Surveillance for disparities in maternal health-related behaviors -- selected states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2001

PROBLEM/CONDITION: Disparities in maternal and infant health have been observed among members of different racial and ethnic populations and persons of differing socioeconomic status. For the Healthy People 2010 objectives for maternal and child health to be achieved (US Department of Health and Human Services. Healthy People 2010. 2nd ed. With understanding and improving health and objectives for improving health [2 vols.]. Washington DC: US Department of Health and Human Services, 2000), the nature and extent of disparities in maternal behaviors that affect maternal or infant health should be understood. Identifying these disparities can assist public health authorities in developing policies and programs targeting persons at greatest risk for adverse health outcomes. REPORTING PERIOD COVERED: 2000-2001. DESCRIPTION OF THE SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver live-born infants. PRAMS employs a mixed mode data-collection methodology; up to three self-administered surveys are mailed to a sample of mothers, and nonresponders are followed up with telephone interviews. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets that can be used to produce statewide estimates of different perinatal health behaviors and experiences among women delivering live infants in 31 states and New York City. This report summarizes data for 2000-2001 from eight states (Alabama, Colorado, Florida, Hawaii, Illinois, Maine, Nebraska, and North Carolina) on four behaviors (smoking during pregnancy, alcohol use during pregnancy, breastfeeding initiation, and use of the infant back sleep position) for which substantial health disparities have been identified previously. RESULTS: Although the prevalence of each behavior varied by state, consistent patterns were observed among the eight states by age, race, ethnicity, education, and income level. Overall, the prevalence of smoking during pregnancy ranged from 9.0% to 17.4%. Younger (aged 35 years, non-Hispanic women, women with more than a high school education, and women with higher incomes reported the highest prevalence of alcohol use during pregnancy. Overall, the prevalence of breastfeeding initiation ranged from 54.8% to 89.6%. Younger women, black women, women with a high school education or less, and women with low incomes reported the lowest rates of breastfeeding initiation. The size of the black-white disparity in breastfeeding varied among states. Overall, use of the back sleep position for infants ranged from 49.7% to 74.8%. Use of the back sleep position was lowest among younger women, black women, women with lower levels of education, and women with low incomes. Ethnic differences in sleep position varied substantially by state. INTERPRETATION: PRAMS data can be used to identify racial, ethnic, and socioeconomic disparities in critical maternal health-related behaviors. Although similar general patterns by age, education, and income were observed in at least seven states, certain racial and ethnic disparities varied by state. Prevalence of the four behaviors among each population often varied by state, indicating the potential impact of state-specific policies and programs. PUBLIC HEALTH ACTION: States can use PRAMS data to identify populations at greatest risk for maternal behaviors that have negative consequences for maternal and infant health and to develop policies and plan programs that target populations at high risk.sk. Although prevalence data cannot be used to identify causes or interventions to improve health outcomes, they do indicate the magnitude of disparities and identify populations that should be targeted for intervention. This report indicates a need for wider targeting than is often done. The results from this report can aid state and national agencies in creating more effective public health policies and programs. The data described in this report should serve as a baseline that states can use to measure the impact of policies and programs on eliminating these health disparitiesTanya M. Phares, Brian Morrow, Amy Lansky, Wanda D. Barfield, Cheryl B. Prince, Kristen S. Marchi, Paula A. Braveman, Letitia M. Williams.July 2, 2004.Also available via the World Wide Web as an Acrobat .pdf file (637.93 KB, 16 p.).Includes bibliographical references (p. 12-13).1522940

Abortion surveillance -- United States, 2002

PROBLEM/CONDITION: CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. REPORTING PERIOD COVERED: This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2002. DESCRIPTION OF SYSTEM: For each year since 1969, CDC has compiled abortion data by state or area of occurrence. During 1973-1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998 and 1999, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these states were not estimated. For 2000-2002, Oklahoma again reported these data, increasing the number of reporting areas to 49. RESULTS: A total of 854,122 legal induced abortions were reported to CDC for 2002 from 49 reporting areas, representing a 0.1% increase from the 853,485 legal induced abortions reported by the same 49 reporting areas for 2001. The abortion ratio, defined as the number of abortions per 1,000 live births, was 246 in 2002, the same as reported for 2001. The abortion rate was 16 per 1,000 women aged 15-44 years for 2002, the same as for 2001. For the same 48 reporting areas, the abortion rate remained relatively constant during 1997-2002. The highest percentages of reported abortions were for women who were unmarried (82%), white (55%), and aged 15 weeks' gestation, including 4.1% at 16-20 weeks and 1.4% at > or =21 weeks. A total of 35 reporting areas submitted data stating that they performed and enumerated medical (nonsurgical) procedures, accounting for 5.2% of all known reported procedures from the 45 areas with adequate reporting on type of procedure. INTERPRETATION: During 1990-1997, the number of legal induced abortions gradually declined. When the same 48 reporting areas were compared, the number of abortions decreased during 1996-2001, then slightly increased in 2002. In 2000 and 2001, even with one additional reporting state, the number of abortions declined slightly, with a minimal increase in 2002. PUBLIC HEALTH ACTION: Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and infants.Lilo T. Strauss, Joy Herndon, Jeani Chang, Wilda Y. Parker, Sonya V. Bowens, Cynthia J. Berg, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion.November 25, 2005.Also available via the World Wide Web as an Acrobat .pdf file (306.36 KB, 36 p.).Includes bibliographical references (p. 5-10)

Abortion surveillance -- United States, 2003

PROBLEM/CONDITION: CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. REPORTING PERIOD COVERED: This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2003. DESCRIPTION OF SYSTEM: For each year since 1969, CDC has compiled abortion data by state or area of occurrence. During 1973-1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998 and 1999, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these states were not estimated. During 2000-2002, Oklahoma again reported these data, increasing the number of reporting areas to 49, and for 2003, Alaska again reported and West Virginia did not, maintaining the number of reporting areas at 49. RESULTS: A total of 848,163 legal induced abortions were reported to CDC for 2003 from 49 reporting areas, representing a 0.7% decline from the 854,122 legal induced abortions reported by 49 reporting areas for 2002. The abortion ratio, defined as the number of abortions per 1,000 live births, was 241 in 2003, a decrease from the 246 in 2002. The abortion rate was 16 per 1,000 women aged 15-44 years for 2003, the same as for 2002. For the same 47 reporting areas, the abortion rate remained relatively constant during 1998-2003. During 2001-2002 (the most recent years for which data are available), 15 women died as a result of complications from known legal induced abortion. One death was associated with known illegal abortion. The highest percentages of reported abortions were for women who were unmarried (82%), white (55%), and aged 15 weeks' gestation, including 4.2% at 16--20 weeks and 1.4% at > or =21 weeks. A total of 36 reporting areas submitted data documenting that they performed and enumerated medical (nonsurgical) procedures, making up 8.0% of all known reported procedures from the 45 areas with adequate reporting on type of procedure. INTERPRETATION: During 1990-1997, the number of legal induced abortions gradually declined. When the same 47 reporting areas are compared, the number of abortions decreased during 1996-2001, then slightly increased in 2002 and again decreased in 2003. In 2000 and 2001, even with one additional reporting state, the number of abortions declined slightly, with a minimal increase in 2002 and a further decrease in 2003. In 2001 and 2002, as in the previous years, deaths related to legal induced abortions occurred rarely. PUBLIC HEALTH ACTION: Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and infants.Lilo T. Strauss, Sonya B. Gamble, Wilda Y. Parker, Douglas A. Cook, Suzanne B. Zane, Saeed Hamdan, division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion.November 24, 2006.Includes bibliographical references (p. 9-10)

Selected practice recommendations for contraceptive use

The U. S. Selected Practice Recommendations for Contraceptive Use 2013 (U.S. SPR), comprises recommendations that address a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific contraceptive methods. These recommendations are a companion document to the previously published CDC recommendations U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 (U.S. MEC). U.S. MEC describes who can use various methods of contraception, whereas this report describes how contraceptive methods can be used. CDC based these U.S. SPR guidelines on the global family planning guidance provided by the World Health Organization (WHO). Although many of the recommendations are the same as those provided by WHO, they have been adapted to be more specific to U.S. practices or have been modified because of new evidence. In addition, four new topics are addressed, including the effectiveness of female sterilization, extended use of combined hormonal methods and bleeding problems, starting regular contraception after use of emergency contraception, and determining when contraception is no longer needed. The recommendations in this report are intended to serve as a source of clinical guidance for health-care providers; health-care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health-care providers when considering family planning options.Introduction -- Methods -- -- How to use this document -- Summary of changes from WHO SPR -- Contraceptive method choice -- -- Maintaining updated guidance -- -- How to be reasonably certain that a woman is not pregnant -- -- intrauterine contraception -- Implants. -- -- Injectables -- -- Combined hormonal contraceptives -- -- Progestin-only pills -- Standard days method -- Emergency contraception -- -- Female sterilization -- -- -- male sterilization. -- -- When women can stop using contraceptives -- -- Conclusion -- -- Acknowledgment -- References -- Appendix A: Summary chart of U.S. medical eligibility criteria for contraceptive use, 2010 -- -- Appendix B: When to start using specific contraceptive methods -- -- Appendix C: Examinations and tests needed before initiation of contraceptive methods -- -- Appendix D: Routine follow-up after contraceptive initiation -- -- Appendix E: Management of women with bleeding irregularities while using contraception -- -- Appendix F: Management of the IUD when a Cu-IUD or an LNG-IUD user is found to have pelvic inflammatory disease.prepared by Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion.Corresponding preparer: Kathryn M. Curtis, PhD, Division of Reproductive Health, CDC.Includes bibliographical references p. 38-46).23784109Chronic DiseasePrevention and ControlSupersede

Chorionic villus sampling and amniocentesis: recommendations for prenatal counseling

Chorionic villus sampling (CVS) and amniocentesis are prenatal diagnostic procedures that are performed to detect fetal abnormalities. In 1991, concerns about the relative safety of these procedures arose after reports were published that described a possible association between CVS and birth defects in infants. Subsequent studies support the hypothesis that CVS can cause transverse limb deficiencies. Following CVS, rates of these defects, estimated to be 0.03%-0.10% (1/3,000-1/1,000), generally have been increased over background rates. Rates and severity of limb deficiencies are associated with the timing of CVS; most of the birth defects reported after procedures that were performed at > or = 70 days' gestation were limited to the fingers or toes. The risk for either digital or limb deficiency after CVS is only one of several important factors that must be considered in making complex and personal decisions about prenatal testing. For example, CVS is generally done earlier in pregnancy than amniocentesis and is particularly advantageous for detecting certain genetic conditions. Another important factor is the risk for miscarriage, which has been attributed to 0.5%-1.0% of CVS procedures and 0.25%-0.50% of amniocentesis procedures. Prospective parents considering the use of either CVS or amniocentesis should be counseled about the benefits and risks of these procedures. The counselor should also discuss both the mother's and father's risk(s) for transmitting genetic abnormalities to the fetus.Introduction -- Use of CVS and amniocentesis -- Limb deficiencies among infants whose mothers underwent CVS -- Gestational age at CVS -- Possible mechanisms of CVS-associated limb deficiency -- Absolute risk for limb deficiency -- Recommendations -- ReferencesJuly 21, 1995.The following CDC staff members prepared this report: Richard S. Olney, Cynthia A. Moore. Muin J. Khoury, J. David Erickson, Larry D. Edmonds, Lorenzo D. Botto, Division of Birth Defects and Developmental Disabilities, National Center for Environmental Health; Hani K. Atrash, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion.Includes bibliographical references (p. 11-12)

Abortion surveillance -- United States, 2005

"Problem/Condition: CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. Reporting Period Covered: This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2005. Description of System: For each year since 1969, CDC has compiled abortion data by state or area of occurrence. Information is requested each year from all 50 states, New York City, and the District of Columbia. For 2005, data were received from 49 reporting areas: New York City, District of Columbia, and all states except California, Louisiana, and New Hampshire. For the purpose of trends analysis, data were evaluated from the 46 reporting areas that have been consistently reported since 1995. Results: A total of 820,151 legal induced abortions were reported to CDC for 2005 from 49 reporting areas, the abortion ratio (number of abortions per 1,000 live births) was 233, and the abortion rate was 15 per 1,000 women aged 15--44 years. For the 46 reporting areas that have consistently reported since 1995, the abortion rate declined during 1995--2000 but has remained unchanged since 2000. For 2005, the highest percentages of reported abortions were for women who were known to be unmarried (81%), white (53%), and aged 15 weeks' gestation (3.7% at 16--20 weeks and 1.3% at >/=21 weeks). A total of 35 reporting areas submitted data stating that they performed and enumerated medical (nonsurgical) procedures, making up 9.9% of all known reported procedures from the 45 areas with adequate reporting on type of procedure. In 2004 (the most recent years for which data are available), seven women died as a result of complications from known legal induced abortion. One death was associated with known illegal abortion. Interpretation: For the 46 reporting areas that have consistently reported since 1995, the number of abortions has steadily declined over the previous 10 years. The abortion rate declined from 1995 to 2000, but remained unchanged since 2000. In 2004, as in the previous years, deaths related to legal induced abortions occurred rarely. Public Health Action: Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and evaluate efforts to prevent unintended pregnancies." - p. 1Sonya B. Gamble, Lilo T. Strauss, Wilda Y. Parker, Douglas A. Cook, Suzanne B. Zane, Saeed Hamdan, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion."November 28, 2008."Cover title.Also available via the World Wide Web.Includes bibliographical references (p. 9-10)

Preventing repeat teen births

Although teen birth rates have been falling for the last two decades, more than 365,000 teens, ages 15-19, gave birth in 2010. Teen pregnancy and childbearing can carry high health, emotional, social, and financial costs for both teen mothers and their children. Teen mothers want to do their best for their own health and that of their child, but some can become overwhelmed by life as a parent. Having more than one child as a teen can limit the teen mother's ability to finish her education or get a job. Infants born from a repeat teen birth are often born too small or too soon, which can lead to more health problems for the baby.Fact sheet released by the Centers for Disease Control and Prevention's Office of Surveillance, Epidemiology and Laboratory Services (OSELS) in association with: Vital signs: Repeat births among teens--United States, 2007-2010 published: MMWR. Morbidity and mortality weekly report ; v. 62, early release, April 2, 2013, p. 1-7.CS238394B.April 2013."Publication date: 4/2/2013."Introduction -- Problem -- What can be done -- Science behind this issue -- Related links -- Social media -- Read associated MMWRMode of access: World Wide Web as an Acrobat .pdf file (2.04 MB, 4 p.).Text document (PDF)

Family planning methods and practice: Africa

The first edition of Family Planning Methods and Practice: Africa, published in 1983, became widely known as \u201cThe Yellow Book.\u201d The influence of this book could be felt internationally. Besides helping educate health practitioners in Africa, it helped health professionals in the Western World learn more about the people of Africa. This second edition of Family Planning Methods and Practice: Africa is the product of collaboration between African and American colleagues, the Centers for Disease Control and Prevention (CDC), and is supported by the United States Agency for International Development (USAID).I. The African Context -- 1. Benefits of family planning -- 2. Traditional practices -- 3. Dynamics of reproductive behavior and population change -- 4. Adolescent women and reproductive health -- -- II. Sexually Transmitted Infections and Infertility -- 5. HIV, AIDS, and reproductive health -- 6. Sexually transmitted infections (STIs) -- 7. Infertility -- -- III. Information for Providing and Using Contraceptives Effectively -- 8. The Menstrual cycle and disturbances -- 9. Pregnancy diagnosis -- 10. Sexuality and reproductive health -- 11. The Essentials of contraception: effectiveness, safety, noncontraceptive benefits, and personal considerations -- -- IV. Contraceptive Methods -- 12. Lactation and postpartum contraception -- 13. Combined oral contraceptives -- 14. Norplant, Depo-Provera, and Progestin-only Pills (Minipills) -- 15. Intrauterine devices (IUDs) -- 16. Condoms -- 17. Vaginal barriers and spermicides -- 18. Fertility awareness methods (natural family planning) -- 19. Coitus interruptus (withdrawal) -- 20. Abstinence -- 21. Tubal sterilization and vasectomy -- -- V. Providing Family Planning Services -- 22. Post-abortion care: treating complications and providing contraception -- 23. Education and counseling -- 24. Clinical implications of management decisions -- 25. Approaches to delivery of family planning services -- 26. Effectively managing your family planning program -- 27. Providing quality family planning services -- 28. Future technologies -- Glossary.On cover: 2000 edition--special section on AIDS.Includes bibliographies and index.Centers for Disease Control and Prevention (CDC). Family Planning Methods and Practice: Africa. Second Edition. Atlanta, Georgia: United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, 2000.This manual was prepared through the technical assistance and support of the Centers for Disease Control and Prevention (CDC). The United States Agency for International Development (USAID) provided funding for the project through a Participating Agency Service Agreement with CDC (HRN-P00-97-000-14). Approved by USAID 9.95.HRN-P00-97-000-1

Abortion surveillance -- United States, 2004

Lilo T. Strauss, Sonya B. Gamble, Wilda Y. Parker, Douglas A. Cook, Suzanne B. Zane , Saeed Hamdan, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion"November 23, 2007"Cover title."The material in this report originated in the National Center for Chronic Disease se Prevention and Health Promotion, Janet Collins, PhD, Director; and the Prevention and Health Promotion, John Lehnherr, Acting Director." - p. 1Also available via the World Wide Web.Includes bibliographical references (p. 9-11)

Contraceptive use -- United States and territories, Behavioral Risk Factor Surveillance System, 2002

PROBLEM: Contraceptive use is an important determinant of unintended pregnancy. In the United States, approximately half of all pregnancies are unintended. Population-based information about contraceptive use patterns is limited at the state level. Information about contraceptive use for states can be used to guide the development of state programs and policies to decrease unintended pregnancy and the spread of sexually transmitted infections. Information about contraceptive use for specific subpopulations can be used to further refine state efforts to improve contraceptive use and subsequently decrease the occurrence of unintended pregnancy. REPORTING PERIOD: Data were collected in 2002 for men and women. DESCRIPTION OF SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is a random-digit--dialed, telephone survey of the noninstitutionalized U.S. population aged > or =18 years. All 50 states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands participated in BRFSS in 2002. These data can be used to track state progress towards the national health objectives for 2010 for responsible sexual behavior. The 2002 BRFSS data represent the first time state data on contraceptive use in all 50 states will be presented and examined by selected sociodemographic characteristics. The 2002 BRFSS also, for the first time, provided an opportunity to examine state-level contraceptive use patterns among men. RESULTS: Variation across states and territories was observed for the majority of contraceptive methods among the different demographics analyzed and among men and women. The percentage of men and women at risk for pregnancy who said they or their partner was using birth control was high overall and ranged from 67% (Guam) to 88% (Idaho). Oral contraceptives (i.e., the pill), vasectomy, tubal ligation, and condoms were the methods most frequently reported by both male and female respondents who said they or their partner was using birth control. Among female respondents using birth control, the pill was the most common method reported. Among men, vasectomy was the most commonly reported method. The prevalence of use for the four most commonly reported methods (pills, vasectomy, tubal ligation, condoms) varied as much as six-fold among states for vasectomy and three- to four-fold for condoms, pills, and tubal ligation. INTERPRETATION: The findings in this report document substantial differences among states and sociodemographic groups within states in contraceptive method use. PUBLIC HEALTH ACTION: These data can help states identify populations with an unmet need for birth control, barriers to birth control use, and gaps in the range of birth control methods offered by health-care providers. An analysis of the prevalence of birth control use by state and selected population characteristics can help states target contraceptive programs to best meet the needs of their population.Diana M. Bensyl, A. Danielle Iuliano, Marion Carter, John Santelli, Brenda Colley Gilbert.November 18, 2005.The material in this report originated in the National Center for Chronic Disease Prevention and Health Promotion, and the Division of Reproductive Health.Also available via the World Wide Web as an Acrobat .pdf file (458.11 KB, 75 p.).Includes bibliographical references (p. 8-9)