HomeMy WebLinkAboutmaternal-infant-health-indicators-report-2025Alameda County
Maternal & Infant
Health Indicators
Alameda County Public Health Department
Health Care Services Agency
April,2025
2
Our Vision of
Health Equity
EVERYONE in Alameda County –
no matter who you are,
where you live,
how much money you make,
or the color of your skin –
can lead a healthy,
fulfilling and productive life.
Table of Contents
Definitions
Births
Perinatal & Maternal Health
Infant Health
Neighborhood Poverty
Breastfeeding & Infant Sleep
Perinatal Mental Health
Structural Drivers
Resources
3
Mission
MPCAH works together through our various programs to ensure that
women, children, youth, fathers, parents and families achieve optimal
health and well-being through the provision of client-centered, culturally
responsive, strengths-based services and supports, combined with
community transformation efforts that aim to improve neighborhood
conditions.
Purpose
Promoting and supporting client-centered decisions and goals for health
which include positive pregnancy outcomes, thriving births, families, and
communities. Maternal and infant mortality
disparities drive interventions, programs and our collective
work,specifically in the Black community and other populations such as
parents of medically fragile and first-time mothers.
Values
➢Relationship-Based
➢Trauma-Informed
➢Race and Equity Focused
Maternal, Paternal, Child, and Adolescent
Health (MPCAH)Purpose and Values
4
•Both Race and Ethnicity are Social Constructs –> assigning meaning to and
categorizing different bodies
•Race: Narrow category based on real or perceived biological differences between groups
of people.
•Ethnicity: Broad category based on common language, religion, nationality, history
or another cultural factor.
•Challenges with Categorization
•Race & Ethnicity overlap in complex ways (census changes)
•Definitions have changed overtime (“Irish”= Race)
•People Can Fit in Multiple Categories (multiracial category)
•People have multiple/intersecting identities
Defining Race & Ethnicity
5
How We Determine Baby's Race/Ethnicity
•The birth certificate allows mothers to select up to 3 race groups and Hispanic/Latina/o/x/e
ethnicity
•Woman or person giving birth's race/ethnicity determines baby’s race/ethnicity
•Public health race/ethnicity is mutually exclusive (one category per mother & baby)
•Starting Out Strong uses similar methodology
•Suite of Alameda County Public Health programs including home visiting, prenatal/postpartum
supports, fatherhood initiatives, and services for children with special healthcare needs
•Different program & data sources have different definitions
Hispanic/Latina/o/x/e
Ethnicity Any Race
Mexican
Chicano
Puerto Rican
Cuban
Central/South American
Race Categories
(Not Hispanic)
African American/Black
American Indian/Alaska
Native
Asian
Pacific Islander
White
Multiracial = More than 1
of the above
Unknown
Race/Ethnicity
Mother’s Race/Ethnicity
not included on baby’s
birth certificate
“Refused to State” or
“Unknown”
6
Why We Categorize Race/Ethnicity
•Data Aggregation/Analyses: to count and compare groups
•Align with National Standards (NCHS,CDC, CDPH, HP2030)
•Measure how well we are doing compared to
other jurisdictions
•Mother’s race/ethnicity incorporates Life Course Perspective
•Social, economic, and physical environment in each stage
of life affect the next stage, critical & sensitive periods for
intervention
•#1 reason: To identify health inequities-Race/Ethnicity is
our best category for measuring inequities between
groups in AC
•Race and Ethnicity are proxies (widely measured
substitutes) for experiences of discrimination and
exposure to programs and policies that uphold
structural racism and result in varying environments
Alameda County Social
and Structural
Determinants of Health
7
8
Bay Area Regional Health Inequities Initiative (BARHII)
Framework
Source: Bay Area Regional Health Inequities Initiative
9
Political Determinants of Health
Legacies of Slavery
Poverty/Wealth, Dehumanization, Policing
Racist Policies and Laws, Historical and
Current
GI Bill
Redlining
Zoning Policy
Regressive Tax System
Jim Crow Segregation
Mass Incarceration
Other examples of racist policies
Chinese Exclusion Act, 1924 Immigration Act
Current Immigration Policy
Sources:https://www.bigcitieshealth.org/uha-drivers-of-inequity/
https://www.kqed.org/lowdown/18486/redlining
$536,020
$285,010
$62,900 $61,620 $44,890
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
Asian White Another race or
ethnicity
Hispanic/
Latino/a/x/e
African American/
Black
Me
d
i
a
n
w
e
a
l
t
h
Median Wealth in the United States, by Race/Ethnicity (2022)
10
Wealth Gaps by Race/Ethnicity, 2022
11.9x
Source: Board of Governors of the Federal Reserve System (2023).
Note: Data source does not provide information on wealth for other races or ethnicities
26.4%
20.8%
15.0%13.9%13.6%12.4%10.3%9.3%
12.1%
0%
10%
20%
30%
American
Indian/
Alaska
Native
African
American/
Black
Pacific
Islander
Hispanic/
Latina/o/x/e
Some other
race
Multiracial White Asian All Races
Pe
r
c
e
n
t
L
i
v
i
n
g
B
e
l
o
w
P
o
v
e
r
t
y
L
i
n
e
Race/Ethnicity
Alameda County Percent of Women age 15-44 years Living Below the Poverty Line, by
Race/Ethnicity (2018-2022)
11
Inequities in poverty among women of reproductive age
Source: ACS PUMS Data, 2018-2022
2.8x
30.1%
18.5%
13.2%
7.3%
4.6%4.0%2.5%
8.9%
0%
5%
10%
15%
20%
25%
30%
35%
African
American/
Black
American
Indian/
Alaska Native
Hispanic/
Latino/a/x/e
Pacific
Islander
Asian White Multiracial All Races
Pe
r
c
e
n
t
o
f
C
h
i
l
d
r
e
n
U
n
d
e
r
6
y
e
a
r
s
i
n
P
o
v
e
r
t
y
Alameda County Percent of Children Under 6 Years Living Below Poverty Level, by
Race/Ethnicity (2017-2021)
12
Inequities in child poverty
Source: Alameda County Maternal Infant and Young Child Health Indicators, 2023
12.0x
$154,570
$139,438
$122,500
$103,385 $95,000 $90,651
$66,597 $63,037
$119,600.00
$-
$40,000
$80,000
$120,000
$160,000
Asian White Multiracial Pacific
Islander
Some other
race
Hispanic/
Latina/o/x/e
American
Indian/
Alaska
Native
African
American/
Black
All Races
Me
d
i
a
n
H
o
u
s
e
h
o
l
d
I
n
c
o
m
e
Race/Ethnicity
Alameda County Median Household Income, by Race/Ethnicity(2018-2022)
13
Inequities in median income
Source: American Community Survey, 5 Year (2018-2022)
2.5x
14
Educational inequities among women and people giving birth
23.2%
8.4%
6.4%
3.3%2.7%1.3%
8.4%
0%
5%
10%
15%
20%
25%
Hispanic/
Latina/o/x/e
African
American/
Black
Pacific Islander White Multiracial Asian All Races
Pe
r
c
e
n
t
a
g
e
L
e
s
s
T
h
e
n
H
i
g
h
S
c
h
o
o
l
E
d
u
c
a
t
i
o
n
Race/Ethnicity
Alameda County Percentage of Women and People Giving Birth Who Did Not Complete
High School, by Race/Ethnicity (2018-2022)
Source: CAPE, with data from Alameda County Vital Statistics files, 2022
17.8x
15
Racial and ethnic differences in the percentage of births
covered by Medi-Cal
Source: CAPE, with data from Alameda County Vital Statistics files, 2020-2022
41.2%39.9%37.1%
26.3%
14.5%
11.3%
6.5%
20.7%
0%
10%
20%
30%
40%
50%
Hispanic/
Latina/o/x/e
African
American/
Black
American
Indian/
Alaska Native
Pacific
Islander
Multiracial White Asian All Races
Pe
r
c
e
n
t
a
g
e
B
i
r
t
h
s
W
i
t
h
M
e
d
i
-Ca
l
P
a
y
e
r
Race/Ethnicity
Alameda County Percent of Births Covered by Medi-Cal, by Race/Ethnicity (2020-2022)
16
African American/Black and
Hispanic/Latina/o/x/e families
bear a disproportionate
amount of poverty due to
structural racism
https://unitedwaysca.org/wp-content/uploads/2023/05/alameda_county.pdf, https://www.healthyalamedacounty.org/indicators/index/view?indicatorId=2107&localeId=238
https://calbudgetcenter.org/resources/paid-family-leave-program-is-out-of-reach-for-many-californians/
*
Starting Out Strong Menu of Supports
One on One Support
Home Visiting, Intensive Case
Management, Care Coordination,
Doula Support, Clinical Case
Management
Group Health Education and
Supports
BIH prenatal and postpartum groups, Café Dad,
Boot Camp For New Dads, BELovedBIRTH Black
CenteringPregnancy, Mom2Mom Depression
Groups, Anger Management, Financial Tools
Outreach and Community Engagement
Family Advisory Committee, Community Baby Showers,
Celebrating Black Motherhood, Boot Camp for New
Dads, Peer Health Leaders, Social Media, Health Fairs,
Presentations
General Health Awareness
DeliverBirthJustice Campaign, FIMR, Safe Sleep, Family Planning
Culturally Relevant/Racially Concordant
•Comprehensive needs assessment and family goal
setting
•Screening and monitoring- depression, substance use,
IPV, child development
•Counseling and support
•Parent education and support using evidenced based
parenting curriculum- Partners for a Healthy Baby
•Linkages, Referrals, Ensuring Access
•Case management Advocacy Accompaniment to court
appearances, social and health care services
•Mental health services- brief treatment and pre-
treatment services
Starting Out Strong
Programs
Startingoutstrong.info
19
Community Strengths
Collective Action
Pre-5 Collaborative
Steering Committee
Perinatal Equity Initiative
Access to Services
Starting Out Strong System Of Care
Community Based Organizations
Referring partners and providers
Social Connection & Cultural
Pride:
Celebrating Black Motherhood
Black Joy Parade
Dia De Los Muertos Celebration
Community Driven Solutions and
Centering Community Wisdom:
Family Advisory Committee
Client feedback and testimonials
Lifting the voices of BIPOC
providers and birth workers
20
Unmet Need for Family Planning Services in Alameda County
and California
In 2016, over 87,000 women and people who can give
birth in Alameda County aged 13-44 needed publicly
funded family planning services
Publicly funded family planning centers in AC served
about 54,000 female clients in 2015
Net savings in California due to publicly funded family
planning services amounted to approximately $1.3
billion in 2016
Publicly funded family planning services are vital to
help families achieve their pregnancy goals
Source: Guttmacher Institute, State of California/Alameda County Data Reports.https://data.guttmacher.org/states/table?state=CA
Alameda County Births
21
22
Declining Births In Alameda County
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2022
21,011
16,598
0
5,000
10,000
15,000
20,000
25,000
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
Nu
m
b
e
r
o
f
B
i
r
t
h
s
Year
Alameda County Trend in Annual Number of Births (2008-2022)
23
Decreasing trend in Alameda County birth rate
15.4
10.7
14.1
9.7
0
6
12
18
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
Bi
r
t
h
R
a
t
e
(
#
B
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r
t
h
s
/
1
,
0
0
0
P
o
p
u
l
a
t
i
o
n
)
Year
Trend in Annual Birth Rate in Alameda County and California
(2008-2022)
California
Alameda County
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2022
24
Numbers of births differ by race and ethnicity
Source: CAPE, with data from Alameda County Vital Statistics files, 2022
5,781
4,747
3,705
1,335
499 375 132 240
1,000
2,000
3,000
4,000
5,000
6,000
7,000
Asian Hispanic/
Latina/o/x/e
White African
American/
Black
Multiracial Other/
Unknown
Pacific
Islander
American
Indian/
Alaska Native
Nu
m
b
e
r
o
f
B
i
r
t
h
s
Race/Ethnicity
Alameda County Number of Births by Race/Ethnicity (2022)
25
Birth rates differ by race and ethnicity
Source: CAPE, with data from Alameda County Vital Statistics files, 2022
12.4 12.2
10.9
8.9
7.9 7.0
4.9
10.1
0
2
4
6
8
10
12
14
Hispanic/
Latina/o/x/e
Pacific
Islander
Asian African
American/
Black
White Multiracial American
Indian/
Alaska
Native
All Races
Bi
r
t
h
R
a
t
e
(
#
B
i
r
t
h
s
/
1
,
0
0
0
P
o
p
u
l
a
t
i
o
n
)
Race/Ethnicity
Alameda County Birth Rate, by Race/Ethnicity (2022)
26
Trends in birth rates differ by race and ethnicity
12.612.2
11.3
10.4
9
87.2
5.3
0
2
4
6
8
10
12
14
16
2015-2018 2019-2022
Bi
r
t
h
R
a
t
e
(
#
B
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s
/
1
,
0
0
0
P
o
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a
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i
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)
Four-Year Average
Alameda County Trends in Birth Rate, by Race/Ethnicity (2015 to 2022)
Hispanic/
Latina/o/x/ePacific Islander
Asian
All Races
African American/
BlackWhite
Multiracial
American Indian/
Alaska Native
Source: CAPE, with data from Alameda County Vital Statistics files, 2015-2022
27
There are racial and ethnic differences in fertility rates
Source: CAPE, with data from Alameda County Vital Statistics files, 2022
51.6 50.1 49.1 45.8 43.3
30.4
23.5
48.2
54.3
0
10
20
30
40
50
60
Hispanic/
Latina/o/x/e
Pacific
Islander
Asian White African
American/
Black
Multiracial American
Indian/
Alaska
Native
All Races California
Bi
r
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R
a
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(
#
B
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s
/
1
,
0
0
0
W
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a
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d
P
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Gi
v
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g
B
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A
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e
15
-44
Ye
a
r
s
)
Race/Ethnicity
Alameda County Fertility Rate, by Race/Ethnicity (2020-2022)
0
10
20
30
40
50
60
70
2013-2017 2018-2022
Fe
r
t
i
l
i
t
y
R
a
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(
#
B
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w
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b
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a
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1
5
-44
y
e
a
r
s
)
Time Period
Alameda County Trend in Fertility Rate (2013 to 2022)Hispanic
Latino/a/x/e
Asian
Pacific Islander
All Races
White
Black
African American
Multiracial
American Indian
Alaska Native
28
Fertility Rates have decreased over time
Source: CAPE, with data from Alameda County Vital Statistics files, 2013-2022
29
Geographic differences in birth rates
Source: CAPE, with data from Alameda County Vital Statistics files, 2022
NA
4.4
5.6
6.5
6.8
8.5
9.4
9.5
9.6
9.7
9.8
9.8
9.9
10.2
10.2
10.7
10.8
11.3
11.3
11.5
11.7
12.5
13.7
0 2 4 6 8 10 12 14 16
Sunol
Remainder of County
Berkeley
Piedmont
Pleasanton
Albany
Alameda
Hayward Acres
San Lorenzo
San Leandro
Union City
Emeryville
Castro Valley
Alameda County
Fremont
Fairview
Livermore
Oakland
Cherryland
Hayward
Dublin
Ashland
Newark
Birth Rate per 1,000 Population
Alameda County Birth Rate by City/Place (2022)
30
31
Where Alameda County residents give birth
Source: CAPE, with data from Alameda County Vital Statistics files, 2022
0.5%
1.1%
1.8%
5.9%
6.5%
7.7%
7.8%
9.2%
18.4%
20.3%
20.8%
0%5%10%15%20%25%
Outside State or Unknown
Home Births
St Rose
ValleyCare
Eden
Washington
Highland General
Kaiser Oakland
Alta Bates
Other CA County
Kaiser San Leandro
Percent of total births in each facility
Alameda County Percentage of Births, by Facility (2022)
32
Differing trends in birth rates by age group
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2022
33.4
57.5
2.90
10
20
30
40
50
60
70
80
90
100
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
Bi
r
t
h
R
a
t
e
(
B
i
r
t
h
s
/
1
,
0
0
0
i
n
A
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G
r
o
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p
)
Year
Alameda County Trends in Birth Rates, by Age Group (2008 to 2022)
35-49 years
20-34 years
10-19 years
33
Inequities in teen birth rates
Source: CAPE, with data from Alameda County Vital Statistics files, 2020-2022CA data from California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, Adolescent Births Dashboard
14.4 13.6
9.2 9.0
2.0 1.6
0.4
6.0
0
2
4
6
8
10
12
14
16
Hispanic/
Latina/o/x/e
American
Indian/
Alaska
Native*
Pacific
Islander
African
American/
Black
Multiracial White Asian All Races
Bi
r
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R
a
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e
(
#
B
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0
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w
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1
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-19
y
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)
Race/Ethnicity
Alameda County* Teen Birth Rate, by Race/Ethnicity (2020-2022)
* = California value
34
Inequities in teen birth rate over time
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2022
14.7
9.38.06.2
3.3 1.81.70.50
5
10
15
20
25
30
35
40
45
2008-2012 2013-2017 2018-2022
Bi
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a
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1
5
-19
y
e
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)
5-Year Average
Alameda County Trend in Teen Birth Rate, by Race/Ethnicity (2008-2022)
Hispanic/
Latina/o/x/e
African American/
Black
Pacific Islander
All Races
Multiracial
White
American Indian/
Alaska Native
Asian
35
There are racial and ethnic differences in the percentage of
births to Non-US born women and people giving birth
Source: CAPE, with data from Alameda County Vital Statistics files, 2022
75.6%
51.0%
36.5%
22.4%17.7%
6.8%
47.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Asian Hispanic/
Latina/o/x/e
Pacific Islander White African
American/
Black
Multiracial All Races
Pe
r
c
e
n
t
a
g
e
o
f
B
i
r
t
h
s
t
o
N
o
n
-US
b
o
r
n
W
o
m
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n
a
n
d
Pe
o
p
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G
i
v
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B
i
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h
Race/Ethnicity
Alameda County Percentage of Births to Women and People Giving Birth who are Non-US
Born by Race/Ethnicity (2022)
36
Leading countries of birth for women and people giving birth
in Alameda County
Asian
Rank Country Percent
1 India 1981 (34.2%)
2 United States 1408 (24.3%)
3 China 947 (16.4%)
4 Philippines 395 (6.8%)
5 Vietnam 210 (3.6%)
Pacific Islander
Rank Country Percent
1 United States 97 (73.5%)
2 Fiji 19 (14.4%)
3 Tonga 12 (9.1%)
African American/Black
Rank Country Percent
1 United States 1063 (79.7%)
2 Ethiopia 77 (5.8%)
3 Eritrea 39 (2.9%)
4 Nigeria 37 (2.8%)
White
Rank Country Percent
1 United States 2748 (74.3%)
2 Afghanistan 208 (5.6%)
3 Yemen 167 (4.5%)
4 Russia 41 (1.1%)
Hispanic/Latina/o/x/e
Rank Country Percent
1 United States 2298 (48.4%)
2 Mexico 1130 (23.9%)
3 Guatemala 607 (12.8%)
4 El Salvador 307 (7.1%)
5 Honduras 155 (3.3%)
Alameda County top countries of birth for women and people giving birth, by race/ethnicity (2022)
0.1%
26.5%
1.3%
8.9%
12.0%
6.6%
24.1%
6.0%
0.2%
14.1%
0.1%
0%10%20%30%
Out of State
Kaiser Hospital San…
Home Births
Washington Hospital
Kaiser Hospital Oakland
Eden Medical Center
Other
ValleyCare Medical…
St. Rose Hospital
Alta Bates Medical Center
ACMC Highland Campus
Alameda County Percentage of Non-Medi-Cal
births occurring in each Facility (2020-2022)
Non-Medi-Cal
0.1%
0.1%
0.3%
3.1%
3.3%
4.2%
5.8%
6.1%
8.6%
33.8%
34.6%
0%10%20%30%40%
Out of State
Kaiser Hospital San…
Home Births
Washington Hospital
Kaiser Hospital Oakland
Eden Medical Center
Other
ValleyCare Medical Center
St. Rose Hospital
Alta Bates Medical Center
ACMC Highland Campus
Alameda County Percentage of
Total Medi-Cal births occurring in each Facility
(2020-2022)
Medi-Cal
37
Among Medi-Cal covered families, the births most often
occurred at Highland Hospital and Alta Bates
38
Nearly all births at Highland Hospital and St. Rose Hospital
were to women and pregnant people covered by Medi-Cal
20.7%
0.0%
0.1%
6.0%
6.1%
6.6%
8.3%
14.3%
21.0%
38.5%
93.4%
98.5%
0%20%40%60%80%100%
Overall
Out of State
Kaiser Hospital San Leandro
Other CA County
HomeBirths
Kaiser Hospital Oakland
Washington Township Hospital
Eden Medical Center
ValleyCare Medical Center
Alta Bates Medical Center
St. Rose Hospital
ACMC Highland Campus
Percentage of Births on Medi-Cal
Alameda County Percentage of Births paid by Medi-Cal, by Facility
(2020-2022)
<0.1%
39
One-quarter of births were unintended pregnancies; 1 in 3
Medi-Cal births and nearly 1 in 5 private insurance births were
unintended
Source: Maternal and Infant Health Assessment, 2016-2018
36.2%
19.0%
25.5%
14.5%
7.2%
9.6%
0%
10%
20%
30%
40%
50%
60%
Medi-Cal Private Insurance Alameda County
Pe
r
c
e
n
t
a
g
e
U
n
i
n
t
n
e
t
i
o
n
a
l
P
r
e
g
n
a
n
c
y
Alameda County Percentage of Births by Birth Intention, by Prenatal Health
Insurance Type (2016-2018)
Unsure of Pregnancy Intentions
Unintended
40
Hispanic/Latina/o/x/e and African American/Black women and
people giving birth had the highest proportions of unintended
pregnancies
Source: Maternal and Infant Health Assessment, 2016-2018
40.5%
31.5%
17.2%16.7%
25.5%
10.3%27.6%
5.8%9.9%
9.6%
0%
10%
20%
30%
40%
50%
60%
70%
Hispanic/
Latina/o/x/e
African
American/
Black
Asian/Pacific
Islander
White All Races
Pe
r
c
e
n
t
o
f
B
i
r
t
h
s
B
y
I
n
t
e
n
t
i
o
n
Alameda County Percentage of Births by Birth Intention, by Race/Ethnicity (2016-2018)
Unsure of Pregnancy Intentions
Unintended
Alameda County
Pregnancy & Maternal
Health Indicators
41
42
Inequities in early prenatal care
Source: CAPE, with data from Alameda County Vital Statistics files, 2018-2022
23.2%
18.1%
14.3%12.8%
8.8%7.8%
5.8%
9.3%
0%
5%
10%
15%
20%
25%
Pacific
Islander
American
Indian/
Alaska Native
African
American/
Black
Hispanic/
Latina/o/x/e
Multiracial White Asian All Races
Pe
r
c
e
n
t
a
g
e
N
o
t
E
n
t
e
r
i
n
g
P
r
e
n
a
t
a
l
C
a
r
e
i
n
F
r
i
s
t
Tr
i
m
e
s
t
e
r
Race/Ethnicity
Alameda County Percentage of Pregnant Women and People Not Receiving First Trimester
Prenatal Care, by Race/Ethnicity (2018 - 2022)
43
Trends in racial and ethnic inequities in early prenatal care
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2022
0%
5%
10%
15%
20%
25%
30%
35%
2008-2012 2013-2017 2018-2022
Pe
r
c
e
n
t
a
g
e
N
o
t
E
n
t
e
r
i
n
g
P
r
e
n
a
t
a
l
C
a
r
e
i
n
F
r
i
s
t
Tr
i
m
e
s
t
e
r
Five-Year Average
Alameda County Trend in Percentage of Pregnant Women and People Not Entering
Prenatal Care in First Trimester, by Race/Ethnicity (2018-2022)
Pacific Islander
American Indian/Alaska
NativeAfrican American/Black
Hispanic/Latina/o/x/e
All Races
Multiracial
White
Asian
44
Adequate Prenatal
Care:
Prenatal care initiated
within the first four
months of pregnancy,
with the
mother/person giving
birth attending 80% or
more of the expected
number of prenatal
care visits
Inequities in not receiving adequate prenatal care
49.8%
40.4%38.0%36.8%36.0%35.7%32.6%35.6%
0%
10%
20%
30%
40%
50%
60%
Pacific
Islander
Multiracial Hispanic/
Latina/o/x/e
African
American/
Black
White American
Indian/
Alaska
Native
Asian All Races
Pe
r
c
e
n
t
a
g
e
N
o
t
R
e
c
e
i
v
i
n
g
A
d
e
q
u
a
t
e
/
A
d
e
q
u
a
t
e
Pl
u
s
P
r
e
n
a
t
a
l
C
a
r
e
Race/Ethnicity
Alameda County Percentage of Pregnant Women and People Who Did Not
Receive Adequate/Adequate Plus Prenatal Care, by Race/Ethnicity (2018-2022)
Source: CAPE, with data from Alameda County Vital Statistics files, 2018-2022
45
Trends in inequities in not receiving adequate prenatal care
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2022
0%
10%
20%
30%
40%
50%
60%
2008-2012 2013-2017 2018-2022Pe
r
c
e
n
t
a
g
e
N
o
t
R
e
c
e
i
v
i
n
g
A
d
e
q
u
a
t
e
/
A
d
e
q
u
a
t
e
P
l
u
s
Pr
e
n
a
t
a
l
C
a
r
e
Time Period
Alameda County Trend in Percentage of Pregnant Women and People Not Receiving
Adequate/Adequate Plus Prenatal Care, by Race/Ethnicity (2008-2022)
Pacific Islander
Multiracial
Hispanic/
Latina/o/x/e
African American/
Black
White
American Indian/
Alaska Native
All Races
Asian
46
Medi-Cal patients had later entry into prenatal care, but higher
percentages of adequate prenatal care
Source: CDPH MCAH Dashboard, Alameda County, 2020-2022
19.1%
25.7%
5.7%
39.3%
0%
10%
20%
30%
40%
50%
Did Not Initiate Prenatal Care in 1st Trimester Less than Adequate Prenatal Care
Pe
r
c
e
n
t
a
g
e
Alameda County Percentage of Pregnant Women or People Not Receiving First
Trimester Prenatal Care or Receiving Less Than Adequate Prenatal Care, by
Insurance Coverage (2020-2022)
Medi-Cal
Private
47
Inequities in pregnant women and people who had any
diabetes at delivery
26.6%
22.2%
16.8%16.5%
13.7%12.9%
9.3%
16.9%
0%
5%
10%
15%
20%
25%
30%
Pacific
Islander
Asian American
Indian/
Alaska Native
Hispanic/
Latina/o/x/e
Multirace African
American/
Black
White All Races
Pe
r
c
e
n
t
a
g
e
o
f
P
r
e
g
n
a
n
t
P
e
o
p
l
e
w
i
t
h
D
i
a
b
e
t
e
s
a
t
De
l
i
v
e
r
y
Race/Ethnicity
Alameda County Percentage of Pregnant Women and People who had Any Diabetes at
Delivery, by Race/Ethnicity (2021-2023)
Source: Source: California Department of Public Health / Maternal, Child and Adolescent Health
Division / Epidemiology, Surveillance and Federal Reporting Section (2021-2023)
48
Inequities in pregnant women and people who had any
hypertension at delivery
30.3%
26.0%
23.1%20.8%20.0%
17.6%
14.6%
19.2%
0%
5%
10%
15%
20%
25%
30%
35%
African
American/
Black
Pacific
Islander
Multirace White Hispanic/
Latina/o/x/e
American
Indian/
Alaska Native
Asian Total
Pe
r
c
e
n
t
a
g
e
o
f
P
r
e
g
n
a
n
t
P
e
o
p
l
e
w
i
t
h
A
n
y
Hy
p
e
r
t
e
n
s
i
o
n
D
i
a
g
n
o
s
e
s
Race/Ethnicity
Alameda County Percentage of Pregnant Women and People Who Had Any Hypertension at
Delivery, by Race/Ethnicity (2021-2023)
Source: Source: California Department of Public Health / Maternal, Child and Adolescent Health
Division / Epidemiology, Surveillance and Federal Reporting Section (2021-2023)
49
Inequities in severe maternal morbidity
Source: Source: California Department of Public Health / Maternal, Child and Adolescent Health
Division / Epidemiology, Surveillance and Federal Reporting Section (2021-2023)
224.1 215.7
152.3
120.4 103.9 103.0
136.5
0
50
100
150
200
250
African
American/
Black
Pacific Islander Hispanic/
Latina/o/x/e
White American
Indian/
Alaska Native*
Asian All Races
Ra
t
e
o
f
P
r
e
g
n
a
n
t
P
e
o
p
l
e
w
i
t
h
S
e
v
e
r
e
M
a
t
e
r
n
a
l
Mo
r
b
i
d
i
t
y
p
e
r
1
0
,
0
0
0
Race/Ethnicity
Alameda County* Rate of Severe Maternal Morbidity Among Pregnant Women and People,
by Race/Ethnicity (2021-2023)
* = California value
Alameda County Infant
Health Indicators
50
51
Overall, there is a decreasing trend in infant deaths
Source: California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, Fetal Mortality Dashboard and Infant Mortality Dashboard
0
20
40
60
80
100
120
140
2008-2009 2010-2011 2012-2013 2014-2015 2016-2017 2018-2019 2020-2021
Nu
m
b
e
r
o
f
D
e
a
t
h
s
Years
Alameda County Average Number of Fetal and Infant Deaths (2008-2021)
Fetal Deaths
Infant Deaths
52
Overall decrease in infant mortality rate trend
Source: California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, Fetal Mortality Dashboard and Infant Mortality Dashboard
4.9
3.5
0
2
4
6
8
2008-2009 2010-2011 2012-2013 2014-2015 2016-2017 2018-2019 2020-2021
De
a
t
h
R
a
t
e
p
e
r
1
,
0
0
0
Time Period
Alameda County Trend in Fetal and Infant Death Rate (2008-2021)
Fetal Deaths
Infant Deaths
8.9
7.6
5.5
2.8 2.7 2.6
3.4
0
2
4
6
8
10
African
American/
Black
Pacific Islander*American Indian/
Alaska Native*
Hispanic/
Latino/a/x/e
White Asian All RacesIn
f
a
n
t
M
o
r
t
a
l
i
t
y
R
a
t
e
(
p
e
r
1
,
0
0
0
L
i
v
e
B
i
r
t
h
s
)
Race/Ethnicity
Alameda County Infant Mortality Rate, by Race/Ethnicity (2019-2021)
53
Infant Mortality Rate by Race/Ethnicity, 2019-2021
Source: CAPE, with data from Alameda County Vital Statistics files, 2019-2021CA data from California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, Infant Mortality Dashboard
3.4x
* = California value
Rare Event and Small Population
54
Infant Mortality Rate inequity has persisted over time
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2020* Source: California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, Fetal Mortality Dashboard
9.38.6
6.6
7.7
3.43.02.62.3
0
2
4
6
8
10
12
2008-2012 2013-2017 2018-2022
In
f
a
n
t
M
o
r
t
a
l
i
t
y
R
a
t
e
(
P
e
r
1
,
0
0
0
L
i
v
e
B
i
r
t
h
s
)
Period
Alameda County* Trend in Infant Mortality Rate, by Race/Ethnicity, Alameda County
(2008-2022)
Multirace
AfricanAmerican/
Black
American Indian/
Alaska Native*
Pacific Islander*
All Races
Hispanic/
Latino/a/x/e
Asian
White
* = California value
Rare Event and Small Population
55
Rank Leading Causes of Infant Deaths
2020-2022
1 Congenital malformations, deformations and chromosomal abnormalities
2 Disorders related to short gestation and low birth weight, not elsewhere
classified
3 Sudden infant death syndrome
4 Accidents (unintentional injuries)
5 Newborn affected by maternal complications of pregnancy
6 Intrauterine hypoxia and birth asphyxia
7 Newborn affected by complications of placenta, cord and membranes
8 Neonatal hemorrhage
9 Diseases of the blood and blood-forming organs and certain disorders involving
the immune mechanism
10 All other causes
Leading causes of infant mortality
56
Inequities in fetal deaths
Source: California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, Fetal Mortality Dashboard and Fetal Mortality Dashboard
8.1 8.0
6.1
4.7 4.4 3.8 3.3
4.5
0
2
4
6
8
10
African
American/
Black
Pacific
Islander*
American
Indian/
Alaska
Native*
Hispanic/
Latina/o/x/e
Multiracial*White Asian All Races
Fe
t
a
l
D
e
a
t
h
R
a
t
e
p
e
r
1
,
0
0
0
Race/Ethnicity
Alameda County* Percentage of Fetal Deaths, by Race/Ethnicity (2018-2020)
* = California value
Rare Event and Small Population
57
Trend in Sudden Unexpected Infant Deaths (SUID), Alameda
County and California
0
10
20
30
40
50
60
70
2007-2009 2010-2012 2013-2015 2016-2018 2019-2021
SU
I
D
r
a
t
e
s
p
e
r
1
0
0
,
0
0
0
b
i
r
t
h
s
Time Period
Alameda County and California Trends in SUID Rates (2007-2021)
Alameda County
California
58
Inequities in Sudden Unexpected Infant Death, California
(2008-2018)
16.9%
10.1%9.4%
7.6%7.3%6.5%5.7%
7.2%
0%1.2%1.6%1.1%0.8%0.5%0.7%1.0%
0%
4%
8%
12%
16%
20%
American
Indian/
Alaska
Native*
Pacific
Islander
African
American/
Black
Hispanic/
Latina/o/x/e
Asian Multiracial White All Races
%
P
r
e
m
a
t
u
r
e
o
r
V
e
r
y
P
r
e
m
a
t
u
r
e
Race/Ethnicity
Alameda County Premature Birth and Very Premature Birth, by Race/Ethnicity (2020-2022)
Singleton Premature Birth (<37
weeks gestational age)
Singleton Very Premature Birth
(<32 weeks gestational age)
59
Inequities in Singleton premature births
Source: CAPE, with data from Alameda County Vital Statistics files, 2020-2022
* = California value
Rare Event and Small Population
60
Inequities in premature births
Source: CAPE, with data from Alameda County Vital Statistics files, 2020-2022
12.9%
11.5%
8.2%7.7%7.7%7.6%
6.5%5.8%
7.5%
0.0%
6.3%
5.1%
6.4%
11.4%
8.1%
6.1%6.1%6.9%
0%
5%
10%
15%
American
Indian/
Alaska
Native
African
American/
Black
Other/
Unknown
Asian Pacific
Islander
Hispanic/
Latina/o/x/e
Multiracial White All RacesPe
r
c
e
n
t
a
g
e
P
r
e
m
a
t
u
r
e
o
r
V
e
r
y
P
r
e
m
a
t
u
r
e
B
i
r
t
h
Race/Ethnicity
Alameda County Premature Births for US-born and Non-US-Born Women and People Giving
Birth, by Race/Ethnicity (2021-2022)
US-Born
Non-US-Born
2.2x
10.2%
7.8%7.0%6.6%5.8%5.2%
4.3%
6.1%
1.6%
0.7%0.9%0.9%0.5%0.8%
0%
4%
8%
12%
African
American/
Black
American
Indian/
Alaska
Native*
Asian Pacific
Islander
Multiracial Hispanic/
Latina/o/x/e
White All Races
Pe
r
c
e
n
t
a
g
e
L
o
w
a
n
d
V
e
r
y
L
o
w
B
i
r
t
h
W
e
i
g
h
t
Race/Ethnicity
Alameda County Low Birth Weight and Very Low Birth Weight Births, by Race/Ethnicity (2020-
2022)
Low Birth Weight (<2,500 g)
Very Low Birth Weight (<1,500 g)
61
Inequities in low birth weight
2.4x
*Rare Event and
Small Population
Source: CAPE, with data from Alameda County Vital Statistics files, 2020-2022
11.1%
7.5%
6.5%6.1%5.4%5.2%5.1%
3.9%
5.9%
5.2%
6.3%
0.0%
5.1%
6.5%
5.2%
8.7%
4.7%
5.8%
0%
2%
4%
6%
8%
10%
12%
African
American/
Black
Asian American
Indian/
Alaska
Native
Other/
Unknown
Multiracial Hispanic/
Latina/o/x/e
Pacific
Islander
White All Races
Pe
r
c
e
n
t
a
g
e
L
o
w
B
i
r
t
h
W
e
i
g
h
t
Race/Ethnicity
Alameda County Low Birthweight Births for US-Born and Non-US-Born Women and People
Giving Birth, by Race/Ethnicity (2021-2022)
US-Born
Non-US-Born
62
Inequities in low birthweight births
Source: CAPE, with data from Alameda County Vital Statistics files, 2020-2022
Alameda County
Breastfeeding and
Infant Sleep
63
64
Due to structural racism and
differences in socioeconomic
position, some women and
people giving birth have more
time and resources to spend on
lactation supports, supplies, and
infant care education
65
Inequities in-hospital breastfeeding initiation
Source: California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, Breastfeeding Initiation Dashboard
14.9%
7.6%
3.6%3.0%2.4%2.2%0.0%
3.1%
44.9%
29.0%
25.7%
20.2%
15.3%
20.8%
14.3%
21.7%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Pacific
Islander
African
American/
Black
Hispanic/
Latina/o/x/e
Multiracial White Asian American
Indian/
Alaska
Native
All Races
Pe
r
c
e
n
t
a
g
e
N
o
t
R
e
p
o
r
t
i
n
g
I
n
-Ho
s
p
i
t
a
l
Br
e
a
s
t
f
e
e
d
i
n
g
o
f
N
e
w
b
o
r
n
Race/Ethnicity
Alameda County Percentage of Women and Pregnant People Not Breastfeeding In Hospital, by
Race/Ethnicity (2020-2022)
No Breastfeeding
Not Exclusively
Breastfeeding
66
Inequities in breastfeeding initiation within Asian subgroups
8.8%
4.9%3.9%3.4%3.0%2.6%1.9%1.6%1.5%1.1%2.2%
29.4%30.6%
18.1%
25.4%
17.4%18.1%
13.7%
20.5%
18.0%17.5%
20.8%
0%
5%
10%
15%
20%
25%
30%
35%
Laotian Cambodian Vietnamese Chinese Multi-Ethnic
Asian
Korean Japanese Filipino Southeast
Asian
Asian Indian Asian
Average
Pe
r
c
e
n
t
a
g
e
N
o
t
R
e
p
o
r
t
i
n
g
I
n
-Ho
s
p
i
t
a
l
Br
e
a
s
t
f
e
e
d
i
n
g
o
f
N
e
w
b
o
r
n
Race/Ethnicity
Alameda County Percentage of Women and Pregnant People Not Breastfeeding In Hospital, Asian
Subgroups (2020-2022)
No Breastfeeding
Not Exclusively
Breastfeeding
Source: California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, Breastfeeding Initiation Dashboard
67
Approximately 1 in 10 families did not place infant on back to
sleep
Source: Maternal and Infant Health Assessment, 2019-2021
20.5%
11.0%10.5%
8.5%
11.1%
0%
5%
10%
15%
20%
25%
African American/
Black
Asian/
Pacific Islander
Hispanic/
Latina/o/x/e
White All RacesPe
r
c
e
n
t
a
g
e
N
o
t
P
l
a
c
i
n
g
I
n
f
a
n
t
o
n
B
a
c
k
t
o
S
l
e
e
p
Race/Ethnicity
Alameda County Percentage of Women and Pregnant People who Did not Place Infant on
Back to Sleep, by Race/Ethnicity (2019-2021)
68
Medi-Cal covered families had higher percentage not placing
infant on back to sleep
Source: Maternal and Infant Health Assessment, 2019-2021
17.1%
8.4%
0%
6%
12%
18%
Medi-Cal Private Insurance
Pe
r
c
e
n
t
a
g
e
N
o
t
P
l
a
c
i
n
g
I
n
f
a
n
t
o
n
B
a
c
k
t
o
Sl
e
e
p
Insurance type
Alameda County Percentage of Women and Pregnant People Not Placing Infant on
Back to Sleep by Insurance Type, Alameda County (2019-2021)
69
Inequities in bed sharing
Source: Maternal and Infant Health Assessment, 2019-2021
47.4%
33.0%
26.4%
16.7%
28.6%
0%
10%
20%
30%
40%
50%
African American/
Black
Hispanic/
Latina/o/x/e
Asian/
Pacific Islander
White All Races
Pe
r
c
e
n
t
a
g
e
A
l
w
a
y
s
o
r
O
f
t
e
n
S
h
a
r
e
d
B
e
d
w
i
t
h
In
f
a
n
t
Race/Ethnicity
Alameda County Percentage of Women and Pregnant People who Always or Often Shared Bed with
Infant, by Race/Ethnicity (2019-2021)
70
Inequities in bed sharing by insurance type
Source: Maternal and Infant Health Assessment, 2019-2021
42.0%
22.5%
0%
10%
20%
30%
40%
50%
Medi-Cal Private InsurancePe
r
c
e
n
t
a
g
e
A
l
w
a
y
s
o
r
O
f
t
e
n
S
h
a
r
e
d
B
e
d
w
i
t
h
I
n
f
a
n
t
Insurance Type
Alameda County Percentage of Women and Pregnant People who
Always or Often Shared Bed with Infant, by Insurance Type (2019-2021)
Alameda County
Perinatal Mental
Health
71
72
Inequities in depressive symptoms
Source: Maternal and Infant Health Assessment, 2019-2021
29.3%
15.8%14.0%
11.0%
15.3%15.2%
12.1%13.6%
8.6%
12.0%
0%
5%
10%
15%
20%
25%
30%
35%
African American/
Black
Asian/
Pacific Islander
Hispanic/
Latina/o/x/e
White All RacesPe
r
c
e
n
t
a
g
e
D
e
p
r
e
s
s
i
v
e
S
y
m
p
t
o
m
s
Race/Ethnicity
Alameda County Percentage of Women and Pregnant People who Experienced Depressive
Symptoms During or After Pregnancy (2019-2021)
Prenatal
Depressive
Symptoms
Postpartum
Depressive
Symptoms
73
Experiencing racism
Source: Maternal and Infant Health Assessment, 2019-2021
53.7%
20.2%
12.2%
4.2%
16.6%
0%
10%
20%
30%
40%
50%
60%
African American/
Black
Hispanic/
Latina/o/x/e
Asian/
Pacific Islander
White All Races
Pe
r
c
e
n
t
a
g
e
O
f
t
e
n
E
x
p
e
r
i
e
n
c
e
d
R
a
c
i
s
m
i
n
L
i
f
e
t
i
m
e
Race/Ethnicity
Alameda County Percentage of Women and Pregnant People who Often
Experienced Racism over Lifetime (2019-2021)
Alameda County
Perinatal Economic
Hardships and
Healthcare Utilization
74
75
Inequities in homelessness or not have a place to sleep during
pregnancy
Source: Maternal and Infant Health Assessment, 2019-2021
* = California value
13.6%
10.5%
7.4%
2.1%
1.1%
4.1%
0%
4%
8%
12%
16%
American Indian/
Alaska Native*
African American/
Black
Hispanic/
Latina/o/x/e
White*Asian/
Pacific Islander*
All Races
Pe
r
c
e
n
t
a
g
e
R
e
p
o
r
t
i
n
g
H
o
m
e
l
e
s
s
n
e
s
s
Race/Ethnicity
Alameda County* Percentage of Women and Pregnant People who were Homeless or Did
Not Have a Place to Sleep During Pregnancy (2019-2021)
76
Inequities in housing insecurity
Source: Maternal and Infant Health Assessment, 2019-2021
12.9%
10.4%
9.0%
3.8%
2.5%
3.9%
0%
4%
8%
12%
16%
American Indian/
Alaska Native*
African American/
Black
Hispanic/
Latina/o/x/e
White*Asian/
Pacific Islander*
All RacesPe
r
c
e
n
t
a
g
e
R
e
p
o
r
t
i
n
g
M
o
v
e
d
o
r
H
a
d
P
r
o
b
l
e
m
s
Pa
y
i
n
g
R
e
n
t
D
u
r
i
n
g
P
r
e
g
n
a
n
c
y
Race/Ethnicity
Alameda County* Percentage of Women and Pregnant People who Moved or Had Problems
Paying Rent During Pregnancy, by Race/Ethnicity
* = California value
77
Inequities in pregnant people or their partners experiencing job loss
36.2%35.4%
25.6%
12.4%10.1%
17.1%
0%
5%
10%
15%
20%
25%
30%
35%
40%
African American/
Black
American Indian/
Alaska Native*
Hispanic
Latina/o/x/e
Asian
Pacific Islander
White All Races
Pe
r
c
e
n
t
a
g
e
R
e
p
o
r
t
i
n
g
P
r
e
g
n
a
n
t
P
e
r
s
o
n
o
r
P
a
r
t
n
e
r
Lo
s
t
J
o
b
D
u
r
i
n
g
P
r
e
g
n
a
n
c
y
Race/Ethnicity
Alameda County* Percentage Reporting Pregnant Person or Partner Lost Job During
Pregnancy, by Race/Ethnicity (2019-2021)
* = California value
Source: Maternal and Infant Health Assessment, 2019-2021
78
Inequities in Pregnant Person or Partner Had Pay or Hours Cut
Back
32.0%
28.3%
21.7%
14.0%
9.2%
16.3%
0%
5%
10%
15%
20%
25%
30%
35%
American Indian/
Alaska Native*
Hispanic
Latina/o/x/e
African American/
Black
White Asian
Pacific Islander
All Races
Pe
r
c
e
n
t
a
g
e
R
e
p
o
r
t
i
n
g
P
r
e
g
n
a
n
t
P
e
r
s
o
n
o
r
Pa
r
t
n
e
r
H
a
d
P
a
y
o
r
H
o
u
r
s
C
u
t
B
a
c
k
D
u
r
i
n
g
Pr
e
g
n
a
n
c
y
Race/Ethnicity
Alameda County* Percentage Reporting Pregnant Person or Partner Had Pay or
Hours Cut Back During Pregnancy, by Race/Ethnicity (2019-2021)
Source: Maternal and Infant Health Assessment, 2019-2021
* = California value
79
Inequities in becoming separated or divorced during pregnancy
14.0%13.2%
7.1%
3.9%
2.6%
4.2%
0%
4%
8%
12%
16%
African
American/
Black
American
Indian/
Alaska Native*
Hispanic
Latina/o/x/e
White*Asian/
Pacific Islander*
All Races
Pe
r
c
e
n
t
a
g
e
R
e
p
o
r
t
i
n
g
S
e
p
a
r
a
t
e
d
o
r
D
i
v
o
r
c
e
d
Du
r
i
n
g
P
r
e
g
n
a
n
c
y
Race/Ethnicity
Alameda County* Percentage Reporting Separated or Divorced During
Pregnancy, by Race/Ethnicity (2019-2021)
Source: Maternal and Infant Health Assessment, 2019-2021
* = California value
9.5%
3.7%3.3%
1.7%
3.9%
0%
2%
4%
6%
8%
10%
Hispanic/
Latina/o/x/e
African American/
Black*
Asian
Pacific Islander
White*All Races
Pe
r
c
e
n
t
a
g
e
R
e
p
o
r
t
i
n
g
N
o
P
r
a
c
t
i
c
a
l
o
r
E
m
o
t
i
o
n
a
l
Su
p
p
o
r
t
D
u
r
i
n
g
P
r
e
g
n
a
n
c
y
Race/Ethnicity
Alameda County* Percentage Reporting Lacking Practical or Emotional Support by
Race/Ethnicity (2019-2021)
80
Inequities in practical or emotional support
Source: Maternal and Infant Health Assessment, 2019-2021
* = California value
81
Inequities in food insecurity during pregnancy, 2019-2021
Source: Maternal and Infant Health Assessment, 2019-2021
* = California value
34.6%34.4%
29.9%
9.8%9.4%
15.5%
0%
10%
20%
30%
40%
American Indian/
Alaska Native*
African American/
Black
Hispanic
Latina/o/x/e
White*Asian
Pacific Islander
All RacesPe
r
c
e
n
t
a
g
e
R
e
p
o
r
t
i
n
g
F
o
o
d
I
n
s
e
c
u
r
i
t
y
D
u
r
i
n
g
Pr
e
g
n
a
n
c
y
Race/Ethnicity
Alameda County* Percentage Reporting Food Insecurity by Race/Ethnicity (2019-2021)
82
Racial and ethnic differences in participation in nutrition
programs during pregnancy
48.9%48.7%
43.4%
15.7%13.9%
26.4%
19.6%
32.9%34.0%
8.4%5.2%
12.5%
0%
10%
20%
30%
40%
50%
60%
Hispanic
Latina/o/x/e
American
Indian/
Alaska Native*
African
American/
Black
White Asian
Pacific Islander
Total AC
Population
Pe
r
c
e
n
t
a
g
e
R
e
p
o
r
t
i
n
g
P
a
r
t
i
c
i
p
a
t
i
o
n
i
n
a
N
u
t
r
i
t
i
o
n
Pr
o
g
r
a
m
D
u
r
i
n
g
P
r
e
g
n
a
n
c
y
Race/Ethnicity
Alameda County Percentage of Women and Pregnant People Supported by Nutrition
Programs, by Race/Ethnicity (2019-2021)
WIC
Cal-Fresh
* = California value
Source: Maternal and Infant Health Assessment, 2019-2021
83
Inequities in being uninsured prior to pregnancy
13.9%
8.6%
4.6%4.2%
7.2%
0%
4%
8%
12%
16%
Hispanic/
Latina/o/x/e
African American/
Black
Asian/
Pacific Islander
White All Races
Pe
r
c
e
n
t
a
g
e
U
n
i
n
s
u
r
e
d
Race/Ethnicity
Alameda County Percentage of Women and Pregnant People who were Uninsured Pre-
Pregnancy, by Race/Ethnicity (2019-2021)
* Other Race/Ethnicity estimates not shown because the relative standard error is > 50%, or fewer than 5 participants reportedSource: Maternal and Infant Health Assessment, 2019-2021
84
Inequities in receiving dental care during pregnancy, 2019-2021
Source: Maternal and Infant Health Assessment, 2019-2021
69.8%
58.8%57.0%55.3%
44.4%
53.2%
0%
20%
40%
60%
80%
American Indian/
Alaska Native*
African American/
Black
Hispanic/
Latina/o/x/e
Asian/
Pacific Islander
White Total
Pe
r
c
e
n
t
a
g
e
w
i
t
h
N
o
D
e
n
t
a
l
C
a
r
e
d
u
r
i
n
g
Pr
e
g
n
a
n
c
y
Race/Ethnicity
Alameda County* Percentage of Women and Pregnant People who Did Not Receive Dental
Care During Pregnancy, by Race/Ethnicity (2019-2021)
* = California value
85
Inequities in Tdap vaccine during pregnancy
Source: Maternal and Infant Health Assessment, 2019-2021
41.3%
37.5%
29.4%
16.5%14.7%
21.8%
0%
10%
20%
30%
40%
50%
American Indian/
Alaska Native*
African American/
Black
Hispanic/
Latina/o/x/e
Asian/
Pacific Islander
White TotalPe
r
c
e
n
t
a
g
e
D
i
d
N
o
t
R
e
c
e
i
v
e
T
d
a
p
V
a
c
c
i
n
e
Race/Ethnicity
Alameda County Percentage of Women and Pregnant People who Did not Receive Tdap
Vaccine During Pregnancy, by Race/Ethnicity (2019-2021)
* = California value
86
Inequities in receiving flu shot during pregnancy
Source: Maternal and Infant Health Assessment, 2019-2021
51.3%
39.5%
17.0%
11.5%9.3%
17.0%
0%
10%
20%
30%
40%
50%
60%
African American/
Black
American Indian/
Alaska Native*
Hispanic/
Latina/o/x/e
Asian/
Pacific Islander
White Total
Pe
r
c
e
n
t
a
g
e
d
i
d
n
o
t
r
e
c
e
i
v
e
f
l
u
s
h
o
t
Race/Ethnicity
Alameda County Percentage of Women and Pregnant People who Did Not Receive Flu Shot
During Pregnancy, by Race/Ethnicity (2019-2021)
* = California value
87
Inequities in postpartum medical visit
Source: Maternal and Infant Health Assessment, 2019-2021
21.7%
16.0%
13.8%
8.2%
10.2%10.7%
0%
4%
8%
12%
16%
20%
24%
American Indian/
Alaska Native*
African American/
Black
Hispanic/
Latina/o/x/e
Asian/
Pacific Islander
White TotalPe
r
c
e
n
t
a
g
e
D
i
d
N
o
t
H
a
v
e
a
P
o
s
t
p
a
r
t
u
m
M
e
d
i
c
a
l
Vi
s
i
t
Race/Ethnicity
Alameda County Percentage of Women and Pregnant People Who Did Not Have a
Postpartum Medical Visit (2019-2021)
* = California value
88
COVID-19 Vaccination Status
22%
19%19%
14%13%
10%
4%
19%
0%
5%
10%
15%
20%
25%
White American
Indian/
Alaska Native
Asian Pacific
Islander
African
American/
Black
Hispanic/
Latina/o/x/e
Multiracial All Races
Pe
r
c
e
n
t
a
g
e
o
f
R
e
s
i
d
e
n
t
s
w
h
o
R
e
c
e
i
v
e
d
C
O
V
I
D
Va
c
c
i
n
a
t
i
o
n
Race/Ethnicity
Alameda County Percentage of Residents Who Received COVID Vaccination, by
Race/Ethnicity (2023)
89
Inequities in health before pregnancy
*= CA valueSource: Maternal and Infant Health Assessment, 2019-2021
4.7%
19.2%
7.6%
13.5%
8.8%
3.4%
5.6%
3.0%
7.9%
5.1%
3.3%
0%
5%
10%
15%
20%
25%
Asian/
Pacific Islander
African American/
Black
Hispanic/
Latina/o/x/e
White All Races
Pe
r
c
e
n
t
w
i
t
h
C
h
r
o
n
i
c
C
o
n
d
i
t
i
o
n
Race/Ethnicity
Alameda County* Percentage of Women and Pregnant People with Pre-pregnancy
Chronic Conditions, by Race/Ethnicity (2019-2021)
Chronic Asthma
Chronic Diabetes
Chronic Hypertension
1.4%*
3.6%*3.1%*3.1%*
90
Population Health Data Sources
California Comprehensive
Birth File - CCBF
(Birth Certificates)
California Comprehensive
Death File - CCDF
(Death Certificates)
California Birth Cohort
File (Linked Birth and
Death Records)
California Fetal Death
File (Fetal Death
Records)
California Hospital Data
Files – HCAI
(Emergency Department
Visits and
Hospitalizations)
California Maternal and
Infant Health
Assessment - MIHA
(Statewide Survey of
Postpartum Women)
California Health
Interview Survey - CHIS
(Statewide Survey of CA
Households)
US American
Community Survey
(National Survey of US
Households)
Databases Surveys
91
Strengths & Limitations of Population Health Data
Strengths
❑Birth and Death Databases most complete and
accurate count of all births and deaths in AC.
❑Hospital data best for medical diagnoses and
procedures for childbirth, newborns and
mothers’outcomes.
❑Surveys best for population health status,
behaviors, actions,utilization and
social determinants.
❑Population data identifies health inequities and
measures trends.
❑Population data allows for comparing
within/across groups and meeting
goals/objectives (HP2030, county rankings).
Limitations
❑Lag time between when data collected and available.
❑Underreporting data elements in birth and
death databases (Medi-Cal births).
❑Inconsistent definitions across data
sources (race/ethnicity).
❑Surveys capture small proportion (sample) of
entire population at a single point in time.
❑Selection, response and recall bias in surveys.
❑Respondents may be hesitant to report status,
behaviors,hardships (stigma).
❑No information on birth experiences or quality of care
in population data.
92
Elaine Bautista,
MPCAH Epidemiologist,
Alameda County Public
Health Department
Contact by phone at 510-268-2335
or by email:
elaine.bautista@acgov.org
Misha Taherbhai,
MPCAH Continous Quality
Improvement Manager
Alameda County Public Health
Department
Contact by phone at 510-667-4432
or by email:
misha.taherbhai@acgov.org
Additional Resources
http://www.acphd.org/data-reports/reports-by-topic/maternal,-child,-and-adolescent-health.aspx
http://www.acphd.org/data-reports/reports-by-topic/maternal,-child,-and-adolescent-health.aspx
http://www.acphd.org/data-reports/reports-by-topic/maternal,-child,-and-adolescent-health.aspx
http://www.acphd.org/data-reports/reports-by-topic/maternal,-child,-and-adolescent-health.aspx
http://www.acphd.org/data-
reports/reports-by-
topic/maternal,-child,-and-
adolescent-health.aspx
For Additional Maternal, Paternal,
Child, Adolescent Health
Indicators Go To: