Progress Toward Healthy People 2010 Targets

The following discussion highlights objectives that met or exceeded their 2010 targets; moved toward the targets, demonstrated no change, or moved away from the targets; and those that lacked data to assess progress. Progress is illustrated in the Progress Quotient bar chart (see Figure 16-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

Objectives that met or exceeded their targets. From its original baseline of 35 percent, the proportion of infants being put to sleep on their backs (16-13) met its target of 70 percent. The national "Back to Sleep" campaign is one initiative that has educated physicians and caregivers about the risks associated with prone sleeping (sleeping with stomach facing down).⁸ Median red blood cell (RBC) folate levels for nonpregnant females aged 15 to 44 years (16-16b) exceeded its target of 220ng/ml. In addition to food fortification, one of the initiatives working to increase folate levels among females is the "Folic Acid Education Campaign." ⁹ Consumption of folic acid by women of childbearing age has been shown to reduce the rate for NTDs.¹⁰

Objectives that moved toward their targets. Progress was made toward the fetal, perinatal, infant, child, adolescent and young adult, and maternal death objectives and subobjectives (16-1a through e, 16-1g and h, 16-2, 16-3a and b, and 16-4, respectively).

The objective for maternal deaths (16-4) is associated with many conditions and causes, some of which may be more manageable with intervention than others. Although some progress was made toward reducing maternal deaths, achieving the target will require that national, State, and local policies address women's needs before and during pregnancy and that gaps in prevention programs and research be identified. Improved monitoring is essential to assessing the effectiveness of policies to reduce maternal illness and death. Through the Maternal and Child Health Bureau at HRSA, HHS has initiated review committees in several States to identify ways to prevent pregnancy-related deaths.¹¹

Progress was made toward the reduction of some birth defects, including spina bifida and other neural tube defects (16-15). However, continued efforts are needed to fully realize the potential for preventing birth defects and birth-defect-related deaths with known causes. Several centers for birth defects research and prevention are collaborating on a large study to determine environmental, genetic, and behavioral factors that cause or contribute to specific birth defects.^{12, 13}

Breastfeeding rates increased for immediate and 6- and 12-months post partum (16-19), and early prenatal care rates (16-6a and b) also slightly increased. Multiple initiatives support breastfeeding, from the Federal level down to the grassroots. For example, 32 States have passed laws allowing women to breastfeed in any public or private location, and 20 have laws exempting breastfeeding from public indecency laws.¹⁴ Five States have also implemented or encouraged development of breastfeeding awareness and education campaigns. Among Federal initiatives that encourage breastfeeding are the "National Breastfeeding Awareness Campaign,"¹⁵ the Healthy Start Initiative,^{16, 17} and the Title V Block Grant Program, which is intended to improve the health of all mothers and children in the Nation.

The proportion of women who have abstained from smoking during pregnancy increased (16-17c), moving toward the target of 99 percent. Federal partnership activities aimed at reducing tobacco use among pregnant women are under way, including efforts to strengthen States' capacity to develop, implement, and evaluate tobacco prevention and cessation programs for women of reproductive age and the Action Learning Lab to assist States directly.¹⁸

Objectives that moved away from their targets. Ten objectives and subobjectives moved away from their targets. The subobjectives for mental retardation (16-14a) and cerebral palsy (16-14b) moved the farthest away from their respective targets. For many children, the cause of mental retardation is unknown. In some cases, mental retardation may be a secondary condition resulting from birth defects, infectious diseases, or trauma.^{19, 20, 21} Because of the high rate of comorbidity, achieving objectives related to mental retardation targets is closely linked to reductions in the number of developmental disabilities and birth defects. Some causes of mental retardation are known and can be prevented. Activities designed to reverse this trend include initiatives to prevent FAS (16-18) and efforts to expand standardized newborn screening that prevents mental retardation caused by a variety of metabolic disorders.

As with mental retardation, the wide variety of contributing factors to cerebral palsy inhibits progress toward achieving the target for this objective. HHS supports, guides, and funds research on the factors that increase risk for cerebral palsy. In addition, the national "Learn the Signs. Act Early." campaign helps health care providers and parents identify earlier signs of developmental disorders, including autism, hearing loss, and cerebral palsy.²²

The rate for cesarean births (C-sections) (16-9), both primary and repeat, moved away from the target. According to the 2002 Birth Report, the rise in cesarean births may be due to nonclinical factors such as demographics, physicians' practice patterns, and maternal choice.²³ For older women, increased rates may be due to patient-practitioner concerns and the increased rate of multiple births.²³ The rate for repeat cesarean births increased. Although the causes for this increase are unknown, they may include reports on the risks associated with vaginal births after cesarean delivery, more conservative practice guidelines, and legal pressures. Although C-sections have been effective in saving lives, they also can increase the risk of illness and death.²⁴ Many programs have been initiated to reduce the rate for cesarean delivery with a focus on increasing the role of midwives, changing physicians' on-call schedules, and requiring second opinions from hospitals.²⁵

Other objectives and subobjectives that moved away from their targets included deaths in young adults aged 20 to 24 years (16-3c), maternal complications during labor and delivery (16-5a), low birth weight and very low birth weight (16-10a and b), and preterm births between 32 and 36 weeks of gestation (16-11b) and less than 37 weeks of gestation (16-11a). The increasing death rate for young adults may be due to the increase in the number of motor vehicle crashes, the leading cause of death in this age group.²⁶ The increase in the rates of maternal complications during hospitalized labor and delivery may be due to the increasing age of pregnant women, the use of epidural analgesia, and suboptimal care provided to select racial and ethnic groups.^{27, 28} Mothers aged 35 years and older and those who are black had the highest rates of labor and delivery complications. Part of the increase in low and very low birth weight rates may be due to recent increases in the rate for multiple births, which may be related to more widespread use of assisted reproductive technologies and pharmacologic treatment of infertility.²³ Similarly, since twins and triplets are more likely to be born early, the rise in multiple births affected the preterm delivery rate.²³

Objectives that demonstrated no change. No change occurred in the rate for infant deaths due to birth defects (16-1f). The new State Infant Mortality Collaborative was created to explore possible explanations for the increasing, stagnant, or high infant mortality rates in five States.²⁹

The rate for preterm births at less than 32 weeks of gestation (16-11c) also did not change. The specific causes of preterm delivery are not known. However, further increases in the proportion of women who receive preconception and prenatal care can improve access to screening and diagnostic tests that can reduce the risk of preterm birth and other poor-birth outcomes. Access to care is critical because it can reduce the risks of poor-birth outcomes.

Objectives that could not be assessed. At the time of the midcourse review, data to assess progress were unavailable for childbirth classes (16-7); very low birth weight infants born at level III hospitals (16-8); weight gain during pregnancy (16-12); age at diagnosis of autism spectrum disorder in children (16-14c); consumption of at least 400 μg of folic acid each day from fortified foods or dietary supplements by nonpregnant women aged 15 to 44 years (16-16a); abstinence from alcohol, binge drinking, and illicit drugs among pregnant women (16-17a, b, and d); FAS (16-18); mothers who breastfeed their babies exclusively through 3- and 6-months post partum (16-19d and e); bloodspot screening (16-20a) and bloodspot followup testing (16-20b); hospitalization for sickle cell disease among children (16-21); medical homes for children with special health care needs (16-22); and service systems for children with special health care needs (16-23).

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