HomeMy WebLinkAboutacphd-mpcah-indicators-slides-feb-2023ALAMEDA COUNTY PERINATAL AND
INFANT HEALTH INDICATORS
Alameda County Public Health Department
Health Care Services Agency
February 2023
1
Alameda County Births2
21,011
19,569
18,231 18,212
17,312
17,000
18,000
19,000
20,000
21,000
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Nu
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Annual Births in Alameda County, 2008-2020
3
Decreasing trend in number of
AC Births since 2008.
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2020.
Annual Birth Rate in Alameda County, 2008-2020
4
14.0
13.6
12.8
12.5
12.7
12.4 12.5
12.3
12.1
11.4
11.0 11.0
10.5
10
11
12
13
14
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
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Decreasing trend in AC Birth
Rate since 2008.
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2020.
Defining Race & Ethnicity
5
Both Race and Ethnicity are Social Constructs!
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.
Problems with Categorization
Race & Ethnicity overlap in complex ways
Definitions have changed overtime (“Irish”= Race)
People Can Fit in Multiple Categories
People have multiple/intersecting identities
https://www.verywellmind.com/difference-between-race-and-ethnicity-5074205.
How We Determine Baby’s Race/Ethnicity
6
The Birth Certificate allows mothers to select up to 3 race groups and
Latino/Hispanic ethnicity
Mother’s race/ethnicity determines baby’s race/ethnicity.
Race/Ethnicity is mutually exclusive (one category per mother & baby).
Starting Out Strong Uses Similar Methodology
Different Program & Data Sources Have Different Definitions
Race Categories
African American NH
American Indian NH
Asian NH
Pacific Islander NH
White NH
Multirace NH- More
than 1 of the above
Hispanic/Latino
Ethnicity- Any Race
Mexican
Chicano
Puerto Rican
Cuban
Central/South
American
Unknown Race/Ethnicity
Mother’s
Race/Ethnicity not
included on baby’s
birth certificate
“Refused to State” or
“Unknown”
Why We Categorize Baby’s Race/Ethnicity
7
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.
#1 reason: To identify health inequities- Race/Ethnicity is our best
category for measuring inequities between groups in AC.
5,866
4,750
4,049
1,504
583 374 165 210
1000
2000
3000
4000
5000
6000
Asian Hispanic/Latino White African
American/Black
Multirace Another Race/
Unknown
Pacific Islander Native
American
Nu
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B
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Number of Births by Race/Ethnicity, 2020
8
Source: CAPE, with data from Alameda County Vital Statistics files, 2020.
17,312 Births Asian, Hispanic/Latino, and
White populations had the
largest numbers of AC
births.
Birth Rate Trend by Race/Ethnicity, 2008-2020
9
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2020.
0
2
4
6
8
10
12
14
16
18
20
22
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16 2015-17 2016-18 2017-19 2018-20
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Hisp/Lat
PacIsl
Asian
All Races
AfAm/Black
White
Multirace
NativeAmer
Hispanic/Latino, Pacific
Islander and Asian
Populations had the highest
AC birth rates.
5.3
6.4
7.1
7.5
9.9
10.1
10.4
10.5
10.8
10.8
10.9
11.0
11.1
11.8
12.0
12.3
12.6
12.7
13.4
13.7
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0
Piedmont
Berkeley
Pleasanton
Sunol
Castro Valley
Union City
Albany
Alameda
Fremont
San Leandro
San Lorenzo
Livermore
Fairview
Emeryville
Oakland
Hayward
Dublin
Cherryland
Newark
Ashland
Birth Rate by City/Place, 2018-2020
10
Source: CAPE, with data from Alameda County Vital Statistics files, 2018-2020.
Ashland and Newark had
the highest birth rates.
Piedmont has the lowest.
Top 4 Zip Codes With
Highest Birth Rates
94621 – Deep East
Oakland,
16.3/1000
94603 – Oakland
Coliseum/San
Leandro 16.2/1000
94538 – Fremont
15.1/1000
94601 – Fruitvale
13.6/1000
0.3%
1.0%
2.6%
5.6%
6.1%
6.8%
7.9%
11.2%
18.3%
19.6%
20.5%
0%5%10%15%20%25%
Outside State or unknown
Home Births
St. Rose
Eden
ValleyCare
Highland General
Washington
Kaiser Oakland
Other CA County
Alta Bates
Kaiser San Leandro
Percentage Births by Facility (%)
Percentage Share Alameda County Births by Facility,
2018-2020
12
Source: CAPE, with data from Alameda County Vital Statistics files, 2018-2020.
70% of mothers gave birth
at Kaiser San Leandro,
Alta Bates, In Another
County or Kaiser Oakland.
94.4
66.9
24.1
32.6
16.9
3.2
0
20
40
60
80
100
2000-02 2002-04 2004-06 2006-08 2008-10 2012-12 2012-14 2014-16 2016-18 2018-20
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20-34 years
35-49 years
10-19 years
Birth Rate Trend by Age Category, 2008-2020
13
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2020.
Increase in older mothers
(35+) and decrease in
younger moms over time.
0
10
20
30
40
50
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16 2015-17 2016-18 2017-19 2018-20Te
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Hisp/Lat
AfAm/Black
PacIsl
All Races
Multirace
NativeAmer
White
Asian
Teen Birth Rate Trend by Race/Ethnicity, 2008-2020
14
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-
Teen Birth Rates decreased over time.
Hispanic/Latina and African American
teenagers had the highest rates.
0
10
20
30
40
50
60
70
80
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16 2015-17 2016-18 2017-19 2018-20
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Hisp/Lat
Asian
All Races
PacIsl
White
AfAm/Black
Multirace
Native Amer
Fertility Rate Trend by Race/Ethnicity, 2008-2020
15
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2020.
Fertility Rates decreased over time.
Hispanic/Latina and Asian females
had the highest rates.
79.2%
52.9%49.3%
35.1%
23.0%20.6%
9.1%
0%
20%
40%
60%
80%
100%
Asian Latino All Races Pacific Islander White Black Multirace
Pe
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Percentage Births to Non-US Born Mothers by
Race/Ethnicity, 2020
16
Source: CAPE, with data from Alameda County Vital Statistics files, 2020.
8,329 non-US Born Mom Births Asian and Hispanic/Latina
mothers were more likely
to be born outside the US.
* There were no non-US born Native American Mothers in 2020.
Top Countries of Mothers’ Birth by Race/Ethnicity,
2020
17
Asian (5,866)
Rank Country Percent
1 India 33.5%
2 US 22.4%
3 China 16.7%
4 Philippines 7.5%
5 Vietnam 4.6%
Black/ African American (1,504)
Rank Country Percent
1 US 80.0%
2 Ethiopia 5.2%
3 Eritrea 3.9%
4 Nigeria 2.7%
Hispanic/Latino (4,750)
Rank Country Percent
1 US 49.5%
2 Mexico 26.1%
3 Guatemala 10.2%
4 El Salvador 6.8%
5 Honduras 2.1%Pacific Islander (165)
Rank Country Percent
1 US 66.1%
2 Tonga 13.9%
3 Fiji 13.3%
White (4,409)
Rank Country Percent
1 US 75.3%
2 Afghanistan 4.5%
3 Yemen 4.3%
4 Russia 1.6%
Source: CAPE, with data from Alameda County Vital Statistics files, 2020.
Percentage Mothers Less than High School
Education by Race/Ethnicity, 2018-2020
18
23.8%
11.4%
9.3%8.3%7.4%
3.6%2.4%1.5%
0%
5%
10%
15%
20%
25%
30%
Hispanic/Latino Native
American
African
American/ Black
All Races Pacific Islander White Multirace Asian
Pe
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(
%
)
Hispanic/Latina mothers
had the highest percentage
of mothers with less than
high school education.
Source: CAPE, with data from Alameda County Vita8l Statistics files, 2018-2020.
51.0%50.0%
26.8%
23.4%23.3%21.2%
11.0%8.7%
0%
10%
20%
30%
40%
50%
60%
Hispanic/Latino Black/ African
American
All Races Pacific Islander Native
American
Multirace Asian White
Pe
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Percentage Medi-Cal Births by Race/Ethnicity, 2020
19
4,510 Medi-Cal Paid Births
*Race/Ethnicity defined differently in HCSI data.
1 in 2 African American
and Hispanic/Latina
deliveries were paid by
Medi-Cal.
Source: CDPH, with data from HCAI patient discharge files, 2020.
Medi-Cal Births by AC Birthing Facility
20
Source: CAPE, with data from Alameda County Vital Statistics files, 2018-2020.
Facilities with highest percentages of Medi-Cal births
Highland, St Rose and Alta Bates
Facilities with the lowest percentages of Medi-Cal births
Kaiser San Leandro, Kaiser Oakland, Eden and Home Births.
Note: Medi-Cal Births are underestimated on birth certificates and hospital
diagnostic and billing data is a better source for payer type.
31.5%
40.5%
25.5%
16.7%17.2%
27.6%10.3%
9.6%
9.9%5.8%
59.1%
50.8%
35.1%
26.6%23.0%
0%
20%
40%
60%
80%
Black/ African American Latino All Races White Asian/ Pacific Islander
Pe
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(
%
)
Unintended Unsure of Pregnancy Intentions
Percentage Unintentional Pregnancy by
Race/Ethnicity, 2016-2018
21
Source: Maternal and Infant Health Assessment (MHIA) Survey 2016-2018.
Over 1/2 of African American
and Hispanic/Latina
pregnancies were
unintentional.
*MIHA combines Asian and Pacific Islander Mothers due to
small sample size of Pacific Islanders. MIHA does not show
data for Native American or Multirace Mothers at the state or
county level.
36.2%
19.0%
25.5%
14.5%
7.2%
9.6%
50.7%
26.2%
35.1%
0%
10%
20%
30%
40%
50%
60%
Medi-Cal Private Alameda County
Pe
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(
%
)
Unintended Unsure of Pregnancy Intentions
Percentage Unintentional Pregnancy:
Medi-Cal vs. Private Insurance 2016-2018
22
Source: Maternal and Infant Health Assessment (MHIA) Survey 2016-2018.
Over 1/2 of pregnancies
were unintentional
among the Medi-Cal
population representing
an unmet need for family
planning services.
Unmet Need for Family Planning Services in AC and
CA
23
In 2016, over 87,000 women in AC aged 13-44 years needed
publicly funded family planning services.
Publicly funded family planning centers in AC served about 54,000
female clients in 2015.
The abortion rate for CA residents was 16.4 per 1,000 women ages
15-44 years in 2017.
Publicly funded family planning centers in CA helped avert about
350,000 unintended pregnancies in 2016.
Source: Guttmacher Institute. Unintended Pregnancy in the US, Fact Sheet September 2016.
https://data.guttmacher.org/
Alameda County Pregnancy and
Maternal Health Indicators24
Percentage of First Trimester Prenatal Care Trend
by Race/Ethnicity, 2008-202025
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2020.
91.2%
68.0%
76.1%
60%
65%
70%
75%
80%
85%
90%
95%
100%
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16 2015-17 2016-18 2017-19 2018-20
Pe
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Ca
r
e
Asian
White
All Races
Multirace
Hisp/Lat
AfAm/Black
PacIslMost groups had high
percentages of early entry
into prenatal care. Pacific
Islander mothers had the
lowest percentages.
* Native American mothers first trimester entry into prenatal care
was similar to other populations, but not included due to yearly
fluctuations.
Percentage of Adequate/Adequate Plus Prenatal
Care Trend by Race/Ethnicity, 2008-202026
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2020.
78.4%
64.7%66.3%
48.3%
40%
50%
60%
70%
80%
90%
Pe
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Ca
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Asian
White
All Races
Multirace
Hisp/Lat
AfAm/Black
PacIsl
Adequate Prenatal Care deceased
among all race/ethnic groups over
time. Pacific Islander mothers had
the lowest percentages.
Adequate/Adequate Plus Prenatal Care: Received ~80% of needed prenatal care visits during pregnancy. (Kotelchuck Index)
* Native American mothers first trimester entry into prenatal care
was similar to other populations, but not included due to yearly
fluctuations.
82.3%
68.7%
93.9%
62.9%
0%
20%
40%
60%
80%
100%
1st Trimester Prenatal Care Adequate Prenatal Care
Pe
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P
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y
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(
%
)
Medi-Cal Private Insurance
Percentage 1st Trimester & Adequate Prenatal Care
Medi-Cal vs. Private, 2018-202027
Later entry into prenatal care, yet slightly
higher percentage of adequate prenatal
care visits among Medi-Cal vs. Private
insurance populations.
Source: CAPE, with data from Alameda County Vital Statistics files, 2018-2020.
267.4
243.8
181.1 176.6 168.7 164.5
119.3 107.8
0
50
100
150
200
250
300
Pacific Islander Asian All Races Latino Native American Multirace African
American/ Black
White
Ge
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D
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Gestational Diabetes Rate by Race/Ethnicity, 2019-
2020 28
*Race/Ethnicity defined differently in HCSI data.
3,117 Gestational Diabetes Diagnoses
Pacific Islander and Asian mothers
had the highest gestational
diabetes rates in AC. African
Americans and Whites had the
lowest.
Source: CDPH, with data from HCAI patient discharge files, 2019-2020.
209.1
180.7
159.7 158.6
133.7 130.5 122.7
83.6
0
50
100
150
200
250
African
American/ Black
Native American Multirace Pacific Islander Latino White All Races Asian
Ge
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Gestational Hypertension Rate by Race/Ethnicity,
2019-2020 29
*Race/Ethnicity defined differently in HCSI data.
2,111 Gestational Hypertension Diagnoses African American and Native
American mothers had the highest
gestational hypertension rates. The
African American rate was 2.5 times
the Asian rate.
Source: CDPH, with data from HCAI patient discharge files, 2019-2020.
224.3
151.5 146.2 140.2
122.1
0
25
50
75
100
125
150
175
200
225
Black/ African American Hispanic All Races Asian/Pacific Islander White
Se
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Severe Maternal Morbidity by Race/Ethnicity,
2019-2021 30
Source: CDPH, with data from HCAI patient discharge files, 2019-2021.
867 Severe Maternal Morbidity Diagnoses African American mothers had the
highest severe maternal morbidity
rates. The African American Rate
was almost 2 times the White Rate.
*CDPH combined Asian and Pacific Islanders and did not show
data for Native American or Multirace Mothers at the count
level due to small numbers.
28.1%27.3%26.7%25.7%25.5%24.2%22.6%21.9%
0%
5%
10%
15%
20%
25%
30%
Black/ African
American
Asian Native
American
White Alameda
County
Multirace Pacific Islander Hispanic/Latino
Pe
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(
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Percentage Low Risk C-Section by Race/Ethnicity,
2018-2020 31
African American, Asian and Native
American mothers had the highest
percentages of low risk c-sections.
Source: CAPE, with data from Alameda County Vital Statistics files, 2018-2020.
Alameda County Infant Health
Indicators32
13.4%
10.1%10.1%
7.7%7.1%6.7%6.7%
5.8%
1.9%1.5%1.0%0.9%1.1%0.9%0.6%
0%
2%
4%
6%
8%
10%
12%
14%
Native
American
African
American/ Black
Pacific Islander Latino All Races Multirace Asian White
Pe
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&
V
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P
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Singleton Premature Birth (<37 weeks gestational age)Singleton Very Premature Birth (<32 weeks gestational age)
Percentage Premature and Very Premature Births
by race/ethnicity, 2018-202033
1,241 Preterm Births, 165 Very Preterm Births
Source: CAPE, with data from Alameda County Vital Statistics files, 2018-
Native American, African American,
and Pacific Islander infants had the
highest percentages of premature
births.
* Native American Premature Birth Rate is less stable due to small
numbers (CI: .6.1-25.5).
*
11.0%
8.0%7.6%7.4%7.3%
5.8%6.4%
10.5%
6.4%
5.2%
7.8%
5.8%
0%
2%
4%
6%
8%
10%
12%
African American/
Black
Pacific Islander Asian Multirace Hispanic/Latino White
Pe
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n
t
S
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t
o
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P
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a
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B
i
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(
%
)
US Born Non US Born
Alameda County
Percentage Singleton Premature Births by Race/Ethnicity
for US versus non-US Born Mothers, 2016-202034
Source: CAPE, with data from Alameda County Vital Statistics files, 2016-2020.
US Born African American infants
had the highest percentages of
premature births followed by non-
US born Pacific Islander infants.
* Native American Premature Birth rate for non-US born mothers
was not stable due to small numbers and is not shown.
10.1%
9.0%
6.8%6.5%
5.8%5.6%5.1%
4.0%
1.7%1.7%
0.8%0.8%1.0%0.8%0.5%
0%
2%
4%
6%
8%
10%
12%
Black/ African
American
Native American Pacific Islander Asian All Races Multirace Latino White
Pe
r
c
e
n
t
a
g
e
L
o
w
&
V
e
r
y
L
o
w
B
i
r
t
h
W
e
i
g
h
t
s
(
%
)
Low Birth Weight (<2,500 g)Very Low Birth Weight (<1,500 g)
Percentage Low Birth Weight (LBW) and Very Low Birth
Weight (VLBW) Births by Race/Ethnicity, 2018-202035
1,007 LBW Births, 138 VLBW Births
Source: CAPE, with data from Alameda County Vital Statistics files, 2018-2020.
African Americans, Native Americans
and Pacific Islander infants had the
highest percentages of low birth
weight births.
* Native American Low Birth Weight is less stable due to small
numbers (CI: .3.3-19.5).
10.9%
7.3%
5.6%5.2%
4.0%4.4%
5.1%
6.2%
5.5%5.0%4.5%
9.1%
0%
2%
4%
6%
8%
10%
12%
African American/
Black
Asian Multirace Hispanic/Latino White Pacific Islander
Pe
r
c
e
n
t
a
g
e
S
i
n
g
l
e
t
o
n
L
o
w
B
i
r
t
h
W
e
i
g
h
t
B
i
r
t
h
s
(%
)
US Born Non US Born
Percentage Singleton Low Birth Weight by Race/Ethnicity
for US versus non-US Born Mothers, 2016-202036
Source: CAPE, with data from Alameda County Vital Statistics files, 2016-2020.
Alameda County
US Born African American infants
had the highest percentages of low
birth weight births followed by non-
US born Pacific Islanders.
* Native American low birth weight percentage for non-US born
mothers was not stable due to small numbers and is not shown.
Number of Infant Deaths in Alameda County, 2008-2020
37
89
76
95
79
73
87
76 75 71 71
55 59 62
30
50
70
90
110
Nu
m
b
e
r
o
f
I
n
f
a
n
t
D
e
a
t
h
s
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2020.
Decrease in number of
infant deaths 2008-2018.
Slight increase since 2018.
4.3 4.3 4.3
4.1 4.0 4.1
3.8 3.7
3.5
3.3 3.3
2.8
3.0
3.2
3.4
3.6
3.8
4.0
4.2
4.4
4.6
4.8
5.0
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16 2015-17 2016-18 2017-19 2018-20
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
)
Infant Mortality Rate Trend in Alameda County, 2008-2020
38
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2020.
Decrease in infant
mortality rate (IMR) over
time.
African
American
21.6% (13)
Asian 29.5%
(17)Hispanic/Latino
23.9% (14)
White 15.9%
(9)
Multirace
6.8% (4)
Pacific Islander
1.7% (1)
Other/Unknown 0.6% (<1)African
American
8.4% (1,511)
Asian 34.2%
(6,134)
Hispanic/Latino
27.0% (4,847)
White 23.9%
(4,277)
Multirace
3.2% (574)
Pacific
Islander 0.9%
(157)
Native
American
0.1% (24)Other/Unknown
2.2% (394 )
Percentage of Births v. Infant Deaths by Race/Ethnicity,
2018-202039
Average Yearly
Births=17,918
Source: CAPE, with data from Alameda County Vital Statistics files, 2018-2020.
Average Yearly Infant
Deaths= 59
African Americans bear a
disproportionate share of
infant deaths in AC.
8.4
7.0
3.3 2.9 2.8 2.2
0
2
4
6
8
10
12
African American/
Black
Multirace All Races Hispanic/Latino Asian WhiteIn
f
a
n
t
M
o
r
t
a
l
i
t
y
R
a
t
e
(
d
e
a
t
h
s
/
1
,
0
0
0
l
i
v
e
b
i
r
t
h
s
)
Infant Mortality Rate (IMR) by Race/Ethnicity, 2018-2020
40
Average Annual Number Infant Deaths = 54
Source: CAPE, with data from Alameda County Vital Statistics files, 2018-2020.
The African American IMR
was over 2 times Alameda
County IMR and 3.8 times
the White IMR.
*Multirace, Native American and Pacific Islander Infant Mortality
Rates are not shown due to small numbers and unstable rates
7.7 7.2
8.9
10.3
11.5 11.4
9.5
8.6
7.7
8.9 8.4
0
2
4
6
8
10
12
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
)
AfAm/Black
Hisp/Lat
All Races
Asian
White
Infant Mortality Rate Trend by Race/Ethnicity, 2008-2020
41
Source: CAPE, with data from Alameda County Vital Statistics files, 2008-2020.
Inequity in African
American Infant Mortality
has persisted over time.
*Multirace, Native American and Pacific Islander Infant Mortality
Rates are not shown due to small numbers and unstable rates.
Percentage Share SIDS Deaths in Alameda County, 2016-
202042
Over the last five years, in Alameda County there was an average of 6 SIDS deaths per year.
Source: CAPE, with data from Alameda County Vital Statistics files, 2016-2020.
White 8.3%
AfAmr/
Black 27.8%
Asian 13.9%Pacific
Islander 8.3%
Hispanic/Lati
no 25.0%
Multirace
16.7%
SIDS/SUIDS=36 Deaths
African American infants
bear a disproportionate
share of SIDS deaths in
AC.
*There were no Native American SIDS deaths during this period.
14.6
8.1
4.5 4.4 3.8 3.5 3.2
0
2
4
6
8
10
12
14
Pacific Islander African
American/Black
All Races Hispanic/Latino White Multirace Asian
Fe
t
a
l
D
e
a
t
h
R
a
t
e
(
f
e
t
a
l
d
e
a
t
h
s
p
e
r
1
,
0
0
0
l
i
v
e
bi
r
t
h
s
+
f
e
t
a
l
d
e
a
t
h
s
)
Fetal Death Rate (FDR) by Race/Ethnicity, 2018-2020
43
Average Annual Number Fetal Deaths = 80
Source: CAPE, with data from Alameda County Fetal Death Data Files and Birth Files, 2018-2020.
Pacific Islander and
African American
pregnant people had the
highest FDRs. Asian
pregnant people had the
lowest rates.
***Race/Ethnicity categorized differently in Fetal Death data.
**Native American Fetal Mortality Rates are not shown due to
small numbers and unstable rates.
* Pacific Islander Fetal Death Rate is less stable due to small
numbers (CI: .5.9-30.1).
*
Alameda County Perinatal & Infant
Health Indicators by Social Gradient44
Social Gradient and Birth Rates
45
Social gradient: people who are less affluent (lower SES) have
worse health outcomes than those who are more affluent.
Race and Class (socioeconomic status) are closely connected.
The most affluent AC neighborhoods have high % of Whites and Asians.
The least affluent AC neighborhoods have high % of Latinos and African
Americans.
Birth Rates and Teen Birth Rates have social gradients.
Poorer neighborhoods have Birth Rates and Teen Birth Rates compared
to more affluent neighborhoods across all race/ethnic groups.
Within race/ethnic groups, those living in poorer neighborhoods have
Birth Rates and Teen Birth Rates compared to those living in more affluent
neighborhoods.
0
5
10
15
20
25
30
35
40
<5%5-9%10-19%20+%
Bi
r
t
h
R
a
t
e
(
#
b
i
r
t
h
s
/
t
o
t
a
l
p
o
p
u
l
a
t
i
o
n
)
Neighborhood Poverty Level
White
Pacific Islander
All Races
Asian
Hispanic/Latino
African
American/ Black
Birth Rate by Race/Ethnicity & Poverty Level,
2015-201946
Sources: CAPE, with data from ESRI and Alameda County Vital Statistics files, 2015-2019.
Most Affluent Least Affluent
Birth Rates increased by increasing
poverty level. Less affluent
neighborhoods had higher birth
rates than more affluent
neighborhoods.
*Multirace and Native American Teen Birth Rates are not shown
due to small numbers and unstable rates.
0.09 1.76
9.71
22.23
0
10
20
30
40
<5%5-9%10-19%20+%Te
e
n
B
i
r
t
h
R
a
t
e
(
#
T
e
e
n
B
i
r
t
h
s
/
F
e
m
a
l
e
p
o
p
1
5
-
19
y
e
a
r
s
)
Neighborhood Poverty Level
White
Hispanic/Latino
All Races
African/American/
Black
Asian
Teen Birth Rate by Poverty Level and
Race/Ethnicity, 2015-201947
Most Affluent Least Affluent
Teen Birth rates increased by
increasing poverty level across all
race/ethnic groups.
Sources: CAPE, with data from ESRI and Alameda County Vital Statistics files, 2015-2019.
*Multirace, Native American and Pacific Islander Teen Birth Rates
are not shown due to small numbers and unstable rates.
MCH Indicators not Impacted by Social Gradient
48
All other MCH Indicators do not follow a social gradient (Infant
Mortality, Low Birth Weight, Prenatal Care, Premature Birth).
This means racial/ethnic inequities persist when controlling for
neighborhood poverty.
African American Rates are higher than every other group across all
neighborhood poverty levels.
African American have Infant Mortality Rates (IMRs), premature
births, and low birth weight babies compared to Whites, Asians
and Latinos regardless of neighborhood poverty.
Conclusion: Neighborhood poverty does not explain poor
infant health outcomes. Racism is an underlying cause of
maternal and infant health inequities in Alameda County.
6.3
9.0 9.4
7.3
2.9 3.3 4.0 4.3
0
2
4
6
8
10
12
14
16
<5%5-9%10-19%20+%
In
f
a
n
t
M
o
r
t
a
l
i
t
y
R
a
t
e
(
D
e
a
t
h
s
/
1
,
0
0
0
po
p
u
l
a
t
i
o
n
)
Neighborhood Poverty Level
African
American/ Black
All Races
Hispanic/Latino
Asian
White
Infant Mortality Rate by Poverty Level and
Race/Ethnicity, 2016-202049
Most Affluent Least Affluent
Conclusion: Neighborhood poverty does not explain poor infant
health outcomes. Racism is an underlying cause of maternal and
infant health inequities in Alameda County.
Sources: CAPE, with data from ESRI and Alameda County Vital Statistics files, 2015-2019.
*Multirace, Native American and Pacific Islander Infant Mortality
Rates are not shown due to small numbers and unstable rates.
Alameda County Breastfeeding and
Infant Sleep 50
87.0%87.1%81.8%
71.5%70.0%
57.4%
32.7%
39.0%
28.1%
37.8%
0%
20%
40%
60%
80%
100%
White Asian/ Pacific Islander All Races Latino Black/ African American
Pe
r
c
e
n
t
a
g
e
B
r
e
a
s
t
f
e
e
d
i
n
g
3
M
o
n
t
h
s
A
f
t
e
r
De
l
i
v
e
r
y
(
%
)
Any Breastfeeding Exclusive Breastfeeding
Percentage Breastfeeding at Three Months by
Race/Ethnicity, 2016-201851
Source: Maternal and Infant Health Assessment (MHIA) Survey 2016-2018.
Black/African Americans and
Latina mothers reported the
lowest rates of breastfeeding
at 3 months.
*MIHA combines Asian and Pacific Islander due to small
sample size of Pacific Islanders. MIHA does not show data for
Native American or Multirace Mothers at the state or county
level.
88.4%
69.8%67.2%
44.8%
27.8%
22.9%
0%
20%
40%
60%
80%
100%
Private (2016-2018)Medi-Cal (2016-2018)Medi-Cal (2013-2015)
Pe
r
c
e
n
t
a
g
e
B
r
e
a
s
t
f
e
e
d
i
n
g
3
M
o
n
t
h
s
A
f
t
e
r
D
e
l
i
v
e
r
y
(%
)
Any Breastfeeding Exclusive Breastfeeding
Percentage Breastfeeding at Three Months:
Medi-Cal vs. Private Insurance52
Source: Maternal and Infant Health Assessment (MHIA) Survey 2013-2015, 2016-2018.
Mothers using Medi-Cal reported
higher breastfeeding rates at 3
months than previously. Their
rates were still lower than those
on private insurance.
91.8%89.4%86.5%
80.9%
73.1%
0%
20%
40%
60%
80%
100%
White Asian/ Pacific Islander All Races Latino Black/ African American
Pe
r
c
e
n
t
a
g
e
P
l
a
c
e
d
I
n
f
a
n
t
o
n
B
a
c
k
t
o
S
l
e
e
p
(
%
)
Percentage Placed Infant on Back to Sleep by
Race/Ethnicity, 2016-201853
Black/African American
mothers reported the
lowest rates of placing
infants on back to sleep.
Source: Maternal and Infant Health Assessment (MHIA) Survey 2016-2018.
*MIHA combines Asian and Pacific Islander due to small
sample size of Pacific Islanders. MIHA does not show data for
Native American or Multirace Mothers at the state or county
level.
91.8%
75.8%75.2%
0%
20%
40%
60%
80%
100%
Private (2016-2018)Medi-Cal (2016-2018)Medi-Cal (2013-2015)
Pe
r
c
e
n
t
a
g
e
P
l
a
c
e
d
I
n
f
a
n
t
o
n
B
a
c
k
t
o
S
l
e
e
p
(
%
)
Percentage Placed Infant on Back to Sleep: Medi-
Cal vs. Private Insurance54
Mothers using
Medi-Cal reported
similar rates of
placing infant on
back to sleep over
time. These rates
are lower than
those on private
insurance.
Source: Maternal and Infant Health Assessment (MHIA) Survey 2013-2015, 2016-2018.
54.5%
42.4%
37.5%36.3%
22.1%
0%
20%
40%
60%
Black/African American Latino Asian/ Pacific Islander All Races White
Pe
r
c
e
n
t
a
g
e
I
n
f
a
n
t
A
l
w
a
y
s
o
r
O
f
t
e
n
S
h
a
r
e
d
B
e
d
(%
)
Percentage Infant Always or Often Shared Bed by
Race/Ethnicity, 2016-201855
Source: Maternal and Infant Health Assessment (MHIA) Survey 2016-2018.
Black/African Americans
and Latina mothers
reported the highest
rates of co-sleeping.
*MIHA combines Asian and Pacific Islander due to small
sample size of Pacific Islanders. MIHA does not show data for
Native American or Multirace Mothers at the state or county
level.
51.5%
44.1%
28.8%
0%
20%
40%
60%
Medi-Cal (2016-2018)Medi-Cal (2013-2015)Private (2016-2018)
Pe
r
c
e
n
t
a
g
e
I
n
f
a
n
t
A
l
w
a
y
s
o
r
O
f
t
e
n
S
h
a
r
e
d
B
e
d
(%
)
Percentage Infant Often/Always Shared Bed: Medi-
Cal vs. Private Insurance56
Mothers using Medi-Cal
reported higher rates of co-
sleeping than previously.
These rates are significantly
higher than those on private
insurance.
Source: Maternal and Infant Health Assessment (MHIA) Survey 2013-2015, 2016-2018.
Alameda County Perinatal Mental
Health57
31.6%
16.7%15.7%
11.8%
8.6%
18.8%
11.5%11.7%
9.9%10.0%
0%
5%
10%
15%
20%
25%
30%
35%
Black/ African American Asian/Pacific Islander All Races Hispanic/Latino White
Pe
r
c
e
n
t
a
g
e
B
r
e
a
s
t
f
e
e
d
i
n
g
3
M
o
n
t
h
s
A
f
t
e
r
D
e
l
i
v
e
r
y
(%
)
Prenatal Depressive Symptoms Postpartum Depressive Symptoms
Percentage Experiencing Depressive Symptoms,
2018-2020 58
African American
mothers had the highest
percentages of prenatal
and postpartum
depressive symptoms
followed by Asian/Pacific
Islander mothers
(prenatal).
Source: Maternal and Infant Health Assessment (MHIA) Survey 2016-2018.
*MIHA combines Asian and Pacific Islander due to small
sample size of Pacific Islanders. MIHA does not show data for
Native American or Multirace Mothers at the state or county
level.
11.8%
20.7%
19.0%
13.0%
15.3%
13.0%
0%
5%
10%
15%
20%
25%
Private (2018-2020)Medi-Cal (2018-2020)Medi-Cal (2016-2018)
Pe
r
c
e
n
t
a
g
e
B
r
e
a
s
t
f
e
e
d
i
n
g
3
M
o
n
t
h
s
A
f
t
e
r
De
l
i
v
e
r
y
(
%
)
Prenatal Depressive Symptoms Postpartum Depressive Symptoms
Percentage Experiencing Depressive Symptoms:
Medi-Cal vs. Private Insurance59
Source: Maternal and Infant Health Assessment (MHIA) Survey 2013-2015, 2016-2018.
Mothers using Medi-Cal
reported higher rates
depressive symptoms
(prenatal and postpartum)
those on private insurance.
Percentage Often Experienced Racism Over
Lifetime, 2016-201860
45.1%
12.7%10.3%10.2%8.9%
0%
10%
20%
30%
40%
50%
Black/African American All Races Asian/ Pacific Islander Hispanic/ Latino White
Of
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
(
%
)
1 in 2 African American mothers
were often discriminated against,
prevented from doing something,
hassled or made to feel inferior
because of their race, ethnicity or
color.
Source: Maternal and Infant Health Assessment (MHIA) Survey 2016-2018.
*MIHA combines Asian and Pacific Islander due to small
sample size of Pacific Islanders. MIHA does not show data for
Native American or Multirace Mothers at the state or county
level.
Take Home Points61
Key Takeaways: Alameda County Births
There has been a in births since 2008. (approx. 17,000 births in 2020.)
AC has seen a dramatic in younger moms (teens and <35 years) and an in
mature moms (35-49 years).
There has been a in birth rates, fertility rates and teen birth rates since 2008.
Zip Codes in East Oakland, Fremont and Fruitvale had the highest birth rates.
Most births occurred at Kaisers (San Leandro and Oakland), Alta Bates and
Neighboring County Facilities.
1 in 2 Black and Latina births were paid by Medi-Cal. Alta Bates, Highland and St.
Rose serve majority Medi-Cal births.
1 in 2 Black and Latina pregnancies were unintended likely due to unmet need for
contraception/family planning.
62
Key Takeaways: Perinatal Health Indicators
Overall, AC moms and infants are very healthy!
AC has high %of moms receiving prenatal care. (Pacific Islander and Medi-Cal
inequities persist.)
AC has lower %of moms receiving adequate number prenatal care visits (slightly
higher for Medi-Cal).
Inequities persist for Black/African American, Native American and Pacific Islander
mothers (gestational hypertension, severe maternal morbidity, low birth weight,
premature births.)
63
Key Takeaways: Infant Health Indicators
AC has seen a in infant mortality over time other indicators have remained
steady.
Black/ African American infants bear a disproportionate burden of infant deaths
and SIDS deaths in AC.
Improving trends in breastfeeding among Black/African American mothers and
Medi-Cal population, but lower rates persist.
Worsening trend in safe sleep practices among Black/African American mothers
and Medi-Cal populations.
Black/ African American infants bear a disproportionate burden of infant deaths
and SIDS deaths in AC.
64
Key Takeaways: Black/African American Social
Determinants of Health
Black mothers disproportionately face economic instability during their
pregnancies.
Black mothers experience health care access and utilization challenges pre-
pregnancy, during pregnancy and postpartum.
Black mothers experience higher rates of chronic asthma and hypertension.
Black mothers experience higher rates of depression (during pregnancy and
postpartum).
Racism and discrimination are common and cumulative experiences for black
mothers.
Conclusion: Racism is a key social determinant of black perinatal and infant
health in Alameda County.
65
Maternal and Infant Population Data
Sources66
MPCAH Population Data Sources
35
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
Strengths & Limitations of Population Data
68
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.
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 are:
Relationship-Based
Trauma-Informed
Race and Equity Focused
MPCAH Purpose and Values
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.
Our Vision of Health Equity
70
Resources
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:
71
Lisa Goldberg, MPCAH
Epidemiologist, Alameda County Public Health Department.
Contact by phone at 510-267-8024
or by email: lisa.goldberg@acgov.org
Misha Taherbhai, Data Management
Analyst, Alameda County Public
Health Department.
Contact by phone at 510-667-4432
or by email
misha.taherbhai@acgov.org