Maternal and Child Health

Maternal and Child Health Block Grant - Title V

Notes:

1. Long-term measure with original  2008 out-year target date.
2. Vital statistics compiled by the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC) 2008.  Deaths: Preliminary Data for 2006, National Vital Statistics Reports, Vol. 56, No. 16, June 11, 2008.
3. Vital statistics compiled by the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC) 2007.  Births:  Preliminary Data for 2006, National Vital Statistics Reports, Vol. 56, No. 7, December 2007.
4. Data not available.  Preliminary birth data for 2006 compiled by the National Center for Health Statistics, Centers for Disease Control and Prevention (National Vital Statistics Report, Vol. 56, No. 7) do not include a description of Maternal Lifestyles and Health Characteristics, such as risk factors during pregnancy.  It is anticipated that the final 2006 birth data (expected to be released in January 2009) will include these data.           

INTRODUCTION

Since its inception, the Title V Maternal and Child Health (MCH) Block Grant program has provided a foundation for ensuring the health of the Nation’s mothers, infants, children, adolescents, including children and adolescents with special health needs, and families.  The MCH Block Grant supports a wide variety of services that address the Title V legislative requirements and the strategic goals outlined by HHS, HRSA and MCHB.  Consistent with other HRSA programs, State Title V programs use their appropriated MCH Block Grant funds to address three overarching goals:  1) improving access to health care; 2) eliminating health disparities; and 3) improving the quality of health care.  Progress in meeting these goals is assessed through the examination of the annual performance measure and indicator data that is reported by States.  While each measure addresses a different aspect of health care delivery specific to pregnant and breastfeeding women, infants, children and adolescents, the measures collectively provide a snapshot into the health, safety and well-being of the Nation’s MCH population.  The Program utilizes these findings to identify emerging public health needs and critical issues relative to MCH.  A strategy used in efforts to improve performance is to provide needed technical assistance to States in areas identified in their needs assessment plans and in their annual applications.  Another strategy is to identify and promote promising practices that can be used by State MCH programs to improve MCH outcomes.  The program also supports States in their efforts to do outreach to increase participation in Medicaid and SCHIP.

DISCUSSION OF RESULTS AND TARGETS

Long-Term Objective:  Expand the capacity of the health care safety net.

Decrease the number of uninsured children.

(Baseline – 2006: 8.7 million; Target – 2008: 8 million, 2015:  7.7 million)

Long-Term Objective:  Promote outreach efforts to reach populations most affected by health disparities.

10.IV.B.1  Decrease the ratio of the black infant mortality rate to the white infant mortality rate.

While there has been progress in reducing infant mortality rates for both racial groups, the proportional discrepancy between Blacks and Whites has remained largely unchanged.  Preliminary data indicate that the Black/White Infant Mortality Ratio declined slightly in FY 2006 to 2.4 to 1.  The target of 2.2 to 1 was not met; however, there was continuing progress in moving towards the target.  (See section on “Targets Substantially Exceeded or Not Met.”)  Rates for FY 2003, FY 2004, and FY 2005 were 2.43 to 1, 2.44 to 1, and 2.38 to 1 respectively.  The target for FY 2009 continues to be 2.1 to 1. 

Long-Term Objective:  Promote effectiveness of health care services.

10.III.A.1.  Reduce the infant mortality rate.

All countries of the world measure the infant mortality rate as an indicator of general health status.  The U.S. has made progress in reducing this rate; however, since 2002, the rate has plateaued.  Race/ethnicity, maternal age, education, smoking, and number of pregnancies are all factors that contribute to the infant mortality rate.

The overall infant mortality rate decreased slightly from 7.0 per 1,000 births in 2002 to 6.9 per 1,000 live births in 2005.  Based on preliminary data, the rate declined to 6.7 per 1,000 live births in 2006.  The performance goal for 2005 was met.  Performance in 2006 tentatively exceeded the target of 6.8 per 1,000 live births, pending the release of the final vital statistics data.  The FY 2009 target is 6.7/1,000.     

10.III.A.2.  Reduce the incidence of low birth weight (LBW) births.

In the past 15 years, the distribution of birthweights in the U.S. has shifted towards lower weights.  The percentage of infants weighing less than 3,500 grams at birth has risen.  Birthweight is an important predictor of early death and long-term disability.  The lower an infant’s birthweight, the greater the risk for a poor outcome.  

The LBW rate (less than 2,500 grams) increased from 7.8 percent in 2002 to 8.2 % in 2005, which was the highest level reported since 1969.  Preliminary data indicate that the rate further increased to 8.3 percent in 2006.  The FY 2005 and FY 2006 program targets of 7.4 % were not met.  (See section on “Targets Substantially Exceeded or Not Met.”)   The revised FY 2009 target for this measure is 8.2 %.
 
10.III.A.3.  Increase percent of pregnant women who received prenatal care in the first trimester.

Overall, the proportion of pregnant women entering prenatal care in the first trimester has increased over the last decade (from 75.8% in 1990 to 83.9% in 2005).  The percent of pregnant women who received prenatal care in the first trimester increased to 84.1 % and 84.2 % in FY 2003 and FY 2004, respectively.  While the FY 2005 rate was slightly lower, the target of 84% was essentially met.  Preliminary birth data for FY 2006 released by the CDC did not include data on the initiation of prenatal care, such as risk factors during pregnancy.  The FY 2009 target for this measure is 86%. 

Data on the timing of prenatal care are derived from the 1989 and the 2003 Revisions of the U.S. Standard Certificate of Live Birth.  It is important to note that the two formats are not directly comparable, due to substantive changes in how information is reported on the timing of prenatal care in the 2003 Certificate.  For 2005, data based on the 1989 Certificate (unrevised) are available for 37 States and data based on the 2003 Certificate (revised) are available for 12 States.  For consistency purposes, the data presented through 2005 and the established targets through 2009 reflect the data that were reported by States using the unrevised Certificate. 

Prenatal care is one of the most important interventions for ensuring the health of pregnant women and their newborn babies.  High quality prenatal care begins early in the pregnancy (preferably in the first trimester), and continues throughout the pregnancy, according to accepted standards of periodicity.  Accordingly, getting pregnant women into early and regular prenatal care has been a key area of emphasis for the Title V program.  The program is strongly committed to achieving the Healthy People 2010 goal of getting 90% of all pregnant women into prenatal care in the first trimester.         

  
10.2.  Reduce neonatal deaths to 4.5 per 1,000 live births.
(Baseline – 1999: 4.7/1,000; Target – 2008: 4.5/1,000, 2015: 4.2/1,000)

10.III.A.4.  Increase percent of very low-birth weight (VLBW) babies who are delivered at facilities for high-risk deliveries and neonates.

The Title V program plays an important role in the delivery of appropriate and effective care for high-risk pregnant women and infants.   Delivering VLBW babies, who are at higher risk for mortality and morbidity than non-LBW babies, at facilities with specialized equipment and personnel capable of the highest standard of care for these babies, significantly assists in reducing their associated mortality. 

The percent of VLBW babies delivered at facilities for high-risk deliveries and neonates declined from 75.2 % in FY 2002 to 71.7 % in FY 2004.  Since FY 2004, there has been steady improvement in the percent of VLBW infants delivered at facilities for high-risk deliveries and neonates, with rates at 73.4 % and 74.7 % for FY 2005 and FY 2006, respectively.  Revised as part of the FY 2008 PART reassessment, the FY 2006 target of 74% was met.  The revised target for FY 2009 is 75.5 %. 

 
10.3.  Increase maternal survival rate.
(Baseline – 1999: 8.3 deaths/100,000 live births; Target – 2008: 8/100,000 live births, 2015: 13.1/100,000 live births)

Long-Term Objective:  Expand the capacity of the health care safety net.

10.I.A.1.  Increase the number of children served by Title V.

Services for children supported under the Title V MCH Block Grant program include: the provision of direct health care, enabling services, population-based services, and infrastructure building activities.  Since FY 2003, the number of children served by Title V has been increasing.  Due to increases in screening services, the number of children served by Title V increased by 4 million between FY 2003 and FY 2004.  The number of children served by Title V varies within a State from year to year.  In FY 2007, the largest number of children (31.7 million) was served by Title V since data collection began in the Title V Information System in the 1990's.  The number served exceeds the FY 2007 target by 9.7 million.  (See section below on “Targets Substantially Exceeded or Not Met.”)  The FY 2009 target for this measure is that 29 million children will be served by Title V.

10.I.A.2.  Increase the number of children receiving Title V services who are enrolled in and have Medicaid and SCHIP coverage.

The number of children receiving Title V services covered by Medicaid and SCHIP increased from a baseline of 5.9 million in FY 2002 to 12.8 million in FY 2007.  The number served exceeded the FY 2007 target by 3 million.  (See section below on “Targets Substantially Exceeded or Not Met.”)  Between FY 2002 and FY 2003, the number of children served by Title V who received these services increased by 3.8 million.  The Title V program has continued to serve an increasing number of children with Medicaid and SCHIP coverage since FY 2004, with annual increases ranging between 0.1 million between FY 2003 and FY 2004 and 1.8 million between FY 2006 and FY 2007.  These increases reflect the efforts of State MCH programs to provide outreach to populations eligible for Medicaid and SCHIP coverage.  The FY 2009 target for this measure is that 11.5 million children with Medicaid and SCHIP coverage will be served by Title V. 

10.E.  Increase the number of children served by the Title V Block Grant per $1 million in funding.

The Title V Block Grant program provides States with Federal funds for a wide variety of health projects to improve the lives of all women and children.  These funds are spent by the States to support services for the maternal and child health populations, including children with special health care needs, at four levels – direct services, enabling services, population-based services, and infrastructure-building. 

Per $1 million in funding, the number of children receiving direct, enabling and population-based services through the Title V MCH Block Grant in FY 2007 reached its highest level at 45,792 since data reporting for this measure began.  This level of service exceeded the FY 2007 target of 32,500 by approximately 41 percent.  (See section below on “Targets Substantially Exceeded or Not Met.”)  The FY 2009 target for this measure is 39,000. 

TARGETS SUBSTANTIALLY EXCEEDED OR NOT MET

Measure:  Decrease the ratio of the black infant mortality rate to the white infant mortality rate.

FY 2006 Target:  2.2 to 1    
FY 2006 Result:  2.4 to 1 (Preliminary data)

While the U.S. has made progress in reducing the overall infant mortality rate, the significant disparity that still exists seriously impacts selected racial groups.  The Black infant mortality rate is more than twice the White rate.  Research has suggested that a higher rate of very low birth weight among Blacks may contribute to, but does not fully explain, racial differences in infant mortality rates.  Additional research is needed to identify factors that contribute to the black/white infant mortality disparity and to examine potential solutions. 

The Program continues to monitor the Black/White Infant Mortality Ratio and to explore promising models and effective strategies for addressing this issue.  Despite the slow rate of
progress, the Program’s targets of 2.2 to 1 and 2.1 to 1 for FY 2008 and FY 2009, respectively, reflect the Program’s ongoing commitment for continued improvement in this area.

Measure:  Reduce the incidence of low birth weight (LBW) births.

FY 2006 Target:  7.4%    
FY 2006 Result:  8.3 % (Preliminary data)

The increasing rate of LBW births is a recognized concern across the Nation.  The percentage of infants born LBW has increased 17 percent since the mid-1990s and 22 percent since 1984.  Recent increases are influenced by the rise in the multiple birth rate, greater use of obstetric interventions, and increases in maternal age at childbearing.  While multiple births are much more likely to be born LBW than singletons, the LBW rate for infants born in single deliveries has also been on the increase.  Singleton LBW rose from 6.3 to 6.4 percent for 2004-2005, and the rate has risen 7 percent since 2000.  LBW levels also increased for 2004-2005 among each of the largest racial/ethnic groups (non-Hispanic White births rose from 7.2% to 7.3%; non-Hispanic Black births rose from 13.7% to 14%; and Hispanic births rose from 6.8% to 6.9%). 

The Program continues to monitor the rate of LBW and its causes.  The full reasons for the increasing rate of LBW births are unclear and are under investigation.  Despite recent increases, the Program remains committed to improvement in this area.  Given these trends, however, the Program’s performance targets for FY 2008 and FY 2009 were revised to 8.2 %.

Low birth weight is associated with short-term morbidity and mortality, as well as long-term disabilities, such as cerebral palsy, autism, mental retardation, vision and hearing impairments, and other developmental disorders.  The reduction of the incidence of low birth weight babies would substantially reduce the risk of, and therefore the number of, babies that die in their first year of life, or suffer from long-term disabilities.

Measure:  Increase the number of children served by Title V.

FY 2007 Target:           22 million   
FY 2007 Result:           31.7 million

The number of children served by Title V is a critical measure of the degree to which the program is successful in reaching and providing services to one of its key target populations. 

From 1997 through 1999, the number of children served by Title V increased steadily.  In 2000, there was a temporary slight decrease from 23.0 million to 22.8 million.  Increases in screening services contributed to a large increase in the number of children served by Title V in FY 2004.  Given the variability in screening services provided for children within the States from year to year and the reductions in State MCH Block Grant allocations since FY 2004, participation data for multiple years were collected to determine if the increases in the number of children served by Title V performance could be maintained.

The Program continues to monitor the number of children served by Title V.  Targets for
FY 2008 and 09 were adjusted.

Measure:  Increase the number of children receiving Title V services who are enrolled in and have Medicaid and SCHIP coverage.

FY 2007 Target:  9.8 million          
FY 2007 Result:  12.8 million   

Between FY 2002 and FY 2003, the number of children receiving Title V services who had Medicaid and SCHIP coverage increased from 5.9 million children to 9.7 million.  The continuing increases in the number of children served by Title V who have Medicaid and SCHIP coverage since FY 2003 reflect the ongoing efforts of the State to do outreach to eligible populations and to increase participation in these programs.    

The Program continues to monitor the number of children served by Title V who have Medicaid and SCHIP coverage.  Targets for FY 2008 and 09 were adjusted to 11 million and 11.5 million, respectively.

Increased coverage under Medicaid and SCHIP for children receiving Title V services assures greater access, availability and continuity of care for the Nation’s children through the provision of a wide range of services. 

Measure:  Increase the number of children served by the Title V Block Grant per
$1 million in funding.

FY 2007 Target:  32,500     
FY 2007 Result:  45,792         

The number of children receiving services through the Title V MCH Block Grant funding mechanism has increased annually since FY 2003.  Per $1 million of funding, the number of children who have received direct, enabling and population-based services through the Title V program has increased from 31,515 in 2004 to 45,792 in 2007.  The FY 2007 performance was impacted by an increased number of children being served by the Title V program.  This increase has been largely due to a greater number of screening services being provided to school-aged children in the States.  Performance for this measure was further impacted by a reduction in the Title V MCH Block Grant funding since FY 2004.

The Program continues to monitor the number of children served by Title V and to explore opportunities for greater program efficiencies.  Performance targets for FY 2008 and 09 were adjusted.

The increase in the number of children served per $1 million in Title V funding shows some level of improvement in program efficiency in using Federal funds as well as a shift toward more population-based services.  Programs have also had to rely more heavily on other sources for program funding, including Medicaid and SCHIP, and to increasing the level of payments made by those receiving services.