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CSO Profiles

Maternal Characteristics and Birth outcomes For Community Services Offices, 1991-2004

Summary

Washington State comprises many diverse communities. The communities described in this report represent the neighborhoods surrounding the Department of Social and Health Services Community Services Offices (CSOs). This study portrays birth rates for the female population age 15-44 residing within the CSO boundaries and characteristics and birth outcomes for Medicaid and non-Medicaid women who gave birth from 1991 through 2004.

Birth rates. From 1991-92 to 2003-04, the birth rate in Washington decreased by 6.6%, from 66.3 per 1000 to 61.9 per 1000. Birth rates at the CSO level vary widely, from 31.4 per 1000 in 2003-04 in Belltown to 150.7 per 1000 in Mattawa. Key factors that influence birth rates include demographics, poverty, and educational attainment.

Medicaid coverage of births. In Washington, pregnant women with family incomes at or below 185% of the Federal Poverty Level are eligible for medical insurance coverage through Medicaid. The proportion of births funded by Medicaid directly reflects the economic well-being of the CSO community at a given point in time. In 2003-04, 45.6% of all Washington births were covered by Medicaid. The proportion of births with Medicaid funding ranged from 17.6% in King Eastside CSO (King County) to 79.8% in Wapato CSO (Yakima County).

Non-citizens are eligible for Medicaid coverage for pregnancy and delivery. The proportion of Medicaid-funded births to non-citizens has increased from 2.6% in 1991-92 to 9.1% in 2003-04. This represents a greater than three-fold increase. Ten CSOs demonstrated a ten-fold or greater increase in the proportion of births to non-citizens.

Race and ethnicity. Washington State has become more diverse in recent years. The percentage of births to non-Hispanic White women declined from 78.0% in 1991-92 to 65.4% in 2003-04. Alternatively, the percentage of births to Hispanic women doubled over the same period, from 8.6% to 17.0%. In five CSOs, more than half the births occurred to women of Hispanic descent in 2003-04: Mattawa (89.1%), Othello (80.9%), Sunnyside (79.1%), Wapato (65.5%), and Pasco (64.2%)

Age at first birth. The average age at first birth increased from 24.8 years in 1991-92 to 25.9 years in 2003-04. Both non-Medicaid and Medicaid women demonstrated increases although non-Medicaid women continue to be approximately 7 years older than Medicaid women at the time of first birth. In 2003-04, the average age at first birth was 22.1 for Medicaid women and 28.9 for non-Medicaid women. In three King County CSOs (Belltown, King North, and Capitol Hill), women having their first birth were on average age 30 or older in 2003-04.

Educational attainment. Between 1992 and 2004, the high school graduation rate for all Washington women who gave birth increased from 71.3% to 78.1%. The graduation rate for Medicaid women has increased from 50.3% in 1992 to 61.7% in 2003-04, yet it remains only two-thirds that of non-Medicaid women (91.8% in 2003-04). Educational attainment was lowest in Mattawa, Othello, Sunnyside, Wapato, Pasco, Long Beach, and White Salmon—where fewer than half of women who gave birth finished high school.

Marital status. From 1991-92 to 2003-04, the proportion of women married at the time of delivery decreased 5.9% from 74.9% to 70.5%. Throughout this time period, the proportion of non-Medicaid women married at the time of delivery remained about double that of Medicaid women. In 2003-04, the proportion of Medicaid women married at delivery was highest (70.5%) for Colfax Outstation in Region 1 and lowest (31.7%) in Forks Branch Office in Region 6.

Prenatal care. The proportion of women beginning prenatal care in the third trimester or with none at all decreased from 4.0% in 1991-92 to 3.0% in 2001-02. Although this decrease was greatest for Medicaid women (37.2%), their rate of late or no prenatal care remained over three times (3.3) that of non-Medicaid women in 2001-02. The apparent increase in late or no prenatal care from 3.0% in 2001-02 to 4.4% in 2003-04 is likely the result of birth certificate format changes implemented in 2003.

Maternal smoking. The maternal smoking rate in Washington State has declined by nearly half since the 1990s, from 18.2% in 1991-92 to 10.2% in 2003-04. Despite this overall trend, disparities between low- and higher-income women persist. In 2003-04, only 4.0% of non-Medicaid women smoked during pregnancy, compared with 17.6% of women with Medicaid funded deliveries. Smoking rates vary widely at the CSO level.

Low birth weight. Low birth weight (LBW) refers to infants weighing less than 2,500 grams at birth. The LBW rate for singleton liveborn infants in Washington State rose slightly, from 4.3% in 1991-92 to 4.7% in 2003-04. Throughout the 1990s, LBW rates for low- and higher-income women converged: the LBW rate gradually declined for Medicaid women but steadily increased for non-Medicaid women. This continued until 2001-02, when the LBW rate for Medicaid women also began to increase slightly.

Preterm births. A preterm birth is defined as a baby born at less than 37 weeks of gestation. The general trend is upward; however, gestational age is reported with much less precision than birth weight. From 1991-92 to 1999-2000, the rate of preterm births among Medicaid women fluctuated between 8.8% (1995-96) and 9.3% (1991-92 and 1997-96), and subsequently increased to 9.7% in 2001-02 and 9.9% in 2003-04. Among non-Medicaid women, the rate of preterm births increased from 6.7% in 1991-92 to 7.8% in 2001-02, and then declined slightly to 7.7% during the next two years.

CONCLUSIONS. These findings emphasize the importance of considering characteristics of individual communities in maternity care programs and family planning activities. Some measures vary widely across the State and within DSHS regions, yet various groups of CSOs also share a number of characteristics. Recognizing the similarities and differences between the communities surrounding the CSOs, and their values and cultural differences, is a necessary step in developing community-specific interventions to meet the needs of these diverse communities and to ensure healthy birth outcomes.

Modified: Tuesday March 04 2008

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