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Section II:
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Priority: HEALTHY BIRTHS (Maternal, Infant and Child Health)

TABLE OF CONTENTS

  1. Health Data
  2. Unmet Needs
  3. Resources in Chautauqua County
  4. Opportunities for Action
According to Healthy People 2010,

The health of mothers, infants, and children is of critical importance, both as a reflection of the current health status of a large segment of the U.S. population and as a predictor of the health of the next generation. This focus area addresses a range of indicators of maternal, infant, and child health-those primarily affecting pregnant and postpartum women (including indicators of maternal illness and death) and those that affect infants' health and survival (including infant mortality rates; birth outcomes; prevention of birth defects; access to preventive care; and fetal, perinatal, and other infant deaths).

Infant mortality is an important measure of a nation's health and a worldwide indicator of health status and social well-being. As noted in the 2010 Initiative,

In the past decade, critical measures of risk of infant death, such as new cases of low birth weight (LBW) and very low birth weight (VLBW) have shown increases in the United States. In addition, the disparity in infant mortality rates between whites and specific racial and ethnic groups (especially African Americans, American Indians or Alaska Natives, Native Hawaiians, and Puerto Ricans) persists. Although the overall infant mortality rate has reached record low levels, the rate for African Americans remains twice that of whites.

Issues and Trends

Figure 1 shows data for infant mortality by race and ethnicity in the U.S. (1988-98). Overall infant mortality has declined during this time period, although the rates for some subpopulations remain higher than for others. Infants of Blacks/African Americans consistently have had the highest mortality rates, and although the rate has declined over time, it still remains higher than for other subpopulations. Infants of Native Americans also have a higher-than-average risk, with greater fluctuations in the mortality rate than for other subpopulations.


Figure 1. Infant Mortality Rates in the U.S. 1988-98.
Figure 1. Infant Mortality Rates in the U.S. 1988-98
(http://www.healthypeople.gov/Document/HTML/Volume2/16MICH.htm#_Toc494699659)

Healthy People 2010 and Healthy Births

The following chart presents the Healthy People 2010 targets for the objectives pertinent to ensuring healthy births, along with baseline data for the year(s) indicated. This chapter examines Chautauqua County data for the Priority: Healthy Births indicators listed in bold type and selected other indicators associated with healthy births.


A. Health Data

1. Infant, Neonatal, Post Neonatal and Spontaneous Fetal Deaths in Chautauqua County

Table 1 shows that Chautauqua County has lower rates of infant deaths, neonatal deaths, postneonatal deaths, and perinatal deaths than does New York State overall.

The County also meets the Healthy People 2010 target rate for infant mortality (4.5 deaths per 1,000 live births), and is close to the 2010 goal for postneonatal deaths (1.3 deaths vs. target of 1.2 deaths per 1,000 live births). However, the County neonatal death rate (3.2 per 1,000 live births) is higher than the 2010 target (2.9). According to the Healthy People 2010 Initiative, short gestation and low birth weight (LBW) are among the leading causes of neonatal death, accounting for 20 percent of neonatal deaths in the United States. County rates for gestation and LBW are examined later in this chapter. The County rate for perinatal deaths (9.0) is twice as high as the 2010 target (4.5 deaths per 1,000 live births).


Healthy People 2010 Baselines and Targets
for Priority: Healthy Births
OBJECTIVE PRIORITY INDICATORS 1998
Baseline
2010 Target
  Reduction in Fetal and Infant Deaths Per 1,000 Live Births
16-1a. Fetal deaths at 20 or more weeks of gestation 6.8 (1997) 4.1
16-1b. Fetal and infant deaths during perinatal period (28 weeks of gestation to 7 days or more after birth) 7.5 4.5
16-1c. All infant deaths (within 1 year) 7.2* 4.5
16-1d. Neonatal deaths (within the first 28 days of life) 4.8 2.9
16-1e. Post-neonatal deaths (between 28 days and 1 year) 2.4 1.2
16-1f. All birth defects 1.6 1.1
16-1g. Congenital heart defects 0.53 0.38
16-h. Reduce deaths from SIDS 0.72** 0.25
 
Objective Reduction in Maternal Deaths 1998
Baseline
2010 Target
  Rate per 100,000 live births
16-4. Maternal Deaths 7.1 3.3
 
Objective Reduction in Maternal Illness and Complications 1998
Baseline
2010 Target
  Per 100 Deliveries
16-5a. Maternal complications during hospitalized labor and delivery 31.2 24
16-5b. (developmental) Ectopic pregnancies    
16-5c. (developmental) Postpartum complications, including postpartum depression    
 
Objective Increase in Maternal Prenatal Care 1998 Baseline 2010 Target
  Percent of Live Births
16-6a. Care beginning in first trimester of pregnancy 83% 90%
16-6b. Early and adequate prenatal care 74% 90%
16.7 (developmental) Increase proportion of pregnant women who attend a series of prepared childbirth classes.    
16.8 Increase proportion of VLB infants born at level III hospitals or subspecialty perinatal centers 73% (1996-97) 90%
 
Objective Reduction in Cesarean Births 1998 Baseline 2010 Target
  Percent of Live Births
16-9a. Women giving birth for the first time 18% 15%
16-9b. Prior cesarean birth 72% 63%
 
Objective Reduction in Low and Very Low Birth Weight 1998 Baseline 2010 Target
  Percent
16-10a. Low birth weight (LBW) 7.6% 5.0%
16-10b. Very low birth weight (VLBW) 1.4% 0.9%
 
Objective Reduction in Preterm Births 1998 Baseline 2010 Target
  Percent
16-11a. Total preterm births 11.6% 7.6%
16-11b. Live births at 32 to 36 weeks of gestation 9.6% 6.4%
16-11c. Live births at less than 32 weeks of gestation 2.0% 1.1%
16.12 (developmental) Increase proportion of mothers who achieve a recommended weight gain during their pregnancies.    
16.13 Increase percentage of healthy full-term infants who are put to sleep on their backs. 35% (1998) 70%
 
Objective Reduction in Developmental Disabilities in Children 1991–94 Baseline 2010 Target
  Rate per 10,000
16-14a. Mental retardation 131** 124
16-14b. Cerebral palsy 32.2† 31.5
16-14c. Autism spectrum disorder Developmental
16-14d. Epilepsy Developmental
 
Objective Increase in Pregnancies Begun With Optimum Folic Acid Level 1991–94 Baseline 2010 Target
  Percent
16.15 Reduce occurrence of spina bifida & other NTDs 6 new cases (1998) 3 new cases
16-16a. Consumption of at least 400 g of folic acid each day from fortified foods or dietary supplements by non-pregnant women aged 15 to 44 years 21% 80%
16-16b. Median RBC folate level among non-pregnant women aged 15 to 44 years 160 ng/ml 220 ng/ml
 
Objective Increase in Reported Abstinence in Past Month From Substances by Pregnant Women*** 1996–97 Baseline 2010 Target
  Percent
16-17a. Alcohol 86% 94%
16-17b. Binge drinking 99% 100%
16-17c. Cigarette smoking†† 87% (1998) 99%
16-17d. Illicit drugs 98% 100%
16.18 (developmental) Reduce occurrence of FAS    
 
Objective Increase in Mothers Who Breastfeed 1998 Baseline 2010 Target
  Percent
16-19a. In early postpartum period 64% 75%
16-19b. At 6 months 29% 50%
16-19c. At 1 year 16% 25%
16-20. (developmental) Ensure appropriate new born bloodspotting screening, followup testing and service referrals.  
16-21. (developmental) Reduce hospitalizations for life-threatening sepsis among children age < 4 years with sickling helpglobinopathides  
16-22. (developmental) Increase proportion of children with special health care needs who have access to a medical home.  
13-17. (developmental) Reduce new cases of perinatally acquired HIV infection  
 
Objective FAMILY PLANNING 1995
Baseline
2010 Target
9.1 Increase the proportion of pregnancies that are intended. (of pregnancies of women aged 15 to 44 years) 51% 70%
9.2 Reduce the proportion of births occurring within 24 months of a pervious birth. (% of pregnancies of women aged 15 to 44 years) 11% 6%
9.3 Increase the proportion of females at risk of unintended pregnancies (and their partners) who use contraception. (% of pregnancies of women aged 15 to 44 years) 93% 100%
9.4 Reduce the proportion of females experiencing pregnancy despite use of reversible contraception method. (% of pregnancies of women aged 15 to 44 years) 13% 7%
9.5 (developmental) Increase the proportion of health care providers who provide emergency contraception.    
9.6 (developmental) Increase male involvement in pregnancy prevention and family planning efforts.    
9.7 Reduce pregnancies among adolescent females (per 1,000 females aged 15 to 17 years)††† 68 (1996) 43
9.8 Increase the proportion of adolescents who have never engaged in sexual intercourse before age 15 years.    
9.8a Females 81% 88%
9.8b Males 79% 88%
9.9 Increase the proportion of adolescents who have never engaged in sexual intercourse (adolescents aged 15 to 17 years)    
9.9a Females 62% 75%
9.9b Males 75% 75%
9.10 Increase the proportion of sexually active, unmarried adolescents aged 15 to 17 years who use contraception that both effectively prevents pregnancies and provides barrier protection against disease.    
Condom    
9.10a Females 67% 75%
9.10b Males 72% 83%
Condom plus hormonal method    
9.10c Females 7% 9%
9.10d Males 8% 11%
9.11 Increase the proportion of young adults who have received formal instruction before turning age 18 year on reproductive health issues, including all of the following topics: birth control methods, safer sex to prevent HIV, prevention of sexually transmitted diseases, and abstinence. 64% 90%
9.12 Reduce the proportion of married couples whose ability to conceive or maintain a pregnancy is impaired. 13% 10%
9.13 (developmental) Increase the proportion of health insurance policies that cover contraceptive supplies and services.    
* Plus Fetal Deaths
 
** Children aged 8 years in metropolitan Atlanta, GA, having an IQ of 70 or less.
 
***Pregnant women aged 15 to 44 years.
 
†Children aged 8 years in metropolitan Atlanta, GA.
 
††Smoking during pregnancy for all women giving birth in 1998 in 46 States, the District of Columbia, and New York City.
 
††† Baseline and target data for adolescents under age 15 not available. According to Healthy People 2010 Initiative, "nearly two-thirds of pregnancies in this age group end in induced abortion or fetal loss. Because of the relatively small numbers of events (and small sample sizes for fetal losses) involved, the resulting rates are not as stable as for older females. Almost no discernible decline in pregnancy rates for this age group occurs on an annual basis."

 
Table 1. Infant Deaths, Neonatal Deaths, Postneonatal Deaths and Perinatal Mortality in Chautauqua County and New York State, 2002.
Table 1.  Infant Deaths, Neonatal Deaths, Postneonatal Deaths and Perinatal Mortality in Chautauqua County and New York State, 2002

For spontaneous fetal deaths in Table 2, the County rate of 7.1 per 1,000 live births is below the rate for New York State (7.7), although the County rate is somewhat higher than for the western New York region (6.3). The County fetal death rate also is higher than the Healthy People 2010 target rate (4.1 per 1,000 live births).


Table 2. Spontaneous Fetal Deaths in Chautauqua County
and New York State, 2000-2002.
  Fetal Deaths 20+ Weeks Births+SFDs Rate*
  2000 2001 2002 Total 2000-2002  
Chautauqua County 9 16 8 33 4,656 7.1
Western New York Region Total 104 121 117 342 54,514 6.3
New York State Total 2,013 1,927 1,987 5,927 768,714 7.7
Healthy People 2010 Target           4.1

* Per 1,000 Live Births+Spontaneous Fetal Deaths 20+ weeks gestation. Source: 2000-2002 Vital Statistics Data as of August, 2004 (https://commerce.health.state.ny.us/hin/).



2. Deaths from SIDS in New York State

Table 3 presents data on sudden infant death syndrome (SIDS) for New York State (excluding New York City) by race/ethnicity for infants less than one year of age.


Table 3. Deaths from Sudden Infant Death Syndrome (SIDS) in New York State (excluding New York City), 2003.
Total Deaths Number Percent of deaths < 1 year,
all causes
SIDS 25 3.2%
White
SIDS 15 2.9%
Black
SIDS 8 4.3%
Hispanic2
SIDS 3 3.0%
Healthy People 2010 Target   2.5%
1Total Deaths = White + Black + Other + Not Stated
2 Hispanic is a separate count equal to Hispanic White + Hispanic Black + Hispanic Other + Hispanic Not Stated
(https://commerce.health.state.ny.us/hin).

 

3. Maternal Mortality in Chautauqua County

As shown in Table 4, no cases of maternal death in Chautauqua County were reported for the years 2000, 2001 and 2002, unlike in the Western New York region and New York State. The county is below the 2010 goal of 3.3 maternal deaths per 100,000 live births.


Table 4. Maternal Mortality in Chautauqua County
and New York State, 2000-2002.
  Maternal Deaths Births Rate (100,000 live births)
  2000 2001 2002 Total 2000-2002  
Chautauqua County 0 0 0 0 4,623 0.0
WNY Region Total 1 2 0 3 54,172 5.5
New York State 41 50 32 123 762,787 16.1
Healthy People 2010 Target   3.3
Source: 2000-2002 Vital Statistics Data as of August, 2004 (http://www.health.state.ny.us/nysdoh/chac/cha/matmort.htm).


4. Maternal Prenatal Care in Chautauqua County

One important factor in fostering healthy births is early prenatal care. As Table 5 shows, Chautauqua County provides a greater percentage of women with early prenatal care (72.9%) than in the western New York region and New York State. The 2010 goal is for 90% of women to receive early prenatal care (early and adequate care in first trimester).


Table 5. Early Prenatal Care in Chautauqua County
and New York State, 2000-2002.
  Births, Early Prenatal Care Births  
  2000 2001 2002 Total 2000-2002 Percentage
Chautauqua County 1,013 1,008 965 2,986 4,097 72.9%
WNY Region Total 13,171 12,634 12,335 38,140 50,951 74.9%
New York State Total 172,615 172,108 175,032 519,755 708,990 73.3%
Healthy People 2010* Target
(Early & Adequate Care/Care in First Trimester)
  90%
Source: 2000-2002 Vital Statistics Data as of August, 2004 (http://www.health.state.ny.us/nysdoh/chac/cha/pnce.htm).

Another way to assess the utilization of prenatal care is to examine the percentage of women receiving late or no prenatal care. Table 6 presents these data. Chautauqua County has fewer women receiving late or no prenatal care (5.9%) than in western New York (7.0%) or New York State (6.2%).


Table 6. Late or No Prenatal Care in Chautauqua County
and New York State, 2000-2002.
  Births, Late or No Prenatal Care Births  
  2000 2001 2002 TOTAL 2000-2002 Percentage
Chautauqua County 84 79 78 241 4,097 5.9%
WNY Region Total 1,219 1,181 1,157 3,557 50,951 7.0%
New York State Total 14,427 15,187 14,163 43,777 708,990 6.2%
Source: 2000-2002 Vital Statistics Data as of August, 2004 (http://www.health.state.ny.us/nysdoh/chac/cha/pncl.htm).


5. Anemia During Pregnancy

In a 1996 WIC report, children showed inappropriate or inadequate nutrient intake and anthropometric risks (low weight for height, for example) as their most frequently recorded risks. Three-quarters of WIC infants were recorded at risk due to the WIC-eligibility of their mothers or because their mothers were at risk during pregnancy. At least one nutritional risk was reported for 99.4 percent of WIC enrollees in April 1996. Not getting enough iron during pregnancy can cause preterm labor and delivering a low-birth weight baby. Table 7 shows the percentages of WIC participants with hematocrit or hemoglobin below New York State standards by level of poverty in 1996.


Table 7. Pregnant WIC Participants with Anemia in
New York State by Level of Poverty, 1996.
Hematocrit or Hemoglobin below State standards 1% to 100% 101% to 130% 131-185% 186% and over Zero Reported Income Income Not Reported
New York State 26.6% 22.9% 21.2% 19.6% 23.3% 31.1%
Decreased hematocrit indicates anemia; below-normal hemoglobin levels may be the result of anemia, among other conditions. http://www.nlm.nih.gov/medlineplus/anemia.html

Data Source: Study of WIC Participant and Program Characteristics 1996 (1998) (https://commerce.health.state.ny.us/hin/).



6. Folic Acid During Pregnancy

Issues related to folic acid during pregnancy are discussed in the following study.

The New York State Department of Health Center for Environmental Health conducted a case-control study in fourteen urban New York State counties of infants born with a heart that did not form normally (congenital heart defect). The study compared the use of regular multivitamins with the use of special vitamins, or prenatal vitamins, for pregnant mothers. Prenatal vitamins usually contain about twice as much folic acid as regular multivitamins. Vitamins containing folic acid are important to study because previous research suggests that folic acid may prevent many serious congenital defects, including some heart defects, as well as neural tube defects (defects of the brain and spinal cord).

The study results suggest that mothers who take prenatal vitamins or vitamins containing high levels of folic acid early in pregnancy, before or during the formation of the fetal heart, had a six percent reduction in the risk of giving birth to a baby with a congenital heart defect. The study also found a 30 percent risk reduction for a group of related congenital heart defects called conotruncal defects, confirming previous research findings.

The results of this study are consistent with current recommendations that all women take folic acid either in a vitamin or in food products fortified with folic acid. These results should encourage public health agencies to continue educating women about the benefits of including folic acid in their diet (https://commerce.health.state.ny.us/hin/).


7. Low Birth Weight and Preterm Births in Chautauqua County

According to the Healthy People 2010 Initiative,

Four causes account for more than half of all infant deaths: birth defects, disorders relating to short gestation and unspecified low birth weight (LBW), sudden infant death syndrome (SIDS), and respiratory distress syndrome. LBW and short gestation contribute to increased risks of poor pregnancy outcomes. Despite the low proportion of pregnancies resulting in LBW babies, expenditures for the care of LBW infants total more than half of the costs incurred for all newborns. The general category of LBW infants includes both those born too early (preterm infants) and those who are born at full term but who are too small, a condition known as intrauterine growth retardation (IUGR). Maternal cigarette smoking is the greatest known risk factor. LBW is associated with long-term disabilities, such as cerebral palsy, autism, mental retardation, vision and hearing impairments, and other developmental disabilities.

In Chautauqua County, fewer LBW infants with weights less than 2.5 kilograms were born to resident mothers (7.2%) than in western New York (8.1%) or New York State (7.92%), as shown in Table 8. However, the county's percentage of LBW infants is higher than the 2010 target of 5.0%.


Table 8. Low Birth Weight Infants of Mothers Residing in
Chautauqua County and New York State, 2002.
(LBW = <2.5K)
  Birth Percentages (x100) Counts (Number of LBW Infants
/ Live County Births, 2002)
Chautauqua County 7.20 (108/ 1501)
WNY Region Total 8.10 (1431 / 17677)
New York State Total 7.92 (19853 / 250806)
Healthy People 2010 Target 5.0 ----

(http://www.healthypeople.gov/Document/pdf/Volume2/16MICH.pdf)

As noted in the Healthy People 2010 guidelines,

included in the LBW category are very low birth weight (VLBW) infants weighing less than 1,500 grams (3.3 pounds), usually is associated with preterm birth. According to the 2010 statement, relatively little is known about risk factors for preterm birth, but the primary risk factors are prior preterm birth and spontaneous abortion, low pre-pregnancy weight, and maternal cigarette smoking. These risk factors account for only one-third of all preterm births, however.

Only 1.0% of Chautauqua County infants were very low birth weight (VLBW), compared to 1.79% in Western New York and 1.55% in New York State. With the Healthy People 2010 target for VLBW infants at 0.9%, the county is close to meeting this goal (see Table 9).


Table 9. Very Low Birth Weight Infants of Mothers Residing in
Chautauqua County and New York State, 2002.
(VLBW = <1.5K)
  Birth Percentages
(x100)
Counts
(Number of VLBW
/100 Births in 2002)
Chautauqua County 1.00 ( 15/ 1501 )
WNY Region Total 1.79 ( 317 / 17677 )
New York State Overall 1.55 ( 3892/250806 )
Healthy People 2010 Target 0.9 ----

(https://commerce.health.state.ny.us/hin/cgi-bin/applinks/vitalrec/birth.cgi/birthpctj)

The general category of LBW infants includes those born too early (preterm infants). As noted in the 2010 Initiative,

11.6% of U.S. births were preterm in 1998. LBW is associated with long-term disabilities, such as cerebral palsy, autism, mental retardation, vision and hearing impairments, and other developmental disabilities.

The Healthy People 2010 goal is 7.6% of fewer live births occurring prior to 37 weeks gestation. In Table 10, Chautauqua County's rate is 10.5%, which compares favorably both to the rates for western New York and New York State (11.2% and 11.5%), but will need to be reduced to meet the 2010 target of 7.6%.


Table 10. Short Gestation Births (<37 weeks) in Chautauqua County
and New York State, 2000-2002.
  Births <37 Weeks Births  
  2000 2001 2002 TOTAL 2000-2002 Percentage
Chautauqua County 165 178 133 476 4,512 10.5%
WNY Region Total 2,058 1,890 1,896 5,844 52,248 11.2%
New York State Total 29,357 27,738 27,646 84,741 735,486 11.5%
Healthy People 2010 Target   7.6%

Source: 2000-2002 Vital Statistics Data as of August, 2004 (https://commerce.health.state.ny.us/hin/).

An alternative consideration for the increase in LBW babies and neonatal deaths in Chautauqua County, despite increased rates of early prenatal care and fewer teen births, is older maternal age coupled with plural births. Of the 108 LBW births in 2002, 90 were singletons and 18 were twins. As Figures 2 and 3 suggests, LBW twins were born to a greater number of older mothers (>30 years of age). The finding must be viewed cautiously, however, as there are relatively few LBW births and other factors have not been considered.


Figure 2. LBW Births (<2.5K) in Chautauqua County
by Maternal Age for Single Births, 2002.
Figure 2. LBW Births (less than 2.5K) in Chautauqua County by Maternal Age for Single Births, 2002


Figure 3. LBW Births (<2.5K) in Chautauqua County
by Maternal Age for Twins, 2002.
Figure 3. LBW Births (less than 2.5K) in Chautauqua County by Maternal Age for Twins, 2002

(https://commerce.health.state.ny.us/hin/cgi-bin/applinks/vitalrec/birth.cgi/birthchart)


9. Family Planning

a. Pregnancy in Chautauqua County

Table 11 presents data on pregnancies for females age 15-44 in Chautauqua County, 2000-2002. The County has a lower pregnancy rate (65.8 pregnancies per 1,000 females) than western New York (75.2) or New York State (90.3).


Table 11. Pregnancy Rate and Trends in Chautauqua County and New York State per 1,000 Females Age 15-44, 2000-2002.
  Pregnancies (Age 15-44) Population  
  2000 2001 2002 Total 2001 Rate
Chautauqua County 1,860 1,934 1,824 5,618 28,455 65.8
Western New York Region Total 25,152 24,546 24,002 73,700 326,678 75.2
New York State Total 385,625 377,933 375,837 1,139,395 4,206,428 90.3
Healthy People 2010 Target   ---
Source: 2000-2002 Vital Statistics Data as of August, 2004 (http://www.health.state.ny.us/nysdoh/chac/cha/tpreg.htm).

Table 12 shows a lower pregnancy rate for adolescents age 10-14 in Chautauqua County (1.0 pregnancies per 1,000 females age 10-14) for 2000-2002. than in western New York (1.5) or New York State (1.6). There were few pregnancies for adolescents age 10-14 in the County for each of these years, and only 15 for the three-year period.


Table 12. Pregnancy Rate and Trends in Chautauqua County and New York State per 1,000 Females Age 10-14, 2000-2002.
  Pregnancies (Age 10-14) Population  
  2000 2001 2002 Total 2001 Rate
Chautauqua County 8 5 2 15 4,890 1.0
Western New York Region Total 99 82 71 252 55,718 1.5
New York State Total 1,154 1,079 1,002 3,235 655,042 1.6
Healthy People 2010 Target*   ---
Source: 2000-2002 Vital Statistics Data as of August, 2004 (http://www.health.state.ny.us/nysdoh/chac/cha/tp1014.htm).
*Baseline and target data for adolescents under age 15 not available. See note in Healthy People 2010 chart in this chapter.

The data in Table 13 reveal that Chautauqua County has a lower rate of pregnancy for females age 15-19 (49.0 per 1,000 females age 15-19) than either western New York (56.7) or New York State (67.1).


Table 13. Pregnancy Rate and Trends in Chautauqua County and New York State per 1,000 Females Age 15-19, 2000-2002.
  Pregnancies (Age 15-19) Population  
  2000 2001 2002 Total 2001 Rate
Chautauqua County 266 302 249 817 5,556 49.0
Western New York Region Total 3,296 3,185 2,991 9,472 55,695 56.7
New York State Total 43,340 41,909 39,893 125,142 621,870 67.1
Healthy People 2010 Target   ---
Source: 2000-2002 Vital Statistics Data as of August, 2004 (http://www.health.state.ny.us/nysdoh/chac/cha/tp1519.htm).

In Table 14, the pregnancy rate in Chautauqua County for adolescents age 15-17 is 3.4 pregnancies per 100 live births, which is slightly higher than the western New York or New York State rates (3.3 and 2.5, respectively.) However, the County rate is below the Healthy People 2010 target of 4.3%.


Table 14. Pregnancy Rate in Chautauqua County and New York State per 100 Live Births Age 15-17, 2000-2002.
  Births (Age 15-17) Births  
  2000 2001 2002 Total 2000-2002 Percentage
Chautauqua County 52 62 43 157 4,622 3.4
Western New York Region Total 656 610 534 1,800 54,167 3.3
New York State Total 6,954 6,522 5,867 19,343 762,551 2.5
Healthy People 2010 Target   4.3
Source: 2000-2002 Vital Statistics Data as of August, 2004 (http://www.health.state.ny.us/nysdoh/chac/cha/pct1517.htm)

Figure 4 presents trends in teenage pregnancy in Chautauqua County and New York State, 1994-2000. Although the rate of teen pregnancies in the County is higher than in the state during 2000, the County rate has declined nearly 18 percent during this time period.

Figure 4. Trends in the Teenage Pregnancy Rate in Chautauqua County and
New York State per 10,000 females age 10-19, 1994-2000.
Figure 4. Trends in the Teenage Pregnancy Rate in Chautauqua County and New York State per 10,000 females age 10-19, 1994-2000
(http://www.oasas.state.ny.us/hps/datamart/2003_PRISMS_Profiles/Chautauqua.pdf)


Figure 5. Trends in the Teenage Abortion Rate in Chautauqua County and
New York State per 10,000 females age 10-19, 1994-2000.
Figure 5. Trends in the Teenage Abortion Rate in Chautauqua County and New York State per 10,000 females age 10-19, 1994-2000.
(http://www.oasas.state.ny.us/hps/datamart/2003_PRISMS_Profiles/Chautauqua.pdf)


10. HIV/AIDS in Chautauqua County

(Note: Some of these data are also presented in the HIV/AIDS and Sexual Activity chapters.)

Table 15 presents trends in AIDS cases and HIV cases in newborns for the years 1997-2001 in Chautauqua County. Over this time period, the rate of county AIDS cases has fluctuated between 2.8 and 7.8 cases per 100,000 residents, with a rate for 2001 of 6.5 cases. The number of newborns with HIV has remained constant at two new cases per year (0.2 per 100 births), excluding 1999.


Table 15. Trends in AIDS Cases and HIV Seropositive Newborns in Chautauqua County, 1999-2003.
  2003 2002 2001 2000 1999
  # RATE # RATE # RATE # RATE # RATE
AIDS Cases** 4 2.9 10 7.2 9 6.5 8 5.7 5 3.6
Newborn HIV Seropositive**
(per 100 births)
N/A N/A N/A N/A 2 0.1 2 0.1 4 0.3
Healthy People 2010 Target
(developmental: reduce incidence)
  --   --   --   --   --

http://www.health.state.ny.us/statistics/chip/chautauqua.htm
Census population estimates were used for 2000-2003; the 1999 population was estimated by NYSDOH. Newborn Seropositivity is per 100 births. All other rates in this section are per 100,000 population. AIDS Cases are presented by diagnosis year and exclude prison inmates. Source: New York State Department of Health

Table 16 shows that in the Buffalo Ryan White Region, more males than females (78.0% vs. 22.0%) were diagnosed with HIV/AIDS as of December 2001. Ages 30-49 had the highest percentage of cases (69.0%), followed by ages 50+ (13.0%). The percentages for blacks and whites are 44.0% and 43.0%, respectively; Hispanics comprise 11% of the total prevalent cases. (Data are not standardized to the population).


Table 16. HIV/AIDS Cases* by Gender, Age and Race/Ethnicity in Ryan White Region: Buffalo, Diagnosed Through December 2003
  Living HIV** Living AIDS*** Cumulative
  Percent Percent Percent
Gender
Male 61.0 73.0 78.0
Female 39.0 27.0 22.0
Unk 0.0 0.0 0.0
TOTAL 100.0 100.0 100.0
Age Group
<13 3.0 1.0 1.0
13-19 6.0 1.0 1.0
20-24 12.0 4.0 4.0
25-29 17.0 10.0 12.0
30-49 57.0 72.0 69.0
50+ 6.0 12.0 13.0
TOTAL 101.0 100.0 100.0
Race/Ethnicity
White 38.0 40.0 44.0
Black 45.0 44.0 43.0
Hispanic 15.0 13.0 11.0
Asian/PI 0.0 1.0 0.0
Native Am 0.0 1.0 1.0
Other/Unk 0.0 0.0 0.0
TOTAL 98.0 99.0 99.0
* Excludes prisoners.
**All cases reported and confirmed from June 2000-March 2004.
*** All cases reported and confirmed from 1983-March 2004.
Ryan White Region Buffalo: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming counties.

Table 17 shows that in Chautauqua County a total of 5 deaths from AIDS occurred between 2000-2002. The age-adjusted rate of 0.9 deaths per 100,000 residents is below the 1998 Healthy People 2010 baseline of 4.9 deaths. The county also has a lower AIDS mortality rate than in western New York or New York State.


Table 17. AIDS Deaths and Death Rates per 100,000 Residents in Chautauqua County and New York State, 2000-2002.
  Deaths from AIDS Population Adjusted
  2000 2001 2002 Total 2001 Rate
*(100,000)
Chautauqua County 1 3 1 5 138,718 0.9
Western New York Region 44 50 29 123 1,584,652 2.6
New York State 2,299 2,086 1,995 6,380 19,084,350 10.9
Healthy People 2010 Target   ---
Source: 2000-2002 Vital Statistics Data as of August, 2004. * Adjusted rates are age adjusted to the 2000 United States population (https://commerce.health.state.ny.us/hin/).

Figure 6 shows the mortality trend for AIDS in Chautauqua County by presenting single year and 3-year average death rates for the years 1993-2002. The single-year mortality rate declined slightly during the ten-year time period; the 3-year average smoothes out year-to-year fluctuations to more clearly illustrate this trend.

Figure 6. Trends in AIDS Death Rate in Chautauqua County, 1993-2002.
Figure 6. Trends in AIDS Death Rate in Chautauqua County, 1993-2002
(https://commerce.health.state.ny.us/hin/)

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B. Unmet Needs

Summary: Healthy Births in Chautauqua County

In Table 1, the County rate for perinatal deaths (9.0 per 1,000 live births) is twice as high as the Healthy People 2010 target (4.5 deaths), and the neonatal death rate (3.2 per 1,000 live births) is higher than the 2010 target (2.9). Chautauqua County also has a rate of 10.5% short gestation births, which will need to be reduced further to meet the 2010 target of 7.6% (Table 10).

Table 18 presents trends for Chautauqua County (1997-2001) on many of the other Healthy Birth targets discussed in this chapter. Data for 2001 are from U.S. census estimates, while the data for 1997-2000 are estimates from New York State Department of Health. Therefore, trends in unmet needs will be reviewed for 1997-2000.

In Table 18, the percentage of women receiving early prenatal care has increased since 1997 (from 69.7% to 73.3%), but needs to increase further to meet the 2010 target of 90%. There were no maternal deaths in 2000 (or in 2001 census estimates). The rate of HIV seropositive newborns fluctuated, but was lower in 2000 than in 1997.

The pregnancy rate for ages 15-19 has declined by about 1/3, although the rate for ages 10-14 has increased slightly. The teenage abortion rate has been in flux during the last few years, and is slightly higher in 2000 than in 1994 (Figure 4).

The rate of diagnosed AIDS cases (males and females) has increased, as has the AIDS mortality rate (males and females). In the Buffalo Ryan White Region (which includes Chautauqua County), the majority of prevalent HIV/AIDS cases is in the 30-49 age group (70.1%); another 17.1% is between ages 13-29 (see Table 16).

Table 18. Trends for Selected Healthy Births Indicators for Chautauqua County, 1999-2003

http://www.health.state.ny.us/nysdoh/cfch/pchaut.htm
* Infant, Neonatal and postneonatal death rates are per 1,000 births. Spontaneous fetal deaths are per 1,000 live births+spontaneous fetal deaths 20+ weeks gestation. AIDS mortality and cases are per 100,000 population, and case rates are presented by diagnosis year. 2000 and 1999 are understated due to reporting lags. Maternal mortality rates are per 100,000 live births.Sources: New York State Department of Health Maternal mortality from Vital Statistics Data. See respective tables in this chapter for additional information.

Healthy People 2010

As pointed out in the Healthy People 2010 Initiative,

Many of the pregnancy risk factors can be mitigated or prevented with good preconception and prenatal care. Preconception screening and counseling offer an opportunity to identify and mitigate maternal risk factors before pregnancy begins. During preconception counseling, healthcare providers also can refer women for medical and psychosocial or support services for any risk factors identified. Interventions targeted at prevention and cessation of substance use during pregnancy may be helpful in further reducing the rate of preterm delivery and low birth weight. Further promotion of folic acid can improve infants' health and chances of survival. Breastfeeding has been shown to reduce rates of infection in infants and to improve long-term maternal health. SIDS may be preventable as well; studies show that putting infants to sleep on their backs can help to prevent SIDS (http://www.healthypeople.gov/Document/pdf/Volume2/16MICH.pdf).

As also discussed in the 2010 Initiative,

Bearing a child while an adolescent is associated with poor outcomes for young females and their children. Giving birth to a second child while still a teen further increases these risks. Research has shown that second and subsequent births to very young females are associated with physical and mental health problems for the mother and the child. Yet, analysis indicates that in the 2 years following the first birth, teenage mothers in the U.S. have a second birth at about the same rate as other mothers. In 1997, nearly one in every five births to teenage mothers was a birth of second order or higher.
 
According to 2010, there is increasing recognition of the value of male involvement in pregnancy prevention and family planning. Several related developments in public health and welfare demonstrate that male involvement is key, including culturally and linguistically appropriate programs promoting condom use and addressing HIV and STD prevention, culturally and linguistically competent services targeting men as part of managed care marketing strategies, emphasis on male responsibility in welfare, child support enforcement, and pregnancy prevention efforts. Concern about the spread of HIV and other STDs and the recognition of condoms as the most effective way of preventing transmission during intercourse have accentuated the need to change the sexual behavior of males. The need for rapid treatment of male partners of females testing positive for bacterial STDs is a critical element in slowing not only STD spread but also that of HIV (http://www.healthypeople.gov/document/Word/Volume1/09Family.doc).

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C. Resources in Chautauqua County

The following list includes public service organizations, agencies and programs in Chautauqua County that offer assistance for pregnant or parenting women, infants, young children, and pregnant women/parenting persons with HIV/AIDS.

  • Abstinence Education Advisory Board, Mayville
  • Baby and Me Tobacco Free
  • 2 Breast feeding/lactation consultants
  • 1 Breastfeeding support group
  • Chautauqua County AIDS Advisory Board, Falconer
  • Chautauqua County Health Department (confidential HIV testing)
  • Chautauqua County Teen Pregnancy Prevention Coalition, Mayville
  • Child Health Plus Initiative, Jamestown
  • Domestic Violence Coalition, Jamestown
  • Family Planning Advisory Committee, Fredonia
  • Growing Together (alternative high school for pregnant/parenting teens), Fredonia/Dunkirk
  • Health Education Network, Fredonia
  • 3 Hospitals with maternity services: Brooks Memorial Hospital, WCA Hospital, and Westfield Hospital
  • 3 Hospitals that offer childbirth education classes: Brooks Memorial, WCA, and Westfield Hospital
  • Infant Mortality Review Committee, Mayville
  • Jamestown Public Schools Center Clinic (family planning clinic)
  • Mental Health Association of Chautauqua County, Jamestown
  • MOMS Program (3 educational sessions)
  • Newborn Education, WCA Hospital, Jamestown
  • NYS Partner Notification Program
  • 10 Obstetricians
  • Project Know (BOCES)
  • PCAP
  • STEPS Consortium
  • Success By Six
  • TEAM (teen motherhood)
  • The Resource Center, Folic Acid Education Program
  • Western New York Family Planning Educators, Rochester
  • Western New York Diabetes Partnership, Jamestown
  • YWCA

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D. Opportunities for Action

Opportunities for action in Chautauqua County pertinent to the needs of pregnant or parenting women, infants, young children, and pregnant women/parenting persons with HIV/AIDS are presented in this section. Data-derived statements are followed by more specific objectives, which are adapted from the Healthy People 2010 Initiative

  • Reduce perinatal, neonatal deaths and short gestation births, and increase the percentage of women receiving early prenatal care.
     
    Reduce births to adolescents under age 15.
    Reduce the teenage abortion rate.
    Reduce the rate of diagnosed AIDS cases, especially in the reproductive0years age groups.
    Reduce the rate of newborn seropositive infants.
    Reduce the AIDS mortality rate.

  • Reduce second and subsequent births while the parent is still a teen. Research has shown that second and subsequent births to very young females are associated with physical and mental health problems for the mother and the child.
     
  • Expand public education and information about family planning and sexual abstinence. Numerous studies and polls indicate a disturbing degree of misinformation about contraceptive methods.
     
  • Increase access to quality contraceptive services, an important factor in promoting healthy pregnancies and preventing unintended pregnancies.
     
  • Expand public education and information about emergency contraception and the relative effectiveness of various contraceptive methods.
     
  • Encourage the media - print, broadcast, and video - to help in the task of conveying accurate and balanced information on contraception, highlighting the benefits as well as the risks of contraceptives.
     
  • Encourage male involvement in pregnancy prevention and family planning. Concerns about the spread of HIV and other STDs, and the recognition of condoms as the most effective way of preventing transmission during intercourse, have accentuated the need to change the sexual behavior of males.
     
  • Expand preconception screening and counseling services to identify and mitigate maternal risk factors before pregnancy begins, such as daily folic acid consumption and alcohol use. Work with healthcare providers to ensure that women are referred for medical and psychosocial or support services for any risk factors identified.
     
  • Provide culturally appropriate and linguistically competent counseling to identify women who are at particularly high risk and take steps to mitigate risks, such as the risk of high blood pressure or other maternal complications.
     
  • Ensure access to quality contraceptive services by encouraging health insurance plans to cover family planning services.
     
  • Determine whether women opt for whatever method may be covered by their health plan rather than the method most appropriate for their individual needs and circumstances, and whether women use contraception if it is not covered under their insurance plan.

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