Health - Pregnancy And Birth

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 believes the United States is capable of guaranteeing that more than 90 percent of pregnant women receive prenatal care during the first trimester of pregnancy.

In 2001, 83.4 percent 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. While 88.5 percent of non-Hispanic white women received prenatal care during

TABLE 6.1
Respondent-assessed health status according to selected characteristics, selected years 1991–2001
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]

Characteristic	1991	1995	1997¹	1998¹	1999¹	2000¹	2001¹
			Percent of persons with fair or poor health
Total^2,3	10.4	10.6	9.2	9.1	8.9	9.0	9.2
Age
Under 18 years	2.6	2.6	2.1	1.8	1.6	1.7	1.8
Under 6 years	2.7	2.7	1.9	1.5	1.4	1.5	1.6
6–17 years	2.6	2.5	2.1	1.9	1.8	1.8	1.9
18–44 years	6.1	6.6	5.3	5.3	5.1	5.1	5.4
18–24 years	4.8	4.5	3.4	3.2	3.4	3.2	3.3
25–44 years	6.4	7.2	5.9	5.9	5.6	5.7	6.0
45–54 years	13.4	13.4	11.7	11.6	11.5	11.9	11.7
55–64 years	20.7	21.4	18.2	18.0	18.5	17.9	19.2
65 years and over	29.0	28.3	26.7	26.7	26.1	27.0	26.6
65–74 years	26.0	25.6	23.1	23.9	22.7	22.6	23.0
75 years and over	33.6	32.2	31.5	30.4	30.2	32.2	30.8
Sex²
Male	10.0	10.1	8.8	8.8	8.6	8.8	9.0
Female	10.8	11.1	9.7	9.4	9.2	9.3	9.5
Race^2,4
White only	9.6	9.7	8.3	8.2	8.0	8.2	8.2
Black or African American only	16.8	17.2	15.8	15.7	14.6	14.6	15.4
American Indian and Alaska Native only	18.3	18.7	17.3	17.6	14.7	17.2	14.5
Asian only	7.8	9.3	7.8	7.1	8.6	7.4	8.1
Native Hawaiian and Other Pacific Islander only	- - -	- - -	- - -	- - -	*	*	*
2 or more races	- - -	- - -	- - -	- - -	12.9	16.4	13.8
Black or African American; White	- - -	- - -	- - -	- - -	*20.5	14.6	*10.1
American Indian and Alaska Native; White	- - -	- - -	- - -	- - -	14.5	18.8	15.0
Hispanic origin and race^2,4
Hispanic or Latino	15.6	15.1	13.0	13.1	11.9	12.9	12.7
Mexican	17.0	16.7	13.1	13.5	12.3	12.9	12.5
Not Hispanic or Latino	#	#	8.9	8.8	8.6	8.7	8.9
White only	9.1	9.1	8.0	7.8	7.7	7.9	7.9
Black or African American only	16.8	17.3	15.8	15.8	14.6	14.6	15.5
Poverty status^2,5
Poor	22.8	23.7	21.4	22.2	21.7	20.9	21.0
Near poor	14.7	15.5	14.6	15.6	14.9	15.3	15.5
Nonpoor	6.8	6.7	6.1	5.7	6.1	6.3	6.2
Hispanic origin and race and poverty status^2,4,5
Hispanic or Latino:
Poor	23.6	22.7	19.8	21.7	18.9	19.1	18.8
Near poor	18.0	16.9	14.0	15.3	14.2	16.5	15.2
Nonpoor	9.3	8.7	8.8	7.9	8.2	8.4	9.2
Not Hispanic or Latino:
White only:
Poor	21.9	22.8	20.6	21.3	20.5	20.1	19.4
Near poor	14.0	14.8	14.1	15.3	14.5	14.7	14.6
Nonpoor	6.4	6.2	5.7	5.3	5.7	5.8	5.8
Black or African American only:
Poor	25.8	27.7	25.6	26.3	27.2	25.3	26.5
Near poor	17.0	19.3	19.5	19.3	18.2	19.4	20.9
Nonpoor	10.9	9.9	9.6	9.0	8.6	9.6	9.3
Geographic region²
Northeast	8.3	9.1	8.0	7.9	7.5	7.6	7.4
Midwest	9.1	9.7	8.1	8.0	8.0	8.0	8.8
South	13.1	12.3	10.8	10.9	10.5	10.7	10.8
West	9.7	10.1	8.8	8.4	8.7	8.8	8.6

their first trimester, only 74.5 percent of African-American women did so. Asian and Pacific Islander (API) women were likely to get prenatal care early in their pregnancies, as 84 percent received care in their first trimester in 2001. Only 75.7 percent of Hispanic women and 69.3 percent of Native American women, however, did so. (See Table 6.2.)

Births and Fertility

Of the 4.1 million births in 2000, 2.4 million were white, 604,346 were African-American, and 815,868 were Hispanic. However, despite a higher number of white births compared to African-American and Hispanic births, the fertility rate—the number of live births per 1,000 women ages fifteen to forty-four in a specified

Characteristic	1991	1995	1997¹	1998¹	1999¹	2000¹	2001¹
Location of residence²	Percent of persons with fair or poor health
Within MSA⁶	9.9	10.1	8.7	8.5	8.3	8.5	8.7
Outside MSA⁶	11.9	12.6	11.1	11.4	11.1	11.1	11.0
* Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error (RSE) of 20–30 percent. Data not shown have a RSE of greater than 30 percent.
- - - Data not available.
#Estimates calculated upon request.
¹Data starting in 1997 are not strictly comparable with data for earlier years due to the 1997 questionnaire redesign.
²Estimates are age adjusted to the year 2000 standard population using six age groups: Under 18 years, 18–44 years, 45–54 years, 55–64 years, 65–74 years, and 75 years and over.
³Includes all other races not shown separately and unknown poverty status.
⁴The race groups, white, black, American Indian and Alaska Native (AI/AN), Asian, Native Hawaiian and Other Pacific Islander, and 2 or more races, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with data year 1999 race-specific estimates are tabulated according to 1997 Standards for Federal data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. The five single race categories plus multiple race categories shown in the table conform to 1997 Standards. The 1999 race-specific estimates are for persons who reported only one racial group; the category "2 or more races" includes persons who reported more than one racial group. Prior to data year 1999, data were tabulated according to 1977 Standards with four racial groups and the category "Asian only" included Native Hawaiian and Other Pacific Islander. Estimates for single race categories prior to 1999 included persons who reported one race or, if they reported more than one race, identified one race as best representing their race. The effect of the 1997 Standard on the 1999 estimates can be seen by comparing 1999 data tabulated according to the two Standards: Age-adjusted estimates based on the 1977 Standards of the percent of persons in fair or poor health are: identical for the white and black groups; 0.1 percentage points lower for the Asian and Pacific Islander group; and 0.8 percentage points higher for the AI/AN group than estimates based on the 1997 Standards.
⁶Poor persons are defined as below the poverty threshold. Near poor persons have incomes of 100 percent to less than 200 percent of the poverty threshold. Nonpoor persons have incomes of 200 percent or greater than the poverty threshold. Missing family income data were imputed for 16–18 percent of persons in 1991 and 1995.
Poverty status was unknown for 20 percent of persons in the sample in 1997, 25 percent in 1998, 28 percent in 1999, 27 percent in 2000, and 29 percent in 2001.
⁶MSA is metropolitan statistical area.
SOURCE: "Table 57. Respondent-Assessed Health Status According to Selected Characteristics: United States, Selected Years 1991–2001," in Health, United States, 2003, Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD, 2003 [Online] http://www.cdc.gov/nchs/data/hus/hus03.pdf [accessed March 11, 2004]

TABLE 6.2
First trimester prenatal care by race and Hispanic origin of mother, 1980, 1985, 1989, and 1990–2001

		Non-Hispanic
Year	All races¹	White	Black	American Indian²	Asian or Pacific Islander²	Hispanic³
2001	83.4	88.5	74.5	69.3	84.0	75.7
2000	83.2	88.5	74.3	69.3	84.0	74.4
1999	83.2	88.4	74.1	69.5	83.7	74.4
1998	82.8	87.9	73.3	68.8	83.1	74.3
1997	82.5	87.9	72.3	68.1	82.1	73.7
1996	81.9	87.4	71.5	67.7	81.2	72.2
1995	81.3	87.1	70.4	66.7	79.9	70.8
1994	80.2	86.5	68.3	65.2	79.7	68.9
1993	78.9	85.6	66.1	63.4	77.6	66.6
1992	77.7	84.9	64.0	62.1	76.6	64.2
1991	76.2	83.7	61.9	59.9	75.3	61.0
1990	75.8	83.3	60.7	57.9	75.1	60.2
1989	75.5	82.7	59.9	57.9	74.8	59.5
1985	76.2	- - -	- - -	57.5	74.1	- - -
1980	76.3	- - -	- - -	55.8	73.7	- - -
- - - Data not available.
¹Includes races other than white and black and origin not stated.
²Includes persons of Hispanic and non-Hispanic origin.
³Includes all persons of Hispanic origin of any race.
SOURCE: Joyce A. Martin, Brady E. Hamilton, Stephanie J. Ventura, Fay Menacker, Melissa M. Park, and Paul D. Sutton, "Table D. First Trimester Prenatal Care by Race and Hispanic Origin of Mother, 1980, 1985, 1990–2001," in "Births: Final Data for 2001," National Vital Statistics Reports, vol. 51, no. 2, December 18, 2002 [Online] http://www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_02.pdf [accessed March 11, 2004]

group—for Hispanics and African-Americans was higher than that of white Americans. The fertility rate for non-Hispanic white Americans was 58.5 in 2000, compared to 73.7 for non-Hispanic African-Americans and 105.9 for Hispanics. (See Table 1.4 in Chapter 1.)

Low Birth Weight and Infant Mortality

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 development problems later in life. In 2001 African-Americans were more likely to have low-birth-weight babies than other racial and ethnic groups. In that year, 13.1 percent of non-Hispanic African-American babies were born with low birth weights, followed by 9.3 percent of Puerto Rican–origin Hispanics and 8.7 percent of Filipinos. Chinese women, at 5.3 percent, were least likely to give birth to low-birth-weight babies. (See Table 6.3.)

The percentage of babies born with low birth weights has increased over the past two decades. While the percentage of non-Hispanic African-American low-birth-weight births declined slightly from 13.3 percent in 1990 to 13.1 percent in 2001, it is still higher than the 12.7 percent registered in 1980. The percentage of low-birth-weight births among white non-Hispanics, Hispanics, Native Americans and Alaska Natives, and APIs has increased since 1980. Approximately 5.7 percent of non-Hispanic white women gave birth to low-birth-weight babies in 1980, compared to 6.7 percent in 2001. Among Hispanics, 6.1 percent of babies born in 1980 had low birth weights, compared to 6.5 percent in 2001. Among Native Americans and Alaska

TABLE 6.3
Low-birthweight live births, according to mother's detailed race, Hispanic origin, and smoking status: Selected years 1970–2001
[Data are based on birth certificates]

Birthweight, race, Hispanic origin of mother, and smoking status of mother	1970	1975	1980	1985	1990	1995	1996	1997	1998	1999	2000	2001
Low birthweight (less than 2,500 grams)	Percent of live births¹
All races	7.93	7.38	6.84	6.75	6.97	7.32	7.39	7.51	7.57	7.62	7.57	7.68
White	6.85	6.27	5.72	5.65	5.70	6.22	6.34	6.46	6.52	6.57	6.55	6.68
Black or African American	13.90	13.19	12.69	12.65	13.25	13.13	13.01	13.01	13.05	13.11	12.99	12.95
American Indian or Alaska Native	7.97	6.41	6.44	5.86	6.11	6.61	6.49	6.75	6.81	7.15	6.76	7.33
Asian or Pacific Islander	- - -	- - -	6.68	6.16	6.45	6.90	7.07	7.23	7.42	7.45	7.31	7.51
Chinese	6.67	5.29	5.21	4.98	4.69	5.29	5.03	5.06	5.34	5.19	5.10	5.33
Japanese	9.03	7.47	6.60	6.21	6.16	7.26	7.27	6.82	7.50	7.95	7.14	7.28
Filipino	10.02	8.08	7.40	6.95	7.30	7.83	7.92	8.33	8.23	8.30	8.46	8.66
Hawaiian	- - -	- - -	7.23	6.49	7.24	6.84	6.77	7.20	7.15	7.69	6.76	7.91
Other Asian or Pacific Islander	- - -	- - -	6.83	6.19	6.65	7.05	7.42	7.54	7.76	7.76	7.67	7.76
Hispanic or Latino²	- - -	- - -	6.12	6.16	6.06	6.29	6.28	6.42	6.44	6.38	6.41	6.47
Mexican	- - -	- - -	5.62	5.77	5.55	5.81	5.86	5.97	5.97	5.94	6.01	6.08
Puerto Rican	- - -	- - -	8.95	8.69	8.99	9.41	9.24	9.39	9.68	9.30	9.30	9.34
Cuban	- - -	- - -	5.62	6.02	5.67	6.50	6.46	6.78	6.50	6.80	6.49	6.49
Central and South American	- - -	- - -	5.76	5.68	5.84	6.20	6.03	6.26	6.47	6.38	6.34	6.49
Other and unknown Hispanic or Latino	- - -	- - -	6.96	6.83	6.87	7.55	7.68	7.93	7.59	7.63	7.84	7.96
Not Hispanic or Latino²
White	- - -	- - -	5.67	5.60	5.61	6.20	6.36	6.47	6.55	6.64	6.60	6.76
Black or African American	- - -	- - -	12.71	12.61	13.32	13.21	13.12	13.11	13.17	13.23	13.13	13.07
Cigarette smoker³	- - -	- - -	- - -	- - -	11.25	12.18	12.13	12.06	12.01	12.06	11.88	11.90
Nonsmoker³	- - -	- - -	- - -	- - -	6.14	6.79	6.91	7.07	7.18	7.21	7.19	7.32
Very low birthweight (less than 1,500 grams)
All races	1.17	1.16	1.15	1.21	1.27	1.35	1.37	1.42	1.45	1.45	1.43	1.44
White	0.95	0.92	0.90	0.94	0.95	1.06	1.09	1.13	1.15	1.15	1.14	1.16
Black or African American	2.40	2.40	2.48	2.71	2.92	2.97	2.99	3.04	3.08	3.14	3.07	3.04
American Indian or Alaska Native	0.98	0.95	0.92	1.01	1.01	1.10	1.21	1.19	1.24	1.26	1.16	1.26
Asian or Pacific Islander	- - -	- - -	0.92	0.85	0.87	0.91	0.99	1.05	1.10	1.08	1.05	1.03
Chinese	0.80	0.52	0.66	0.57	0.51	0.67	0.64	0.74	0.75	0.68	0.77	0.69
Japanese	1.48	0.89	0.94	0.84	0.73	0.87	0.81	0.78	0.84	0.86	0.75	0.71
Filipino	1.08	0.93	0.99	0.86	1.05	1.13	1.20	1.29	1.35	1.41	1.38	1.23
Hawaiian	- - -	- - -	1.05	1.03	0.97	0.94	0.97	1.41	1.53	1.41	1.39	1.50
Other Asian or Pacific Islander	- - -	- - -	0.96	0.91	0.92	0.91	1.04	1.07	1.12	1.09	1.04	1.06
Hispanic or Latino²	- - -	- - -	0.98	1.01	1.03	1.11	1.12	1.13	1.15	1.14	1.14	1.14
Mexican	- - -	- - -	0.92	0.97	0.92	1.01	1.01	1.02	1.02	1.04	1.03	1.05
Puerto Rican	- - -	- - -	1.29	1.30	1.62	1.79	1.70	1.85	1.86	1.86	1.93	1.85
Cuban	- - -	- - -	1.02	1.18	1.20	1.19	1.35	1.36	1.33	1.49	1.21	1.27
Central and South American	- - -	- - -	0.99	1.01	1.05	1.13	1.14	1.17	1.23	1.15	1.20	1.19
Other and unknown Hispanic or Latino	- - -	- - -	1.01	0.96	1.09	1.28	1.48	1.35	1.38	1.32	1.42	1.27
Not Hispanic or Latino²
White	- - -	- - -	0.86	0.90	0.93	1.04	1.08	1.12	1.15	1.15	1.14	1.17
Black or African American	- - -	- - -	2.46	2.66	2.93	2.98	3.02	3.05	3.11	3.18	3.10	3.08
Cigarette smoker³	- - -	- - -	- - -	- - -	1.73	1.85	1.85	1.83	1.87	1.91	1.91	1.88
Nonsmoker³	- - -	- - -	- - -	- - -	1.18	1.31	1.35	1.40	1.44	1.43	1.40	1.42
- - - Data not available.
¹Excludes live births with unknown birthweight. Percent based on live births with known birthweight.
²Prior to 1993, data from states lacking an Hispanic-origin item on the birth certificate were excluded.
³Percent based on live births with known smoking status of mother and known birthweight. Data from states that did not require the reporting of mother's tobacco use during pregnancy on the birth certificate are not included. Reporting area for tobacco use increased from 43 states and the District of Columbia (DC) in 1989 to 49 states and DC in 2000–01.
Notes: 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 12. Low-Birthweight Live Births, According to Mother's Detailed Race, Hispanic Origin, and Smoking Status: United Sates, Selected Years 1970–2001," in Health, United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD, 2003 [Online] http://www.cdc.gov/nchs/data/hus/tables/2003/03hus012.pdf [accessed May 14, 2004]

Natives, 6.4 percent of babies born in 1980 had low birth weights, compared to 7.3 percent in 2001. Approximately 6.7 percent of APIs had low-birth-weight babies in 1980, compared to 7.5 percent in 2001. (See Table 6.3.)

The infant mortality rate (rate of deaths before one year of age) has declined for most races and ethnic groups. In 2001 non-Hispanic African-Americans suffered the highest rate of infant mortality, with 13.5 deaths per 1,000 live births. That rate was more than double the rate for non-Hispanic whites, which was 5.7 deaths per 1,000 live births. Hispanic women had 5.4 deaths per 1,000 live births, while Native Americans and Alaska Natives had 9.7 deaths (a substantial increase over 8.3 percent in 2000) and APIs had 4.7 deaths per 1,000 live births. (See Table 6.4.)

TABLE 6.4
Infant mortality rates, according to detailed race and Hispanic origin of mother, selected years 1983–2001
[Data are based on linked birth and death certificates for infants]

Race and Hispanic origin of mother	1983¹	1985¹	1990¹	1995²	1998²	1999²	2000²	2001²
			Infant³ deaths per 1,000 live births
All mothers	10.9	10.4	8.9	7.6	7.2	7.0	6.9	6.8
White	9.3	8.9	7.3	6.3	6.0	5.8	5.7	5.7
Black or African American	19.2	18.6	16.9	14.6	13.8	14.0	13.5	13.3
American Indian or Alaska Native	15.2	13.1	13.1	9.0	9.3	9.3	8.3	9.7
Asian or Pacific Islander	8.3	7.8	6.6	5.3	5.5	4.8	4.9	4.7
Chinese	9.5	5.8	4.3	3.8	4.0	2.9	3.5	3.2
Japanese	*5.6	*6.0	*5.5	*5.3	*3.4	*3.5	*4.5	*4.0
Filipino	8.4	7.7	6.0	5.6	6.2	5.8	5.7	5.5
Hawaiian	11.2	*9.9	*8.0	*6.5	9.9	*7.0	9.0	*7.3
Other Asian or Pacific Islander	8.1	8.5	7.4	5.5	5.7	5.1	4.8	4.8
Hispanic or Latino^4,5	9.5	8.8	7.5	6.3	5.8	5.7	5.6	5.4
Mexican	9.1	8.5	7.2	6.0	5.6	5.5	5.4	5.2
Puerto Rican	12.9	11.2	9.9	8.9	7.8	8.3	8.2	8.5
Cuban	7.5	8.5	7.2	5.3	*3.7	4.6	4.6	4.2
Central and South American	8.5	8.0	6.8	5.5	5.3	4.7	4.6	5.0
Other and unknown Hispanic or Latino	10.6	9.5	8.0	7.4	6.5	7.2	6.9	6.0
Not Hispanic or Latino:
White⁵	9.2	8.6	7.2	6.3	6.0	5.8	5.7	5.7
Black or African American⁵	19.1	18.3	16.9	14.7	13.9	14.1	13.6	13.5
*Estimates are considered unreliable. Rates preceded by an asterisk are based on fewer than 50 events. Rates not shown are based on fewer than 20 events.
¹Rates based on unweighted birth cohort data.
²Rates based on a period file using weighted data.
³Infant (under 1 year of age)
⁴Persons of Hispanic origin may be of any race.
⁵Prior to 1995, data shown only for states with an Hispanic-origin item on their birth certificates.
Notes: The race groups white, black, American Indian or Alaska Native, and Asian or Pacific Islander include persons of Hispanic and non-Hispanic origin. National linked files do not exist for 1992–94.
SOURCE: "Table 19. Infant, Neonatal, and Postneonatal Mortality Rates, According to Detailed Race and Hispanic Origin of Mother: United States, Selected Years 1983–2001," in Health, United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD, 2003 [Online] http://www.cdc.gov/nchs/data/hus/tables/2003/03hus019.pdf [accessed May 14, 2004]

Health - Pregnancy And Birth

Births and Fertility

Low Birth Weight and Infant Mortality

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