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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

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LEND Presentation April, 2008

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  1. 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

  2. MCHB BUDGET 2008

  3. 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)

  4. 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)

  5. 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)

  6. 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

  7. 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

  8. 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

  9. 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

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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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.

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

  27. 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

  28. 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

  29. 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.

  30. Contact Peter C. van Dyck, M.D., M.P.H. HRSA/MCHB http://mchb.hrsa.gov/

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