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ALAMEDA COUNTY MATERNAL AND INFANT HEALTH INDICATORS
Alameda County Public Health DepartmentHealth Care Services Agency
October 2018
Kiko Malin, Jill Miller, Lisa Goldberg and Misha Taherbhai.Alameda County Public Health Department.
Key Questions
1. Who is giving birth in Alameda County?
2. How healthy are moms, newborns, and infants in Alameda County and what health inequities exist?
3. How healthy are young children and women of child bearing age in Alameda County and what inequities exist?
4. How has Alameda County been doing over time and within different communities?
5. How is Alameda County doing compared to Healthy People 2020 (HP2020) and within California?
2
Types of Data Presented3
Count: Number of events or cases at a given point in time.
Counts are used to look at the magnitude of the health event within a population.
22,148
21,414
19,572 19,551
18,000
19,000
20,000
21,000
22,000
23,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Nu
mb
er o
f B
irth
s
In 2016, there were
19,551 births in
Alameda County.
Types of Data Presented4
Percentage: Share of events over the population that can be
affected at a given point in time. Percentages are used to compare populations of different sizes for example comparing different
races/ethnicities or age groups.10-19 years 2.1%
20-34 years 69.9%
35-49 years 27.9%
In 2016, 27.9% of births
where to women 35-49
years of age.
Types of Data Presented5
Rate: measure of a health event in a specific population over a set time
period.
Rates are used to compare populations of different sizes or over different time periods.
15.315.0
14.8 14.7
14.2 14.3 14.414.5
14.0
13.5
12.712.4
12.612.3
12.512.3
12.1
11
12
13
14
15
16
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016Bir
th R
ate
(# b
irth
s/1
,00
0 p
op
ula
tio
n)
The Alameda County
birth rate went from
15.3 births per 1,000
population in 2000 to
12.1 in 2016.
Ratio: a relationship between two numbers indicating how many
times the first number contains the second. Ratios are used to show health disparities or to compare outcomes across different groups.
8.6%
5.9% 5.8% 5.8%5.4%
4.8%4.1%
0%
2%
4%
6%
8%
10%
12%
AfricanAmerican
Asian PacificIslander
Multirace All Races Latino White
Perc
enta
ge L
ow
& V
ery
Low
Bir
th
Wei
ghts
(%
)
Types of Data Presented6
In 2016, the percentage of low birth weight births among African
Americans was 2.1 times the percentage of low birth weight births
among whites.
Determining Baby’s Race/Ethnicity 7
The Birth Certificate allows mothers to select up to 3 race groups and Latino/Hispanic ethnicity
Mother’s race/ethnicity determines baby’s race/ethnicity.
Race/Ethnicity is mutually exclusive (one category per mother & baby).
Race Categories
African American NH
American Indian NH
Asian NH
Pacific Islander NH
White NH
Multirace NH- More than 1 of the above
Hispanic/Latino Ethnicity-Any Race
Mexican
Chicano
Puerto Rican
Cuban
Central/South American
Declined to State (DTS) Race/Ethnicity
Mother’s Race/Ethnicity not included on baby’s birth certificate
“Refused to State” or “Unknown”
8
▪ Births
▪ Age
▪ Non US–Born Moms
▪ First-Time Moms
▪ Medi-Cal & WIC Births
▪ Recent Data
▪ Trends
▪ Race/Ethnicity
▪ Location/Place
Who is giving birth in Alameda County?
Birth Trend in Alameda County, 2000-2016
Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.
9
22,148
21,414
19,572 19,551
18,000
19,000
20,000
21,000
22,000
23,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Nu
mb
er o
f B
irth
s
Annual Birth Rate Trend in Alameda County, 2000-201610
Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.
15.3
15.014.8
14.7
14.2 14.3 14.414.5
14.0
13.5
12.7
12.412.6
12.312.5
12.312.1
11
12
13
14
15
16
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Bir
th R
ate
(Bir
ths
per
1,0
00
po
pu
lati
on
)
Birth Rate Trend by Race/Ethnicity, 2000-201611
Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.
0
2
4
6
8
10
12
14
16
18
20
22
24
2000-02 2002-04 2004-06 2006-08 2008-10 2010-12 2012-14 2014-16
Bir
th r
ate
(Bir
ths
per
1,0
00
po
pu
lati
on
)
PacIsl
Hisp/Lat
Asian
All Races
AfAm/Black
White
Multirace
AmerInd
6,162
5,126
4,513
1,5851,344
618
170 330
1000
2000
3000
4000
5000
6000
Asian Latino White Black/ AfricanAmerican
Other/Unknown Multirace Pacific Islander American Indian
Nu
mb
er o
f B
irth
s
Number of Births by Race/Ethnicity, 201612
Source: CAPE, with data from Alameda County Vital Statistics files, 2016.
19,551 Births
Birth Rate by Race/Ethnicity, 201613
Source: CAPE, with data from Alameda County Vital Statistics files, 2016.
13.913.5 13.4
12.1
9.2 9.0 8.67.9
0
2
4
6
8
10
12
14
16
18
Latino Pacific Islander Asian All Races AfricanAmerican
Multirace White AmericanIndian
Bir
th r
ate
(B
irth
s p
er 1
,00
0 p
op
ula
tio
n)
Birth Rate by City/Place, 2014-201614
Source: CAPE, with data from Alameda County Vital Statistics files, 2014-16.
6.56.5
7.28.1
10.210.4
10.811.6
11.912.012.112.212.312.3
12.813.0
13.413.6
14.414.915.015.0
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0
Piedmont
Sunol
Berkeley
Pleasanton
Remainder of County
Castro Valley
Alameda
Fairview
San Leandro
San Lorenzo
Livermore
Emeryville
Alameda County
Union City
Albany
Fremont
Oakland
Newark
Hayward
Dublin
Ashland
Cherryland
Percentage of Births by Alameda County Hospital, 2008-201615
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2016.
0%
5%
10%
15%
20%
25%
30%
2008 2009 2010 2011 2012 2013 2014 2015 2016
Perc
enta
ge o
f A
nn
ual
Bir
ths
Alta Bates (Berkeley)
Kaiser Hayward/San Leandro
Washington (Fremont)
Kaiser Oakland
Highland General (Oakland)
ValleyCare (Pleasanton)
St Rose (Hayward)
Eden (Castro Valley)
Home Births
Source: CAPE, with data from Alameda County Vital Statistics files, 2000 and 2016
Percentage of Total Births by Age Category, 2000 & 201616
10-19 years 7.8%
20-34 years 73.4%
35-49 years 18.8%
2000 Births
10-19 years 2.1%
20-34 years 69.9%
35-49 years 27.9%
2016 Births
17.7
12.3
8.3
5.6
4.1
2.8
1.2
0
5
10
15
20
Latino Black/AfricanAmerican
All Races Multirace PacificIslander
White Asian
Teen
Bir
th R
ate
(Bir
ths
per
1,0
00
fem
ales
age
s1
5-1
9 y
ears
)
Teen Birth Rate by Race/Ethnicity, 201617
Source: CAPE, with data from Alameda County Vital Statistics files, 2016.
415 Teen Births
Teen Birth Rate Trend by Race/Ethnicity, 2000-201618
Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.
0
10
20
30
40
50
60
70
2000-02 2002-04 2004-06 2006-08 2008-10 2010-12 2012-14 2014-16
Teen
Bir
th R
ate
(Bir
ths
per
1,0
00
fem
ales
age
s 1
5-1
9
year
s)
Hisp/Lat
PacIsl
AfAm/Black
All Races
Multi
White
Asian
19
52.8%
48.2% 47.7%
44.0%40.9%
34.9%
30.3% 30.0%
0%
10%
20%
30%
40%
50%
60%
Multirace White Asian All Races Black/ AfricanAmerican
Latino AmericanIndian
PacificIslander
Perc
enta
ge o
f Fi
rst
Tim
e M
om
s
Percentage of First Child Births (First-time Moms) by Race/Ethnicity, 2016
20
Source: CAPE, with data from Alameda County Vital Statistics files, 2016.
8,594 First Child Births
81.6%
54.5%52.1% 50.0%
20.5%17.7%
11.0%
0%
20%
40%
60%
80%
100%
Asian Latino Pacific Islander All Races White Black Multirace
Perc
enta
ge o
f B
irth
s
Percentage Births to Non US-born Mothers by Race/Ethnicity, 201621
Source: CAPE, with data from Alameda County Vital Statistics files, 2016.
9,777 non US-born Mom Births
Top 5 Countries of Mothers’ Birth, 201622
Asian
Ranking CountryNumber live
births 1 India 1,8182 China 1,277
3 US 1,133
4 Philippines 556
5 Other 343
6 Vietnam 315
Source: Alameda County Vital Statistics files, 2016.
Latino
Ranking CountryNumber live
births 1 US 2,3292 Mexico 1,857
3 El Salvador 333
4 Guatemala 313
5 Other 191
0%
10%
20%
30%
40%
50%
60%
2000-02 2002-04 2004-05 2006-08 2008-10 2010-12 2012-14 2014-16
Perc
enta
ge o
f M
edi-
Cal
Bir
ths
Hisp/Lat
AfAm/Black
AmerInd
PacIsl
All Races
Multirace
Asian
White
Percentage of Medi-Cal Births* by Race/Ethnicity, 2000-2016
23
Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.*Medi-Cal births are underestimates due to missing data
2016 Medi-Cal Births Range: 4,890-6,516.
0%
20%
40%
60%
80%
100%
2008 2009 2010 2011 2012 2013 2014 2015 2016
Perc
enta
ge S
har
e o
f M
edi-
Cal
Bir
ths Highland General
(Oakland)
St Rose (Hayward)
Alta Bates (Berkeley)
ValleyCare (Pleasanton)
Eden (Castro Valley)
Washington (Fremont)
Home Births
Kaiser Oakland
Kaiser Hayward/SanLeandro
Percentage Share of Medi-Cal Births* within each Alameda County Hospital, 2008-2016
24
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2016.
*Medi-Cal births are underestimates due to missing data2016 Medi-Cal Births Range: 4,890-6,516.
Percentage of WIC Participant Births by Race/Ethnicity, 2008-2016
25
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2016.
0%
10%
20%
30%
40%
50%
60%
70%
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16
Perc
enta
ge o
f W
IC P
arti
cip
ant
Bir
ths
Hisp/Lat
AfAm/Black
AmerInd
PacIsl
All Races
Multirace
Asian
White
26
▪ Prenatal Care
▪ Premature Birth
▪ Low Birth Weight
▪ Infant Deaths
▪ Fetal Deaths
▪ Recent Data
▪ Trends
▪ Race/Ethnicity
▪ Compared to HP2020 & California
How healthy are moms & newborns in Alameda County?
Percentage of Medi-Cal Prenatal Care* by Race/Ethnicity, 2008-2016
27
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2016.
*Medi-Cal prenatal care visits are underestimates due to missing data.
0%
10%
20%
30%
40%
50%
60%
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16
Perc
enta
ge o
f M
edi-
Cal
Pre
nat
al C
are
Hisp/Lat
AfAm/Black
AmerInd
PacIsl
All Races
Multirace
Asian
White
Percentage of First Trimester Prenatal Care by Race/Ethnicity, 2016
28
17,265 1st Trimester Entry into Prenatal CareSource: CAPE, with data from Alameda County Vital Statistics files, 2016.
76.5%
85.2% 87.2%89.4% 91.5% 91.7% 92.8% 93.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Pacific Islander AfricanAmerican/
Black
Latino All Races White Asian Multirace AmericanIndian
Perc
enta
ge o
f 1
st T
rim
este
r P
ren
atal
Car
e
75.7%
67.6%
77.3%
60%
65%
70%
75%
80%
85%
90%
95%
100%
2000-02 2002-04 2004-05 2006-08 2008-10 2010-12 2012-14 2014-16
Perc
enta
ge o
f 1
st T
rim
este
r En
try
into
Pre
nat
al C
are
Asian
White
Multirace
All Races
AmerInd
AfAm/Black
Hisp/Lat
PacIsl
Percentage of First Trimester Prenatal Care Trend by Race/Ethnicity, 2000-2016
29
Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.
93.8%92.8%
89.0%88.0%
76.9%
91.9%
88.2%
83.8%
87.9%
77.7%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Asian White Black/African American Hispanic/Latino Pacific Islander
Perc
enta
ge 1
st T
rim
este
r P
ren
atal
Car
eUS born Non-US born
Percentage of First Trimester Prenatal Care by Race/Ethnicity for US versus Non-US Born Mothers, 2012-2016
30
Source: CAPE, with data from Alameda County Vital Statistics files, 2012-2016.
75.4%
69.8% 69.6% 68.8%66.7% 65.7% 65.3%
56.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Asian White All Races Multirace AmericanIndian
AfricanAmerican/
Black
Latino Pacific Islander
Perc
enta
ge A
deq
uat
e/A
deq
uat
e P
us
PN
C
Percentage of Adequate/Adequate Plus Prenatal Care by Race/Ethnicity, 2016
31
13,607 Adequate/Adequate Plus Prenatal CareSource: CAPE, with data from Alameda County Vital Statistics files, 2016.
Percentage of Adequate/Adequate Plus Prenatal Care by Race/Ethnicity, 2008-2016
32
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2016.
66.1%67.6%
58.9%
40%
50%
60%
70%
80%
90%
100%
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16
Perc
enta
ge A
deq
uat
e/A
deq
uat
e P
lus
Pre
nat
al C
are
Asian
White
Multirace
All Races
AmerInd
AfAm/Black
Hisp/Lat
PacIsl
77.7%
74.5%
65.3%
70.8%
57.9%
80.6%
69.5%
60.6%
67.1%
61.0%
50%
60%
70%
80%
Asian White Black/African American Hispanic/Latino Pacific Islander
Perc
enta
ge A
deq
uat
e P
ren
atal
Car
e US born Non -US born
Percentage of Adequate Prenatal Care by Race/Ethnicity for US versus non-US Born Mothers, 2012-2016
33
Source: CAPE, with data from Alameda County Vital Statistics files, 2012-2016.
8.4% 8.2%
7.1%6.8%
6.6% 6.5%
5.5%
0%
2%
4%
6%
8%
10%
AfricanAmerican/ Black
Multirace Pacific Islander Latino All Races Asian White
Perc
enta
ge P
rete
rm b
irth
(<3
7 w
eeks
ges
tati
on
al a
ge)
Percentage Singleton Premature Births by race/ethnicity, 201634
1.5 times
1,229 Premature BirthsSource: CAPE, with data from Alameda County Vital Statistics files, 2016.
14.0%
9.5%
7.4%
5.2%
0%
2%
4%
6%
8%
10%
12%
14%
2000-02 2002-04 2004-05 2006-08 2008-10 2010-12 2012-14 2014-16
Perc
enta
ge o
f P
rem
atu
re B
irth
s (<
37
wee
ks g
esta
tio
nal
ag
e)
AfAm/Black
Asian
All Races
Multirace
PacIsl
Hisp/Lat
White
Percentage of Singleton Premature Births Trend by Race/Ethnicity, 2000-2016
35
Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.
1.8 times
1.9 times
1,229 Singleton Premature Births (2016)
10.6%
7.3% 7.5%7.1%
5.3%
4.1%
6.8%
4.2%
6.6%
7.6%
5.3%
8.6%
0%
2%
4%
6%
8%
10%
12%
Black/AfricanAmerican
MultiRace Asian Hispanic/Latino White Pacific Islander
Perc
enta
ge P
rem
atu
re B
irth
s (%
)US born Non US-born
Percentage Singleton Premature Births by Race/Ethnicity for US versus non US Born Mothers, 2012-2016
36
Source: CAPE, with data from Alameda County Vital Statistics files, 2012-2016.
8.6%
5.9% 5.8% 5.8%5.4%
4.8%
4.1%
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
Black/ AfricanAmerican
Asian Pacific Islander Multirace All Races Latino White
Perc
enta
ge L
ow
Bir
th W
eigh
t B
irth
s (<
2,5
00
gra
ms)
Percentage Singleton Low Birth Weight (LBW) Births by race/ethnicity, 2016
37
2.1 times
1,027 LBW BirthsSource: CAPE, with data from Alameda County Vital Statistics files, 2016.
10.3%
9.2%
3.6% 3.8%
0%
2%
4%
6%
8%
10%
12%
2000-02 2002-04 2004-05 2006-08 2008-10 2010-12 2012-14 2014-16
Perc
enta
ge o
f Lo
w B
irth
Wei
ght
Bir
ths
(<2
,50
0 g
ram
s)
AfAm/Black
Asian
All Races
Multirace
Hisp/Lat
White
Percentage of Singleton, Low Birth Weight Births Trend by Race/Ethnicity, 2000-2016
38
Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.
2.4 times
2.8 times
9.9%
7.0%
5.5%5.0%
3.7%
2.1%
4.9%
6.1%
4.1%4.8%
4.0%
7.0%
0%
2%
4%
6%
8%
10%
12%
Black/AfricanAmerican
Asian MultiRace Hispanic/Latino White Pacific Islander
Perc
enta
ge L
ow
Bir
th W
eigh
t B
irth
s (<
2,5
00
gra
ms)
US born Non-US born
Percentage Singleton Low Birth Weight by Race/Ethnicity for US versus non-US Born Mothers, 2012-2016
39
Source: CAPE, with data from Alameda County Vital Statistics files, 2012-2016.
Number of Infant Deaths in Alameda County, 2000-2016
40
Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.
101
132
90
97
109 106
90
105
89
78
94
80
73
86
75 75
67
60
80
100
120
140
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Nu
mb
er o
f In
fan
t D
eath
s
4.9 4.9
4.6
4.94.9
4.8
4.5
4.3 4.3 4.3 4.3
4.2
4.04.1
3.7
3.5
3.7
3.9
4.1
4.3
4.5
4.7
4.9
2000-02 2002-04 2004-05 2006-08 2008-10 2010-12 2012-14 2014-16
Infa
nt
Mo
rtal
ity
Rat
e (
dea
ths
per
1,0
00
live
bir
ths)
Infant Mortality Rate Trend in Alameda County, 2000-2016
41
Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.
1.2 decrease (24 fewer deaths)
African American 22.1% (16)
Latino 28.6% (21)
Asian 16.6% (12)
White 18.9% (14)
Multirace 10.6% (8)
Pacific Islander 1.8% (1)
Other/Unknown 1.4% (1)African
American 8.6% (1,679)
Latino 26.8% (5,234
Asian 30.8% (6,006)
White 23.1% (4,503)
Multirace 3.0% (582)
Pacific Islander 1.0%
(192)
Other/Unknown 6.6% (1,320 )
Percentage of Births v. Infant Deaths by Race/Ethnicity, 2014-2016
42
Births=19,517 Infant Deaths= 72
Source: CAPE, with data from Alameda County Vital Statistics files, 2014-2016.
Infant Mortality Rate by Race/Ethnicity, 2014-2016
Source: CAPE, with data from Alameda County Vital Statistics files, 2014-2016.
43
Average Annual Number Infant Deaths = 72
9.5
3.9 3.7
3.0
2.0
0
2
4
6
8
10
African American/Black
Latino All Races White Asian
Infa
nt
Mo
rtal
ity
Rat
e (d
eath
s p
er 1
,00
0 li
ve b
irth
s)3.2 times
10.6
11.7
9.3
10.210.8
12.011.7
9.5
8.17.6
8.9
10.4
11.4 11.6
9.5
0
2
4
6
8
10
12
14
2000-02 2002-04 2004-05 2006-08 2008-10 2010-12 2012-14 2014-16
Infa
nt
Mo
rtal
ity
Rat
e (d
eath
s p
er 1
,00
0 li
ve b
irth
s)
AfAm/Black
Hisp/Lat
All Races
White
Asian
Infant Mortality Rate Trend by Race/Ethnicity, 2000-201644
Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.
3.2 times
2.8 times
6.6
2.8 2.51.9
1.3
3.0
1.11.2
1.2
0.7
0
2
4
6
8
10
12
African American/Black
Latino Alameda County White Asian
Infa
nt
Dea
th R
ate
(dea
ths
per
1,0
00
live
bir
ths)
Neonatal Death Rate Post-neomatal Death Rate
Neonatal and Post-Neonatal Infant Mortality Rates by Race/Ethnicity, 2014-2016
Source: CAPE, with data from Alameda County Vital Statistics files, 2014-2016.
45
Neonatal Deaths= 30 per yr; Post-neonatal Deaths=14 per yr.
Leading Causes of Infant Death in Alameda County, 2012-2016
Cause 5-Yr Total Number Percent
All Other Perinatal Conditions 116 30.9%
Congenital Abnormalities 91 24.2%Perinatal Conditions- Short Length of Gestation and Low Birth Weight Disorders 43 11.4%
Neonatal Medical Conditions 35 9.3%
Sudden Infant Death Syndrome (SIDS) 33 8.8%Perinatal Conditions - Maternal Pregnancy, Labor, and Delivery complications 28 7.4%
Infectious Diseases 14 3.7%
All Other Infant Diseases 11 2.9%
Accidents or Assault 5 1.3%Total 376 100%
Source: CAPE, with data from Alameda County Vital Statistics files, 2012-2016.
46
SIDS 17.8%
Neonatal Conditions 4.4%
Perinatal-maternal
pregnancy labor and delivery
complications 6.7%
Perinatal- short gestation and lbw disorders 13.3%
All other perinatal conditions 32.2%
Congenital abnormalities
18.9%
All Other Causes 6.7%
SIDS 5.9% Neonatal Conditions
10.8% Perinatal-maternal
pregnancy labor and delivery
complications 7.7%
Perinatal- short gestation and lbw disorders
10.8%
All other perinatal
conditions 30.4%
Congenital abnormalities
25.9%
All Other Causes 8.4%
Percentage of Infant Deaths by Cause of Death African Americans v. All Other Race/Ethnic Groups, 2012-2016
47
All Other Race/Ethnic Groups* =286 Deaths Black/African Americans= 90 Deaths
Source: CAPE, with data from Alameda County Vital Statistics files, 2012-2016.
*All Other Race/Ethnic Groups include: White, Hispanic/Latino,Multirace, Pacific Islander, and Unknown/Other.
Number of Fetal Deaths in Alameda County, 2008-201648
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2016.
141
124
116
93
103
115 111
66
106
60
80
100
120
140
2008 2009 2010 2011 2012 2013 2014 2015* 2016
Nu
mb
er o
f Fe
tal D
eath
s
*2015 Fetal Deaths may be underreported.
Fetal Mortality Rate in Alameda County, 2008-2016
49
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2016.
6.7
6.16.0
4.9
5.3
6.0
5.6
3.4
5.4
2.0
3.0
4.0
5.0
6.0
7.0
2008 2009 2010 2011 2012 2013 2014 2015* 2016
Feta
l Mo
rtal
ity
Rat
e (F
etal
Dea
ths
per
1,0
00
live
b
irth
s +
feta
l dea
ths)
*2015 Fetal Death Rate may be an underestimate.
15.314.7
13.512.6
11.8
10.210.8
0
2
4
6
8
10
12
14
16
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16
Feta
l Mo
rtal
ity
Rat
e (f
etal
dea
ths
per
1,0
00
live
bir
ths
+ fe
tal d
eath
s
AfAm/Black
All Races
Hisp/Lat
Asian
White
Fetal Mortality Rate Trend by Race/Ethnicity, 2009-201650
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2016.
2.7 times
3.4 times
*2015 Fetal Death Rate may be an underestimate.
Fetal and Infant Mortality Rates by Race/Ethnicity, 2014-2016
Source: CAPE, with data from Alameda County Vital Statistics files, 2014-2016.
51
Fetal Deaths=94; Infant Deaths=72.
10.8
4.8 4.6 4.1 4.1
9.5
3.7 3.93.0
2.0
0
5
10
15
20
African American/ Black All Races Latino White Asian
Infa
nt
and
Fet
al M
ort
alit
y R
ates
Fetal Mortality Rate Infant Mortality Rate
Comparisons: Infant Health Indicators52
Indicator HP2020 California Alameda County AC Ranking
1st Trimester Prenatal Care
77.9% or more
83.3% 89.1% 2/56
Adequate/Adequate Plus Prenatal Care
77.6% or more
77.9% 73.3% 38/56
Breastfeeding Initiation during early postpartum
81.9% or more
93.8% 97.4% 8/56
Exclusive Breastfeeding3 months after delivery
46.2% 29.1% 34.6% ―
Sources: CAPE, with data from Alameda County Vital Statistics files, 2014-2016.Healthy People 2020.California Department of Public Health (CDPH) 2018 County Health Profiles. California Department of Public Health In-Hospital Breastfeeding 2018.Maternal and Infant Health Assessment (MIHA), 2013-2015.
Comparisons: Infant Health Indicators53
Indicator HP2020 California Alameda County AC Ranking
Teen Births ― 17.6/1000 10.2/1000 7/52
Premature Births 11.4% or less 8.5% 6.6%* ―
Low Birth Weight 7.8% or less 6.8% 7.1%* 42/52
Very Low Birth Weight 1.4% or less 1.2% 1.2% ―
Infant Mortality Rate6.0/1000 or
fewer4.6/1000 3.7/1000 ―
Sources: CAPE, with data from Alameda County Vital Statistics files, 2014-2016. Healthy People 2020. California Department of Public Health (CDPH) 2018 County Health Profiles.
*Low Birth Weight and Premature Births in this table are based on all births not just singleton births.
54
▪ SIDS & Safe Sleep
▪ Breastfeeding
▪ Recent Data
▪ Race/Ethnicity
How healthy are infants in Alameda County?
SIDS Deaths in Alameda County
55
Over the last five years, in Alameda County there was an average of 7 SIDS cases per year.
Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.
The Percentage of SIDS cases in Alameda County, 2012-2016
5 -Year Total
The trend shows a slight decrease in SIDS rates over time that is not statistically significant (p=0.07)
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
SID
S D
eath
s p
er 1
,00
0 li
ve b
irh
ts
White 15.2%
African American
48.5%
Asian/Pacific …
Latino 9.1%
Multirace 18.2%
2.0
1.5
1.3
1.5
1.71.6
1.9 1.9
0.24 0.22 0.26 0.30 0.29 0.30 0.260.20
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
2.2
2.4
2005-2009 2006-2010 2007-2011 2008-2012 2009-2013 2010-2014 2011-2015 2012-2016SID
S M
ort
alit
y R
ate
(SID
S d
eath
s p
er 1
,00
0 b
irth
s)
AfAm/Black
All OtherRaces
SIDS Mortality Rate Trend by Race/Ethnicity, 2005-201656
Source: CAPE, with data from Alameda County Vital Statistics files, 2005-2016.
9.3 times8.5 times
All Other Races: White, Asian, Pacific Islander, Multirace, Latinoand American Indian.
+Higher than County Percentage
- Lower than County Percentage
Percentage Placed Infant on Back to Sleep by Race/Ethnicity, 2013-2015
57
Source: Maternal and Infant Health Assessment (MHIA) Survey 2013-2015.
*
92.6%87.6%
83.4%
77.4%
65.6%
0%
20%
40%
60%
80%
100%
White Asian/ Pacific Islander All Races Latino Black/ African American
Perc
enta
ge P
lace
d In
fan
t o
n B
ack
to S
leep
+
-
48.4%
44.0%
37.5% 37.2%
20.6%
0%
10%
20%
30%
40%
50%
Black/ African American Latino Asian/ Pacific Islander All Races White
Perc
enta
ge In
fan
t A
lway
s o
r O
ften
Sh
ared
Bed
Percentage Infant Always or Often Shared Bed by Race/Ethnicity, 2013-2015
58
Source: Maternal and Infant Health Assessment (MHIA) Survey 2013-2015.
-
+Higher than County Percentage
- Lower than County Percentage
93.8%
88.0%
84.9%82.8% 82.6%
81.2%80.1%
78.1%
50%
60%
70%
80%
90%
100%
AmericanIndian*
White Multirace PacificIslander*
All Races Asian Latino Black/ AfricanAmerican
Perc
enta
ge E
xclu
sive
ly B
reas
tfed
New
bo
rn in
Ho
spit
al
Percentage of Exclusive Early Breastfeeding by Race/Ethnicity, 2016
Source: California Department of Public Health, In-Hospital Breastfeeding, 2016
59
*Breastfeeding data likely an overestimate.
78.9% 78.4%73.5%
70.3%65.3%
51.0%
28.2%
34.6%31.9%
28.9%
0%
20%
40%
60%
80%
100%
White Asian/ Pacific Islander All Races Latino Black/ African American
Perc
enta
ge B
reas
tfee
din
g 3
Mo
nth
s A
fter
Del
iver
y Any Breastfeeding Exclusive Breastfeeding
Percentage Breastfeeding at 3 Months by Race/Ethnicity, 2013-2015
60
Source: Maternal and Infant Health Assessment (MHIA) Survey 2013-2015.
-
+Higher than County Percentage
- Lower than County Percentage
Reproductive Life Planning61
▪ Unintended Pregnancies
▪ Postpartum Birth Control Use
▪ Family Planning
▪ Recent Data
▪ Race/Ethnicity
Unintended Pregnancies US
In 2011, 45% (2.8 million/6.1 million) pregnancies in the US each year were unintended.
In 2011, 5% of reproductive-age women had an unintended pregnancy each year.
❑Demographic Disparities Teen Moms (15-17 years) & Young Moms (18-24 years)
Poor Women (<200% Federal Poverty Level)
Less than high school education
Single/Cohabitating Moms
Racial/Ethnic Groups
62
Source: Guttmacher Institute. Unintended Pregnancy in the US, Fact Sheet September 2016. https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states
Unintended Pregnancies CA
In 2010, 48% of all pregnancies (393,000) in California were unintended.
CA unintended pregnancy rate in 2010: 50 per 1,000 women aged 15–44 years.
In 2010, 42% of unintended pregnancies in California resulted in births; 45% in abortions; the remainder resulted in miscarriages.
In 2010, federal and state government spent $1.8 billion on unintended pregnancies in CA.
63
Source: Guttmacher Institute. State Facts about Unintended Pregnancy in CA, Fact Sheet August 2017. https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california
34.8% 34.0%
24.9%16.8% 18.5%
25.2%
9.9%
12.7%
14.0% 9.9%
0%
20%
40%
60%
80%
Black/ African American Latino All Races White Asian/ Pacific Islander
Perc
enta
ge o
f U
nin
ten
tio
nal
Pre
gnan
cy
Unintended Unsure of Pregnancy Intentions
Percentage Unintentional Pregnancy by Race/Ethnicity, 2013-2015
64
Source: Maternal and Infant Health Assessment (MHIA) Survey 2013-2015.
Percentage Postpartum Birth Control Use by Race/Ethnicity, 2013-2015
65
Source: Maternal and Infant Health Assessment (MHIA) Survey 2013-2015.
89.8%85.8% 85.1% 84.5%
78.1%
0%
20%
40%
60%
80%
100%
Latino All Races Asian/ Pacific Islander White African American
Perc
enta
ge P
ost
par
tum
Bir
th C
on
tro
l Use
Percentage Births <18 Months apart by Race/Ethnicity, 201566
Source: Family Health Outcomes Project (FHOP) Alameda County Databook 2015.
30.9%
23.1% 22.3%21.3%
20.2%
0%
10%
20%
30%
40%
White All Races African American Asian/ PacificIslander
Latino
Perc
enta
ge b
irth
s <1
8 m
on
ths
Ap
art
Unmet Need for Family Planning Services in CA
In 2014, over 2.6 million CA women aged 13-44 years were in need of publicly funded family planning services.
Publicly funded family planning centers in CA served 1.3 million female clients in 2014.
Publicly funded family planning centers in CA helped avert over 321,000 unintended pregnancies in 2010.
This would have resulted in 156,000 unplanned births and 116,00 abortions.
This saved the state and federal government over $1.79 billion.
67
Source: Guttmacher Institute. State Facts about Unintended Pregnancy in CA, Fact Sheet August 2017. https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california
▪ Teen Birth Rate
▪ Infant Mortality Rate
▪ % Low Birth Weight
MCH Indicators by Social Gradient68
11.712.9
15.2
17.4 17.5
13.8
15.6
13.9
12.1
9.8
0
5
10
15
20
25
<5% 5%-9% 10%-19% 20%-29% >=30%
Bir
th R
ate
(bir
ths
per
1,0
00
po
pu
lati
on
)
Neighborhood Poverty Level
Latino
All Races
White
African American
Asian
Birth Rate by Poverty Level and Race/Ethnicity, 2012-201669
Source: CAPE, with data from Alameda County Vital Statistics files, 2012-2016.
Most Affluent Least Affluent
9.3
19.2
28.4
36.2
6.6
16.7
27.3
30.7
0
10
20
30
40
<10% 10%-19% 20%-29% >=30%
Teen
Bir
th R
ate
(Tee
n B
irth
s p
er 1
,00
0 F
emal
e p
op
15
-19
ye
ars)
Neighborhood Poverty Level
African American
Latino
All Races
White
Asian
Teen Birth Rate by Poverty Level and Race/Ethnicity, 2012-201670
Source: CAPE, with data from Alameda County Vital Statistics files, 2012-2016.
Most Affluent Least Affluent
5.56.2
13.7
16.3
3.1 3.2
5.3
6.5
0
2
4
6
8
10
12
14
16
<10% FPL 10-19 FPL 20-29 FPL >=30 FPL
Infa
nt
Mo
rtal
ity
Rat
e (D
eath
s p
er 1
,00
0 li
ve b
irth
s)
Neighborhood Poverty Level
AfricanAmerican
White
All Races
Latino
Asian
Infant Mortality Rate by Poverty Level and Race/Ethnicity, 2012-201671
Source: CAPE, with data from Alameda County Vital Statistics files, 2012-2016.
3.0 times
Most Affluent Least Affluent
Social Gradient Takeaways
1. Race and Class (socioeconomic status) are closely connected
The most affluent neighborhoods have high % of Whites and Asians.
The least affluent neighborhoods have high % of Latinos and African Americans.
2. Birth Rates, Teen Birth Rates, and Infant Mortality are associated with neighborhood poverty.
Poorer neighborhoods have Birth Rates compared to more affluent neighborhoods.
Poorer neighborhoods have Teen Birth Rates compared to more affluent neighborhoods, especially for Latino and African American teens.
Infant Mortality with neighborhood poverty, especially for African Americans
The African American IMR in the poorer neighborhoods is 3X the African American IMR in the most affluent neighborhoods.
72
Social Gradient: Key Takeaways
3. Racial/Ethnic Inequities persist when controlling for neighborhood poverty
African Americans in the most affluent neighborhoods have % of premature babies than Whites, Asians and Latinos in the poorest neighborhoods.
African Americans in the most affluent neighborhoods have % of low birth weight babies than Whites, Asians and Latinos in the poorest neighborhoods.
4. Conclusion: Neighborhood poverty does not fully explain poor infant health outcomes. Racism is an underlying cause of maternal and infant health inequities in Alameda County.
73
RACISM MATTERS, NOT BIOLOGY
Source: Camara Jones, American Journal of Epidemiology, 2001
Impacts of Racism on Health74
Improving African American Birth Outcomes
Supporting and strengthening existing programs specifically serving African-American families Black Infant Health
Healthy Start
Focused attention on improved outreach to the African-American community
Introduction of RBA measures that relate more directly to infant mortality
Department-wide Initiative “Turn the Curve on African American IMR.” Next steps include: Awareness campaign
Implicit bias training with providers
Collaborating with partners on housing/financial security
75
How healthy are young children in Alameda County?76
37.8%
32.6%
18.1% 17.3%
11.6%9.5%
5.2%
2.3%
0%
5%
10%
15%
20%
25%
30%
35%
40%
AmericanIndian*
AfricanAmerican
PacificIslander*
Latino All races Multirace White NH Asian
Ch
ildre
n <
6 y
ears
livi
ng
in p
ove
rty
Children 5 years and under Living in Poverty by Race/Ethnicity, 2016
*Data for American Indians and Pacific Islanders is from 5 year census files- 2012-2016.Source: Cape with data from US Census Bureau American Community Survey, 1 year and 5 year files 2016.
77
7.2 times
55.6%54.0%
37.4% 36.8%
33.0%30.7%
18.4%16.8%
0%
10%
20%
30%
40%
50%
60%
AfricanAmerican
Latino Multirace AmericanIndian*
All races Pacific Islander* White NH Asian
Perc
enta
ge o
f C
hild
ren
<6
on
Pu
blic
Insu
ran
ce
Percentage Children 5 Years and under with Public Health Insurance by Race/Ethnicity, 2016
78
Source: Cape with data from IPUMS USA Integrated files, 1 year file 2016 and 5 year file 2012-2016.
*Data for American Indians and Pacific Islanders is from 5 year files- 2012-2016.
Percentage Children 5 Years and underby Race/Ethnicity, 2016
79
Source: Cape with data from US Census and IPUMS USA Integrated files, 1 year file 2016 and 5 year file 2012-2016.
*Data for American Indians and Pacific Islanders is from 5 year files- 2012-2016.
37.8%
32.6%
18.1% 17.3%
11.6%9.5%
5.2%2.3%
36.8%
55.6%
30.7%
54.0%
33.0%
37.4%
18.4%16.8%
0%
10%
20%
30%
40%
50%
60%
AmericanIndian*
AfricanAmerican
PacificIslander*
Latino All races Multirace White NH Asian
Perc
enta
ge o
f C
hild
ren
<6 y
ears
Living in Poverty With Public Health Insurance
*Data for American Indians and Pacific Islanders is from 5 year files- 2012-2016.
102.5
38.934.8
25.1
18.0
0
20
40
60
80
100
120
African American All Races Latino Asian/ PacificIslander
White
Ast
hm
a H
osp
ital
izat
ion
Rat
e (#
h
osp
ital
izat
ion
s/1
0,0
00
po
pu
lati
on
0-4
yea
rs)
Asthma Hospitalizations for Children 0-4 years by Race/Ethnicity, 2013-3Q2015
80
Source: CAPE, with data from OSHPD ED Visits, 2013-3Q2015.
HP2020 Objective: 18.2 or less
1,035 Hospitalizations
539.6
259.0
224.5 221.1
145.4
0
200
400
600
African American All Races White Latino Asian/ Pacific Islander
Un
inte
nti
on
al In
jury
Ho
spit
aliz
atio
n R
ate
(#
ho
spit
aliz
atio
ns/
10
0,0
00
po
pu
lati
on
0-4
yea
rs)
Unintentional Injury Hospitalizations for Children 0-4 years by Race/Ethnicity, 2013-2015
81
Source: CAPE, with data from OSHPD Hospitalizations, 2013-3Q2015.
689 Hospitalizations
How healthy are women of child bearing age (15-44 years) in Alameda County?
82
31.6%
19.9%
17.2%
14.5%13.5%
12.2%
9.1% 8.7%
0%
5%
10%
15%
20%
25%
30%
35%
40%
AfricanAmerican
AmericanIndian*
PacificIslander*
Latino Multirace All races Asian White NH
Perc
enta
ge w
om
en 1
5-4
4 y
rs li
vin
g in
po
vert
y
Women Living in Poverty by Race/Ethnicity, 201683
3.6 times
*Data for American Indians and Pacific Islanders is from 5 year census files- 2012-2016.Source: Cape with data from US Census Bureau American Community Survey, 1 year and 5 year files 2016.
Percentage Women Uninsured and with Public Health Insurance by Race/Ethnicity, 2016
84
Source: Cape with data from IPUMS USA Integrated files, 1 year file 2016 and 5 year file 2012-2016.
*Data for American Indians, Pacific Islanders, and Multirace is from 5 year files- 2012-2016.
37.9%
29.2%
20.4%
17.2%
12.2%14.0% 13.4%
9.1%7.5%
11.2%
5.5%
31.0%
11.9%
3.6%2.4%
9.5%
0%
5%
10%
15%
20%
25%
30%
35%
40%
AfricanAmerican
Latino All races AmericanIndian*
PacificIslander*
Asian White NH Multirace*
Perc
enta
ge o
f W
om
en 1
8-4
4 y
ears
With Public Health Insurance Uninsured
Percentage Women 15-44 yearsby Race/Ethnicity, 2016
85
Source: Cape with data from US Census and IPUMS USA Integrated files, 1 year file 2016 and 5 year file 2012-2016.
*Data for American Indians, Pacific Islanders, and Multirace is from 5 year files- 2012-2016.
31.6%
19.9%17.2%
14.5%12.2%
13.5%
8.7% 9.1%
37.9%
17.2%
12.20%
29.2%
20.4%
9.1%
13.4% 14.0%
0%
10%
20%
30%
40%
50%
AfricanAmerican
AmericanIndian*
Pacific Islander* Latino All races Multirace* White NH Asian
Perc
enta
ge W
om
en 1
5-4
4 y
ears
Living in Poverty With Public Health Insurance
18.9%
11.1%
8.9%7.5% 6.9%
4.2%3.3% 2.9%
0%
5%
10%
15%
20%
25%
30%
Latino AmericanIndian*
AfricanAmerican
All races PacificIslander*
Multirace* Asian White
Perc
enta
ge W
om
en 1
8-4
4 y
ears
wit
h le
ss t
han
HS
Edu
cati
on
Women with Less than High School Education by Race/Ethnicity, 2016
86
6.5 times
Source: Cape with data from US Census and IPUMS USA Integrated files, 1 year file 2016 and 5 year file 2012-2016.
*Data for American Indians and Pacific Islanders is from 5 year files- 2012-2016.
Percentage Overweight/Obese Women, 2012-2016
87
Source: Cape with data from California Health Interview Survey (CHIS) pooled data 2012-2016.
73.4%
60.6% 59.4%
48.1%
36.3%
29.6%
0%
20%
40%
60%
80%
Latino African American Multirace All Races White Asian
Perc
enta
ge W
om
en O
verw
eigh
t/O
bes
e (B
MI ≥
25
.0)
Key Takeaways
1. Who is giving birth in Alameda County( AC)?
There has been a in AC births since 2000. (Ave. 19,500 births per year since 2012.)
Asians and Latinos have the largest # of births. Latinos have the highest birth rate.
AC has seen a dramatic in teen moms (15-19 years) and an in mature moms (35-44 years).
AC has large % of non US-born moms (Asian, Latino).
88
Key Takeaways
2. How healthy are moms, newborns, and infants in Alameda County?
Overall, AC moms, newborns and infants are very healthy!
AC has high % of moms receiving prenatal care and breastfeeding. (Pacific Islanders inequities persist.)
AC has seen a in preterm births over time.
Other AC indicators have remained steady. Likely due to persistent African American inequities.
Differences exist between US and non-US born Black and Pacific Islander mothers.
◼ Non-US born Black mothers have lower % low birth weight and preterm births. Yet, Non-US born Black mothers have lower % of early and adequate prenatal care.
◼ Non-US born Pacific Islander mothers have higher % low birth weight and preterm births and similar rates of PNC.
89
Key Takeaways
SIDS, Safe Sleep Practices and Breastfeeding
African Americans disproportionately affected by SIDS deaths.
Majority of AC moms engage in safe sleep behaviors and many breastfeed infants. African American inequities persist.
Reproductive Planning
About 1/3 of pregnancies were unintended or unsure with % among African Americans and Latinos.
Majority of AC moms use birth control postpartum. However, substantial unmet need for family planning services in Alameda County (50%).
Fetal and Infant Mortality
AC has seen a in infant mortality over time. The fetal death trend is unclear due to underreporting in 2015.
African American Fetal and Infant Mortality is much higher than all other race/ethnic groups in AC.
Infant Mortality with neighborhood poverty, especially for African Americans.
Racism is an underlying cause of maternal and infant health inequities in Alameda County.
90
Key Takeaways
3. How healthy are young children and women 18-44 years in Alameda County?
Most young children are women of childbearing age are very healthy.
Racial/ethnic inequities exist in key SES indicators: poverty rates, health insurance, injury and high school completion.
African American, Latino, and American Indian young children and women are most affected.
4. How has Alameda County been doing over time and within different communities?
High neighborhood poverty is associated with poor mom and infant health outcomes.
Life course approaches are needed.
MPCAH has targeted programs to improve African American mother, infant and child outcomes.
5. How is Alameda County doing compared to Healthy People 2020, within California?
AC does very well compared to other counties on key birth and family planning indicators.
91
EVERYONE in Alameda County –no matter who you are,
where you live, how much money you make,or the color of your skin –
can lead a healthy, fulfilling and productive life.
Our Vision of Health Equity92
93
For Additional Alameda County Maternal, Child, and Adolescent Health Indicators:www.acphd.org/data-reports/reports-by-topic/maternal,-child,-and-adolescent-health.aspx
Lisa Goldberg, MPCAH Epidemiologist, Alameda County Public Health Department.Contact by phone at 510-267-8024 or by email: lisa.goldberg@acgov.org
Kiko Malin, Director, Family Health Services Division, Alameda County Public Health Department.Contact by phone at 510-267-5979 or by email: kiko.malin@acgov.org
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