Wisconsin's Top 10 Maternal & Child Health Priority Needs
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Disparities in Birth Outcomes
Disparities in
birth outcomes are related to National Performance Measure #15, #17, and #18
by addressing very low birthweight and early prenatal care.
Wisconsin
's continuing State Performance Measure #9 addresses the ratio of the Black
infant mortality rate to White infant mortality rate.
In
Wisconsin
in 2003, the Black infant mortality rate was 15.3 deaths per 1,000 live
births, nearly 3 times the rate of 5.3 for White infants.
The White infant mortality rate is declining steadily with a near 50%
reduction over the past 20 years. In
contrast, the Black infant mortality rate has varied slightly but has not
declined during this period. Comparing
Wisconsin
's Black infant mortality rates relative to other states, for the period
1979-1981,
Wisconsin
ranked 3rd best. However great
strides in infant mortality reduction made by other states, compared to a
lack of improvement in
Wisconsin
has led to sharp drops in
Wisconsin
's rank relative to other states. For
the period 1999-2001,
Wisconsin
's rank dropped to 32 among 34 states with a sufficient number of Black
births. The infant mortality
disparity of Blacks as compared to Whites ranked
Milwaukee
as the 4th worse among 16
U.S.
cities (Big Cities Health Inventory, 2003).
Analysis of 3-year average infant mortality rates for
Wisconsin
's American Indian population identifies a disturbing trend with rates
increasing from 8.4 in 1998 -2000 to 12.9 from 2002-2003.
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Contraceptive Services
This priority
takes into account the concerns voiced by many during the needs assessment
process regarding unintended pregnancy, teen births, and abstinence from
sexual activity. Our priority
aligns with National Performance Measure #8 which examines rate of teen
births.
Wisconsin
's new State Performance Measure #1 attempts to examine the access and
utilization of contraceptive services by monitoring the percent of eligible
women enrolled in the Wisconsin Medicaid Family Planning Waiver during the
year.
Women are
defined as "in need of contraceptive services and supplies" during
a given year if they are ages 13-44 and meet three criteria: 1) they are
sexually active, that is, they have ever had intercourse; 2) they are
fecund, meaning that neither they nor their partner have been
contraceptively sterilized, and they do not believe that they are infecund
for any other reason; and 3) during at least part of the year, they are
neither intentionally pregnant nor trying to become pregnant.
Women are defined as "in need of publicly-funded contraceptive
services and supplies" if they meet the above criteria and have a
family income under 250% of the federal poverty level (estimated to be less
than $42,625 for a family of four). All
women younger than 20 who need contraceptive services and supplies are
assumed to need publicly supported care, either because their personal
incomes are below 250% of poverty or because of their heightened need--to
preserve confidentiality--for obtaining care that not depend on their
family's resources or private insurance.
640,420 women
ages 13-44 are estimated to be in need of contraceptive services and
supplies in
Wisconsin
. Ninety-three percent of
females aged 15-44 years at risk of unintended pregnancy used contraception
in 1995. Approximately 17% of
the estimated need for public support family planning services has been met
through the Medicaid Family Planning Waiver through December 31, 2004.
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Mental Health For All Population Groups
Mental health as
a priority need links with the National Performance Measure #16 that focuses
on deaths from suicide.
Wisconsin
's new State Performance Measure
(SPM) #3 will monitor the percent of children, ages 6 months - 5 years, who
have age appropriate social and emotional developmental levels.
(It is important to note that we recognize the importance of women's
mental health, postpartum depression, the stigma associated with a mental
illness diagnosis, and adolescent indicators of need, however, our SPM focus
is on young children.)
According to the
2000 National Survey of Early Childhood Health, parents of children 4-35
months of age most frequently have concerns about how their child behaves
(48%), how their child talks and makes speech sounds (45%), the child's
emotional well-being (42%), and how their child gets along with others
(41%). Infant mental health
focuses on several complementary issues: 1) promoting a healthy bond between
the child and caregivers; 2) assessing and promoting healthy social and
emotional development; 3) developing intervention services for children at
risk of poor developmental outcomes because of family issues such as
domestic violence and substance abuse; and 4) provisions for specialized
treatment for children and families who need intensive help because of
postpartum depression or other diagnosed mental illness of the parent, abuse
and neglect, or a diagnosed emotional or behavioral disorder.
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Medical Home For All Children
This priority
need is an outgrowth of the National Performance Measure (NPM) #3 which
focuses on children with special health care needs.
During the needs assessment process it became evident that medical
home was an important concept for all children.
Wisconsin
's new State Performance Measure #5 reads the same as the NPM except for the
population target including all children.
A child with a
medical home does not use a hospital emergency room as their primary place
of care. According to the
Wisconsin Family Health Survey in 2003, 2.5 % of Hispanic children and 14.7%
of African American children used a hospital emergency room as their primary
place of care compared to less than 1% of White children.
National SLAITS data indicate that: children without a medical home
are twice as likely to experience delayed or forgone care; non-White
children are significantly less likely to have a medical home; and poor
children and children whose special health care needs have a significant
adverse impact on their activity levels are more than twice as likely not to
have a medical home and have unmet health care needs.
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Dental Health (including CSHCN,
racial/ethnic, linguistic, geography, income)
The dental
health priority has shifted focus to access and accessibility.
The National Performance Measure #9 concentrates on delivery of
protective sealants whereas
Wisconsin
's new State Performance Measure #2 will observe the percent of Wisconsin
Medicaid and BadgerCare recipients, ages 3-20, who received any dental
services during the year.
Both Governor
Jim Doyle, in his KidsFirst Initiative, and the state health plan,
Healthiest Wisconsin 2010, identify oral health as a critical need.
The National Survey of CSHCN reported that 83.1% of Wisconsin CSHCN
required dental services and 92.6% received all needed dental services.
7.4% did not receive all needed dental services, which translates to
13,000 children with unmet oral health needs each year.
The Wisconsin Family Health Survey revealed that 4.3% of CSHCN, or
12,800 children, did not receive needed dental care.
The two primary reasons given were they couldn't afford dental care
or had inadequate insurance.
In
Wisconsin
, 30.8% of children have at least one primary or permanent tooth with an
untreated cavity. Compared to
White children, a significantly higher proportion of minority children had
caries experience and untreated decay. Twenty-five
percent of the White children screened had untreated decay compared to 50%
of African American children, and 45% of Asian children, and 64% of American
Indian children. In addition,
children who attend lower income schools have significantly more untreated
decay (44.5%) compared to children in both middle (31.7%) and higher income
schools (16.6%).
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Health Insurance and Access to Health Care
There is a
strong relationship between health insurance coverage and access to health
care. During the needs
assessment process, our stakeholders had difficulty looking at one need
without the other; thus, we combined them into one priority.
The National Performance Measure #13 requires data on percent of
children without health insurance. The
Wisconsin
new State Performance Measure #6 monitors the movement to achieve this need
by measuring the percent of children less than 12 years of age who receive
one physical exam a year.
Wisconsin
ranks high in the proportion of
people who have health insurance. However,
state data indicate that the maternal and child health population are less
likely to be insured for the entire year.
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Smoking and Tobacco Use
There is not an
National Performance Measure for tobacco use.
The
Wisconsin
continuing State Performance Measure #7 looks at percent of women who use
tobacco during pregnancy. Smoking
during pregnancy is a major risk factor for infant mortality, low
birthweight, prematurity, stillbirth, and miscarriage.
Overall in 2003, 9,769 or 14% of pregnant women in
Wisconsin
reported smoking during pregnancy; this rate is higher than the national
rate of 11.0%. In terms of
racial differences, American Indian women continue to report the highest
percentage of smoking during pregnancy, nearly 3 times as high as the
overall state percentage.
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Intentional Childhood Injuries
Discussions
during the needs assessment process resulted in dividing injury into
intentional and unintentional injuries.
The National Performance Measure #16 relates to the priority as it
addresses deaths from suicide among older teens.
However,
Wisconsin
's new State Performance Measure #4 focuses on child abuse, neglect and
maltreatment issues. We will
monitor the number of substantiated reports of child maltreatment to
Wisconsin
children, ages 0-17, during the year.
In 2002, there
were 42,698 total reports of child abuse and neglect with substantiations in
Wisconsin
. The largest number of
substantiated reports are for children between the ages of 12 and 14.
Between 2000 and 2002, there were slightly more reports and
substantiations for female children than males.
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Unintentional Childhood Injuries
The priority
need for unintentional childhood injuries relates with the National Performance
Measure #10 and the new State Performance Measure #10 both addressing death
from motor vehicle crashes but for different age groups; 14 and under; and
15- 19, respectively.
In
Wisconsin
, there are almost two times the number of unintentional injuries and deaths
than intentional or violent injuries and deaths in this 0-21 age group.
More than 2,100 children, teenagers, and young adults up to 21 years
of age died from injuries and more than 37,300 were hospitalized from
1998-2002. Of these deaths, 916
died from injuries related to motor vehicles.
The leading injury hospitalization for children ages 0-21 were motor
vehicle related and fall injuries totaling 4,054 out of more than 37,300
hospitalizations.
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Overweight and At Risk for Overweight
The concern
about overweight and at risk for overweight was clear during the needs
assessment process and surfaced as a priority need for
Wisconsin
. The National Performance Measure
#11 which relates to breastfeeding is the closest measure to this priority
need. The
Wisconsin
's continuing State Performance Measure #8 looks closely at the percent of
children, 2-4 years who are obese or overweight.
The prevalence
of overweight in
Wisconsin
children from birth to age 5 is 12.2%. Overweight
and at-risk-for-overweight has increased among all racial and ethnic groups.
The prevalence of at-risk-for-overweight for children aged 2 to 5 or
older increased from 13.8% in 1994 to 15.9% in 2003.
In 2003, the highest rates for overweight and at-risk-for-overweight
were among American Indian (19.2% and 20.0%), Asian (19.3% and 17.8%), and
Hispanic (17.8% and 17.6%). Rates
for Whites were slightly lower at 11.8% and 15.9%, and Blacks were at 10.1%
and 13.6%.
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