or African American
1995–97	1998–2000	2001–2003	1995–97	1998–2000	2001–2003	1995–97	1998–2000	2001–2003
	Percent of live births weighing less than 2,500 gramsa
United States	7.41	7.59	7.81	6.34	6.60	6.90	13.15	13.18	13.33
New England	6.59	7.00	7.28	5.86	6.28	6.61	11.78	12.08	11.86
Connecticut	7.21	7.61	7.55	5.92	6.40	6.47	12.67	12.83	12.46
Maine	5.97	5.96	6.29	6.01	5.99	6.31	13.55d	10.45d	8.47d
Massachusetts	6.57	7.04	7.42	5.89	6.36	6.74	11.22	11.53	11.56
New Hampshire	5.38	6.08	6.37	5.26	5.85	6.26	8.24d	9.26d	11.70
Rhode Island	7.03	7.35	7.94	6.22	6.63	7.23	11.06	12.55	11.80
Vermont	5.94	6.09	6.47	5.86	6.02	6.53	d	d	d
Middle Atlantic	7.64	7.82	7.93	6.10	6.49	6.72	13.08	12.90	12.75
New Jersey	7.69	7.96	8.02	6.08	6.46	6.86	13.71	13.69	13.22
New York	7.70	7.80	7.81	5.98	6.44	6.52	12.40	12.19	12.06
Pennsylvania	7.49	7.74	8.05	6.24	6.56	6.88	14.09	13.81	13.93
East North Central	7.57	7.74	7.91	6.38	6.57	6.88	13.82	13.86	13.85
Illinois	7.92	7.98	8.14	6.34	6.51	6.94	14.34	14.16	14.16
Indiana	7.61	7.71	7.71	6.93	7.13	7.11	13.50	13.01	13.11
Michigan	7.69	7.89	8.05	6.32	6.31	6.76	13.55	14.38	14.08
Ohio	7.62	7.84	8.21	6.57	6.85	7.22	13.57	13.30	13.63
Wisconsin	7.23	6.57	6.67	5.40	5.75	5.93	13.25	13.45	13.35
West North Central	6.60	6.76	6.98	6.09	6.24	6.48	12.90	12.88	12.38
Iowa	6.23	6.23	6.54	5.95	5.98	6.31	12.01	12.36	12.38
Kansas	6.76	7.00	7.11	6.28	6.64	6.81	12.88	12.58	12.52
Minnesota	5.85	6.01	6.27	5.58	5.69	5.81	11.84	11.05	10.29
Missouri	7.61	7.71	7.88	6.56	6.67	6.99	13.47	13.68	13.32
Nebraska	6.54	6.69	6.91	6.25	6.30	6.64	11.47	12.78	12.56
North Dakota	5.73	6.38	6.32	5.66	6.39	6.14	11.54d	10.25d	8.50d
South Dakota	5.65	5.96	6.73	5.62	5.85	6.53	9.40d	13.14d	8.54d
South Atlantic	8.40	8.52	8.75	6.65	6.89	7.26	13.13	13.08	13.31
Delaware	8.55	8.54	9.55	6.82	6.68	7.99	13.74	14.05	14.39
District of Columbia	13.70	12.68	11.54	5.89	6.40	6.16	16.29	15.35