Updated on: 09/22/2022

Maternal and Child Health

People of color are more likely to experience risk factors for complications in pregnancy, maternal morbidity, infant mortality, and preterm births, which are associated with less access to prenatal care and exposure to toxins.

Note: Hispanic is used to reflect current data collection practices. We acknowledge this may not be the preferred term. Throughout this report, NH refers to Non-Hispanic. People of color refers to individuals identifying as Black, American Indian/Alaska Native, Asian, Hispanic, Native Hawaiian, Pacific Islander, and Other. Unless otherwise noted, adults are ages 18+. Data are most recently available for the specified data source.

Risk Factors for Complications in Pregnancy (2018-2020)

In 2020, those who identified as Black or Other reported being overweight more than other racial groups. While those who identify as Asian were consistently more likely than other groups to report having gestational diabetes.

*GDM refers to Gestational Diabetes Mellitus.

Overweight refers to BMI ≥25.0 to <30.0.

Obese refers to BMI 30.0.

Other includes those who identified as Other and American Indian races. Unknown is not included in Other. For the group identified as Other, GDM Data from 2018-2020 and Obesity data in 2018, 2020 were insufficient.

Pregnancy indicators from PRAMS.

Adequate Prenatal Care (1997-2019)

From 2017 to 2019, the percentage of births to parents who received adequate prenatal care (APC) decreased from 81% to 83%.

Pregnant people of color are less likely to have APC than White people and from 2012 - 2018, Black pregnant people have been the least likely to have APC.

Adequate prenatal care is based on Adequacy of Prenatal Care Utilization (APNCU) Index. Data from the Birth Data Reports via the Registry of Vital Records and Statistics. Other includes those who identified as Other

Equity Spotlight

Women are more likely to work in part-time jobs which often have lower wages and less access to benefits such as health care.38Learn more about how employment impacts your health.

Severe Maternal Morbidity (2009-2018)

Since 2009, Black pregnant and postpartum people have consistently had the highest rates of SMM. In 2018, Black pregnant and postpartum people were almost three times as likely to have SMM than White pregnant and postpartum people. Hispanic and pregnant and postpartum people in the Other race group were 1.5 times as likely to have SMM.

SMM 21 shown (including blood transfusions). SMM identified using International Classification of Diseases (ICD) diagnosis and procedure codes. Other includes those who identified as Other, American Indian races, unknown, refused, and missing. For more information on SMM please see the Maternal Mortality and Morbidity Initiative via the Pregnancy, Infancy and Early Childhood Division.

Severe maternal morbidity (SMM) occurs when unexpected outcomes of labor and delivery have significant short- or long-term consequences to a woman’s health.39 Maternal mortality rates and SMM have significantly increased over the last two decades in the United States40,41 and trends in MA indicate similar increases.42 However, SMM is 50 to 100 times more common than maternal death and racial/ethnic disparities in SMM exist. Nationally, Black pregnant and postpartum people have the highest proportion of SMM, and 70% greater risk of SMM.43 The consequences of increasing SMM prevalence, in addition to health effects to postpartum people, include higher medical costs and longer hospital stays.42 Recognizing and tracking SMM by race/ethnicity along with developing and carrying out interventions to improve the quality of maternal care, are essential to addressing racial/ethnic inequities in SMM.

Infant Mortality Rate (1999, 2009, 2019)

Despite MA having the lowest overall infant mortality rate (IMR) in the US, people of color are still more likely to have greater IMRs than White people.

In 2019, Black IMR was 2.5 times than White IMR and 2.8 times higher than Asian IMR.

Other category (includes those who identified as Other or American Indian races) not shown for 1997 and 2007 due to suppressed rates. Data from the Death Data Reports via the Registry of Vital Records and Statistics.

Preterm Births (1999, 2009, 2019)

Since 1999 preterm births have occurred more frequently among parents who identify as Black, Hispanic, and Other.

Preterm birth refers to births occurring at less than 37 weeks of gestation. Other includes those who identified as Other or American Indian races. Data from the Birth Data Reports via the Registry of Vital Records and Statistics

Children with Lead Poisoning (2015-2019)

Children of color are more likely to have lead poisoning than White children.

Blood lead levels ≥10 µg/dL are considered poisoned. Race/ethnicity shown is based on maternal race/ethnicity. Data from the MA DPH Annual Childhood Lead Poisoning Surveillance Report.

Equity Spotlight

Public housing and older housing stock have historically been located in low-income areas with a majority Black population.11 Public housing sites tend to be in historically less desirable locations with increased exposure to toxins such as lead.44Learn more about how housing impacts health here.

Download the raw data (accessible version) used to create these visualizations.

11 Gross, T. (2017). A 'Forgotten History' Of How the U.S. Government Segregated America. National Public Radio; Fresh Air. Retrieved from http://www.npr.org/2017/05/03/526655831/a-forgotten-history-of-how-the-u-s-government-segregated-america

38 Hegewisch, A., Liepmann, H., Hayes, J., & Hartmann, H. (2010). Separate and Not Equal? Gender Segregation in the Labor Market and the Gender Wage Gap. Institute for Women's Policy Research. DOI: DOI:10.1037/e686432011-001

39 Centers for Disease Control and Prevention. (2018). Severe maternal morbidity in the United States. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html

40 Callaghan, W.M., MacKay, A.P., & Berg, C.J. (2008). Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991-2003. American Journal of Obstetrics and Gynecology, 199(2), 133-e1. DOI: 10.1016/j.ajog.2007.12.020

41 Callaghan, W.M., Creanga, A.A., & Kuklina, E.V. (2012). Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstetrics & Gynecology, 120(5), 1029-1036. DOI: 10.1097/aog.0b013e31826d60c5

42 Harvey, E.M., Ahmed, S., Manning, S.E., Diop, H., Argani, C., Strobino, D.M. (2018). Severe maternal morbidity at delivery and risk of hospital encounters within 6 weeks and 1 year postpartum. Journal of Women's Health, 27(2): 140-7. DOI: 10.1089/jwh.2017.6437

43 Liese, K.L., Mogos, M., Abboud, S., Decocker, K., Koch, A.R., & Geller, S.E. (2019). Racial and Ethnic Disparities in Severe Maternal Morbidity in the United States. Journal of Racial and Ethnic Health Disparities, 6(4), 790-798. DOI: 10.1007/s40615-019-00577-w

44 U.S. Department of Housing and Urban Development. (1995). U.S. Housing Market Conditions Summary. Retrieved from https://www.huduser.gov/period...

Indicator selection

This report gathered equity metrics found throughout DPH published data reports in one common location. When choosing the indicators to feature in this dashboard, we focused on publicly available data and the State Health Assessment (SHA) priority indicators. In some instances proxy measures were used if race/ethnicity data were limited (e.g. Hepatitis B Vaccinations Rates in place of Viral Hepatitis Prevalence Rates). Only indicators that had sufficient data for breakdowns by race/ethnicity were included.

Time-frame for Data Shown

In all cases, the most recent data for each indicator are incorporated. For some topics (e.g. hospitalizations for various causes), only older data are available by race/ethnicity. However, the goal of this dashboard is to capture the current experiences of this priority population. As such, the years of data presented are different for each chart; we opted for the most recent data available over using the same (older) year across all indicators in the report

Race/Ethnicity Group Definition and Data Collection

This report presents race/ethnicity data as it is collected and defined by each source. DPH complies with the the Federal Office of Management and Budget (OMB) Standards and have adapted the recommendations to capture this information. We acknowledge that the race/ethnicity breakdowns presented here may not reflect each group's preferred terms. We recognize that race groups are not monolithic. Grouping into larger categories (e.g. Asian) and grouping Hispanic separately (e.g. Black and Hispanic is not a category in this report) is problematic and may not fully capture the experiences specific groups have. Data on language and disability status are not reflected in this version of the report but we plan to include these in future versions. Detailed information on the specific race/ethnicity group definitions and data collection practices can be found using the links to data sources provided for each chart. The DPH Race/Ethnicity/Language Data Standards Guide provides information on current department wide minimum compliance for collecting, defining, and reporting this information.

Data Suppression

For some charts, race/ethnicity groups may not be shown. This varies by data source and reflects insufficient sample size to support reliable estimates or suppression to protect residents privacy. For more information on the DPH suppression guidelines, please see the Department of Public Health Confidentiality Procedures.

Current Analysis

Unless otherwise noted, the differences between race/ethnicity groups in this report are based on descriptive observations (i.e. estimates are higher or lower than others) and key findings for the data shown in charts do not represent statistically significant differences. Any language that indicates statistical significance is taken directly from reports that have performed these analyses separately from this dashboard. For more information on how analyses were performed and definitions for significance, please see the data source notes provided for each chart.

CI refers to Confidence Interval (if available), which describes the certainty of a value. The Department of Public Health uses a 95% confidence interval.

Future Plans

This initial report focuses on communities of color. Additional dashboards on the other priority populations will be created. We also plan to expand dashboard contents including adding more indicators, updating data currently included, and incorporating intersectionality of populations (e.g. data by race/ethnicity and sexual orientation/gender identity).

Visual representations of statistical significance and additional analytics to compare differences between groups will also be incorporated.