Lend presentation april 2008
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LEND Presentation April, 2008

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Lend presentation april 2008

  • This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • In Slide Show, click on the right mouse button

  • Select “Meeting Minder”

  • Select the “Action Items” tab

  • Type in action items as they come up

  • Click OK to dismiss this box

  • This will automatically create an Action Item slide at the end of your presentation with your points entered.

LENDPresentationApril, 2008

Health Resources And Services Administration

Maternal And Child Health Bureau

Peter C. Van Dyck, MD, MPH


Lend presentation april 2008

MCHB

BUDGET 2008


The mch bureau authorizing legislation

The MCH Bureau Authorizing Legislation

  • MCH Services Block Grant (Title V, Social Security Act)

  • Traumatic Brain Injury (Section 1252 and 1253 Public Health Service Act)

  • Healthy Start (Title III, Public Health Service Act, Section 330H)


The mch bureau authorizing legislation1

The MCH Bureau Authorizing Legislation

  • Emergency Medical Services Children (Section 1910, Public Health Service Act)

  • Newborn Hearing Screening (Title III, Public Health Service Act, Section 399M)


The mch bureau authorizing legislation2

The MCH Bureau Authorizing Legislation

  • Sickle Cell Service Demonstration Program (Section 712(c) of the American Jobs Creation Act of 2004)

  • Family to Family Health Information Centers (Section 501(c)(1)(A) of the Social Security Act)


Mch formula and allocation

MCH Formula and Allocation

  • Whenever the total appropriation exceeds $600 million;

    • 12.75% of the amount is used to fund the Community Integrated Service System (CISS) set-aside program

    • Remainder is allocated as 85% to States and 15% retained by the Secretary for SPRANS projects


Mch budget for 2007 and 2008 millions

MCH Budget for 2007 and 2008 (millions)

FY2007

2008(PB)

2008(H)

2008(S)

2008(APPR)

  • MCHBG…$693.0….$693.0….$750.0….$673.0….$666.2

    • State..….$566.5...$578.9…..$568.9...$566.5…$556.6

    • SPRANS...$99.9…$102.2…..$100.4..…$79.9.….$78.6

    • CISS………$10.6…$11.9......$10.1….…$10.6…...$10.4

    • Earmark...$16.0…------….….$70.6…...$16.0…...$20.6

1-numbers may not add due to rounding


Mch budget for 2007 and 2008 millions1

MCH Budget for 2007 and 2008 (millions)

FY2007

2008(PB)

2008(H)

2008(S)

2008(A)

  • Healthy Start...$101.5...$100.5...$120.0...$101.5…$99.7

  • Hearing…….….....$9.8…...-----.……$11.0.…$12.0….$11.8

  • EMSC……….…….$19.8.....-----…….$22.3..…$20.0.…$19.5

  • TBI………….………$8.9…...-----….….$8.9……$10.0…..$8.8

  • Sickle Cell….…....$2.2…...$2.2………$2.2.….$3.2…….$2.7

  • Family to Family.$3.0…...$4.0………$4.0…..$4.0…….$4.0

  • Autism………….….-----…...-----……..$0.0…...$37.0….$36.4

1-numbers may not add due to rounding


Mch budget for 2007 and 2008 millions2

MCH Budget for 2007 and 2008 (millions)

2007

2008(PB)

2008(H)

2008(S)

2008(A)

SPRANS Earmarks

  • Oral Health…...$4.80…$0.0….$12.0…….$4.8……$4.72

  • Sickle Cell…..…$3.84…$0.0…...$4.0…….$3.84.…$3.77

  • Epilepsy…….....$2.88...$0.0……$5.8..….$2.88….$2.83

  • Genetics….….…$1.92…$0.0..….$3.8..….$1.92….$1.89

  • Mental Health..$1.54…$0.0…….$0.0…...$0.0……$0.0

  • Fetal Alcohol.…$0.99…$0.0…….$0.0…...$0.99….$0.97

  • 1rst Mother……..-----….-----……..-----..…$1.54….$1.51

  • Prepare Birth…..-----….-----…...$15.0….…-----…..$4.9

  • Autism……………-----…..-----……$30.0…….-----…..$0.0

1-numbers may not add due to rounding


Lend presentation april 2008

Healthy People 2010 Focus Area 16:Maternal, Infant, and Child HealthProgress ReviewSeptember 20, 2007


Lend presentation april 2008

Overview

  • Approximately 6 million pregnancies each year in U.S.

  • U.S. infant mortality internationally ranked 29th (2004)

  • Birth defects affect 1 in 33 U.S. births annually

  • 2005 (preliminary) U.S. cesarean rate is highest ever recorded

  • Breastfeeding saves on health care costs: reduced sick care visits, prescriptions, hospitalizations


Lend presentation april 2008

Highlighted Objectives

Target met or exceeded

16-13 Infants put to sleep on their backs

16-14c Autism spectrum disorder

Improving

16-1c Infant mortality

16-1h Sudden infant death syndrome (SIDS)

16-6a Prenatal care

16-15 Neural tube defects (NTDs)

16-16a Folic acid consumption

16-19 Breastfeeding

Getting worse

16-4 Maternal mortality

16-9 Cesarean births

16-10a Low birthweight

16-11a Preterm births

No trend data

16-23 Service systems for special health care needs


Lend presentation april 2008

SIDS deaths

Infants put to sleep on their backs

Per 100,000 live births

Sudden Infant Death Syndrome

and Sleep Position

Percent

80

80

Sleep position 2010 Target: 70

60

60

40

40

20

20

SIDS deaths 2010 Target: 23

0

0

2002

2004

2003

1999

2000

2001

1998

1996

1997

SOURCE: National Vital Statistics System (NVSS), NCHS, CDC and National Infant Sleep Position Study, NICHD, NIH.

Obj. 16-1h & 16-13


Lend presentation april 2008

Age at Identification of Autism Spectrum Disorder, Metropolitan Atlanta, 2002

Decrease desired

Median age (months)

0

Total

White

Black

Hispanic

Female

Male

n=180

62

2010 Target: 66

n=91

n=71

n=10

n=27

n=153

0 36 48 60 72 84 96

Median Age (Months)

Note: The data are for children aged 8 years of age in metropolitan Atlanta, Georgia. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race.

SOURCE: Metropolitan Atlanta Development Disabilities Surveillance Program (MADDSP), CDC, NCBDDD.

Obj. 16-14c


Lend presentation april 2008

Infant Mortality

Decrease desired

Rate per 1,000 live births

16

14

Black

12

10

American Indian

8

Total

White

6

Hispanic

Asian

4

2010 Target: 4.5

2

0

1998 1999 2000 2001 2002 2003 2004

Note: Includes all deaths <1 year. American Indian includes Alaska Native. Asian includes Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. For 1940-79, infant deaths are classified by their race as reported on the death certificate. For 1980-2004, infant deaths are classified by race of mother.

SOURCE: National Vital Statistics System (NVSS), NCHS, CDC.

Obj. 16-1c


Lend presentation april 2008

Infant Mortality

Decrease desired

Rate per 1,000 live births

White

Black

1940

2004

Rate per 1,000 live births

16

14

Black

12

10

American Indian

8

Total

White

6

Hispanic

Asian

4

2010 Target: 4.5

2

0

1998 1999 2000 2001 2002 2003 2004

Note: Includes all deaths <1 year. American Indian includes Alaska Native. Asian includes Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. For 1940-79, infant deaths are classified by their race as reported on the death certificate. For 1980-2004, infant deaths are classified by race of mother.

SOURCE: National Vital Statistics System (NVSS), NCHS, CDC.

Obj. 16-1c


Lend presentation april 2008

5 Leading Causes of Infant Death*, 2004

Number (thousands)

6

A re-analysis of cause of death data indicates that 37% of infant deaths are due to preterm-related causes of death.

5

4

3

(20%)

(17%)

2

(8%)

1

(6%)

(4%)

0

Short gestation/

low birthweight§

SIDS

Maternal

pregnancy

complications

Unintentional

injuries

Congenital

anomalies

*Includes all deaths <1 year. §Not elsewhere classified.Note: SIDS represents “Sudden Infant Death Syndrome.”

SOURCE: National Vital Statistics System (NVSS), NCHS, CDC.


Lend presentation april 2008

Prenatal Care

Beginning in First Trimester, 2004

Increase desired

84

Total

American Indian

Black

Hispanic

Asian

White

< 15 years

15-19 years

20-24 years

25-29 years

30-34 years

35+ years

Less than high school

High school

At least some college

2010 Target: 90

0 40 50 60 70 80 90 100

Percent

= 95% confidence interval. Note: American Indian includes Alaska Native. Asian includes Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Excludes estimates for ID, FL, KY, NH, NY (not inc. NYC), PA, SC, TN, and WA. Data by education level are for mothers aged 20 years and over. Data for 2003 exclude PA and WA. SOURCE: National Vital Statistics System (NVSS), CDC, NCHS.

Obj. 16-6a


Lend presentation april 2008

Prenatal Care

Beginning in First Trimester, 2004

Percent of live births

Increase desired

1990

2003

84

Total

American Indian

Black

Hispanic

Asian

White

< 15 years

15-19 years

20-24 years

25-29 years

30-34 years

35+ years

Less than high school

High school

At least some college

2010 Target: 90

0 40 50 60 70 80 90 100

Percent

= 95% confidence interval. Note: American Indian includes Alaska Native. Asian includes Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Excludes estimates for ID, FL, KY, NH, NY (not inc. NYC), PA, SC, TN, and WA. Data by education level are for mothers aged 20 years and over. Data for 2003 exclude PA and WA. SOURCE: National Vital Statistics System (NVSS), CDC, NCHS.

Obj. 16-6a


Lend presentation april 2008

Recommended Daily Intake of Folic Acid

and Neural Tube Defects

Decrease desired

Increase desired

Per 10,000 live births

2010 Target: 3

Spina Bifida

and Other NTDs§

Baseline data

Most recent data

Percent

2010 Target: 80

1991-94

2003

2003-04

1996

Recommended Daily

Intake of Folic Acid*

*Proportion of non pregnant women aged 15-44 years getting ≥400µg of folic acid per day from supplements and fortified foods. § New cases among live births and fetal deaths at greater than 20 weeks gestation.

SOURCE: National Health and Nutrition Examination Survey, NCHS, CDC and National Birth Defects Prevention Network, NCBDDD, CDC.

Obj. 16-15 & 16-16a


Lend presentation april 2008

Any Breastfeeding

Increase desired

Percent

2000

2002

2004

100

2010 Target: 75

80

60

2010 Target: 50

40

2010 Target: 25

20

0

Ever

At 12 months

At 6 months

= 95% confidence interval. Note: Any breastfeeding is defined by breastmilk as at least one of the types of milk

an infant was fed. Data are presented by birth year.

SOURCE: National Immunization Survey (NIS), CDC, NCIRD and NCHS.

Obj. 16-19a, b, c


Lend presentation april 2008

Exclusive Breastfeeding

Through 6 Months, 2004

Increase desired

Total

Black

American Indian

Hispanic

White

Native Hawaiian

Asian

Less than high school

High school

Some college

College graduate

11

2010 Target: 17

0 20 40 60 80 100

Percent

= 95% confidence interval. Note: Exclusive breastfeeding is defined as no food or drink other than breastmilk. Data are presented by birth year. Native Hawaiian includes other Pacific Islander. American Indian includes Alaska Native. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. Data for races shown are not mutually exclusive.

SOURCE: National Immunization Survey (NIS), CDC, NCIRD and NCHS.

Obj. 16-19e


Lend presentation april 2008

Maternal Mortality, 2004

Decrease desired

Total

Hispanic

Asian

White

Black

<20 years

20-24 years

25-29 years

30-34 years

35 years and over

13.1

2010 Target: 4.3

0 10 20 30 40 50

Rate per 100,000 live births

= 95% confidence interval. Note: Data for the American Indian and Alaska Native population are statistically unreliable and are suppressed. Asian includes Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race.

SOURCE: National Vital Statistics System (NVSS), CDC, NCHS.

Obj. 16-4


Lend presentation april 2008

First Cesarean Births

Among Low-Risk Pregnancies*

Decrease desired

Percent

30

20

10

0

2010 Target: 15

1998 1999 2000 2001 2002 2003 2004

* Among women with no prior cesarean birth, a low-risk pregnancy is defined as one with a full-term (at least 37 weeks gestation) singleton (not a multiple pregnancy), with vertex presentation (head facing in a downward position in the birth canal).

SOURCE: National Vital Statistics System (NVSS), NCHS, CDC.

Obj. 16-9a


Lend presentation april 2008

Repeat Cesarean Births

Among Low-Risk Pregnancies*

Decrease desired

Percent

100

90

80

70

60

0

2010 Target: 63

1998 1999 2000 2001 2002 2003 2004

* Among women with a prior cesarean birth, a low-risk pregnancy is defined as one with a full-term (at least 37 weeks gestation) singleton (not a multiple pregnancy), with vertex presentation (head facing in a downward position in the birth canal).

SOURCE: National Vital Statistics System (NVSS), NCHS, CDC.

Obj. 16-9b


Lend presentation april 2008

Low and Very Low Birthweight Infants, 2004

Decrease desired

Percent of live births

Low Birthweight (<2500 grams)

Very low birthweight (<1500 grams)

2010 Target: 5

2010 Target: 0.9

American

Indian

Total

White

Asian

Black

Hispanic

Percent of live births

Low birthweight

(<2500 grams)

Very low birthweight

(<1500 grams)

= 95% confidence interval. Note: American Indian includes Alaska Native. Asian includes Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race.

SOURCE: National Vital Statistics System (NVSS), CDC, NCHS.

Obj. 16-10a & b


Lend presentation april 2008

Percent of live births

Preterm Births, 2004

Percent of live births

Decrease desired

32-36 weeks

<32 weeks

<32 weeks

32-36 weeks

2010 Target

Total preterm births: 7.6

Black

Total

Asian

White

Hispanic

American

Indian

Note: American Indian includes Alaska Native. Asian includes Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race.

SOURCE: National Vital Statistics System (NVSS), NCHS, CDC.

Obj. 16-11 a, b, & c


Lend presentation april 2008

Children With Special Health Care Needs Who Have Comprehensive Care Systems*, 2001

Increase desired

Total

2 or more races

American Indian

Hispanic

Black

Asian

White

Native Hawaiian

Poor

Near poor

Middle/high income

35

2010 Target: 100

0 20 40 60 80 100

Percent

*Proportion of children under 18 years of age with special health care needs who receive their care in family-centered, comprehensive, and coordinated systems. Note: American Indian includes Alaska Native. Native Hawaiian includes other Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race.

SOURCE: National Survey of Children with Special Health Care Needs, CDC, NCHS and HRSA, MCHB

Obj. 16-23


Lend presentation april 2008

Summary

  • Improvements in infant mortality have stalled as preterm births and low birth weight have increased.

  • Cesarean deliveries have continued to increase over the past decade, and maternal mortality has not improved.

  • Major racial and ethnic disparities persist.

  • Breastfeeding rates have improved, but long-term and exclusive breastfeeding rates remain low.

  • Improvements in rates of sudden infant death syndrome and neural tube defects have corresponded with public health interventions.


Contact

Contact

Peter C. van Dyck, M.D., M.P.H.

HRSA/MCHB

http://mchb.hrsa.gov/


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