The State of Health in New Mexico 2018
1. Maternal and Infant Health
Healthy Babies Start with Healthy Mothers
The New Mexico Pregnancy Risk Assessment Monitoring Survey (PRAMS) provides data on maternal experiences before, during and shortly after pregnancy.
MultivitaminsFolic acid supplementation before pregnancy and in the first 12 weeks of pregnancy reduces the risk of neural tube defects (spina bifida and anencephaly). In 2015, 32% of New Mexico mothers reported taking a multivitamin every day in the month prior to pregnancy which is close to the Healthy People 2020 goal of 33%. Also, 70% of New Mexico women were aware that folic acid can help prevent birth defects.
Pregnancy IntentionUnintended pregnancy is associated with a higher risk of health and economic problems for mothers and their children. Over half (55%) of New Mexico mothers in 2015 reported that they wanted to be pregnant, 26% of mothers had an unintended pregnancy, 43% of pregnancies were unintended. Another 27% reported they did not know what they wanted. The birth rate for adolescents of all racial/ethnic groups continues to decrease (Figure 1). The racial/ethnic disparity in teen childbearing in New Mexico remains wide. Hispanic and American Indian teens had birth rates at least twice as high as the rate among white teens during 2014-2016.
SmokingMaternal cigarette smoking during pregnancy causes a shortage of oxygen during fetal development and places the infant at risk of prematurity, low birth weight (LBW), congenital heart defects, and Sudden Unexpected Infant Death (SUID). In New Mexico, 7% of mothers reported smoking in the last trimester of pregnancy in 2015. Prevalence of smoking during pregnancy was higher as maternal poverty level increased (Figure 2). A greater percentage of White mothers smoked (8%) than Hispanic mothers (6%) and American Indian mothers (6%). A greater percentage of mothers with less than a high school education smoked (13%) than mothers with a high school education (6%) or with some college or college degrees (5%).
Prenatal CareRegular prenatal care reduces the risk of pregnancy complications. In 2015, 16% of mothers received inadequate prenatal care. The proportion of prenatal care that was inadequate was highest among American Indian mothers (27%), teenage mothers (21%), mothers with household incomes <100% of Federal Poverty Level (FPL) (24%), and Medicaid recipients (18%). Screening for gestational diabetes, which increases the risk of pregnancy complications, is a component of prenatal care. In 2015, 10% of mothers had gestational diabetes. American Indian mothers had the highest percent of gestational diabetes (18%).
DepressionDepression before pregnancy increases the risk of postpartum depression. In 2015, 11% of women reported having depression before pregnancy and 11% reported having postpartum depression. Among women who were depressed before pregnancy, 32% experienced postpartum depression compared to 9% of women who were not depressed before pregnancy.
Food InsecurityPoor nutrition during pregnancy increases the risk of LBW babies, pre-term births, infant mortality, and mothers experiencing anemia. In 2015, 9% of mothers reported eating less than they should due to financial hardship. Fourteen percent of mothers with household incomes <100% of FPL reported eating less than they should have, as did 12% of American Indian mothers, 11% of mothers without a high school diploma and 12% of mothers with no more than a high school education, and 16% of mothers residing in New Mexico's most rural counties.
BreastfeedingBreast milk is uniquely suited to the infant's nutritional needs and has unmatched immunological and anti-inflammatory properties that protect against many illnesses and diseases for both mothers and infants. Breastfeeding is essentially without cost. Exclusive breastfeeding for the first six months of the baby's life reduces the risk of developing gastroenteritis, asthma, allergies, respiratory and ear infections as well as obesity later in life. In 2015, 91% of New Mexico mothers initiated breastfeeding. The percentage of New Mexico mothers who initiated breastfeeding and continued to breastfeed for at least two months decreased as the level of family income decreased (Figure 2). In 2015, 86% of mothers with household incomes <100% FPL initiated breastfeeding compared to 93% of mothers with incomes between 101% and 185% of FPL and 96% of mothers with incomes > 185% FPL. In 2015, 79% of mothers were breastfeeding their infant for two or more months.
Infant MortalityDuring 2007-2016, the infant mortality rate trend in New Mexico was flat while there was a slight downward trend in the U.S. infant mortality rate (Figure 3). The rate in New Mexico ranged from 5.0 to 6.3 deaths per 1,000 live births during the ten-year period. The leading causes of infant death in New Mexico were perinatal conditions, including LBW, premature births, complications during pregnancy, labor and delivery; birth defects, medical conditions, Sudden Unexpected Infant Death (SUID) which includes accidental suffocation and strangulation in bed, unknown or ill-defined causes and SIDS; and injuries.
Sudden Unexpected Infant Death (SUID)Twenty-eight infants died from SUID in 2015. According to the 2015 New Mexico PRAMS, 30% of infants did not sleep in a crib, cradle or bassinet. Most of those infants slept on an adult bed with another person (28% infants). Other sleep practices that place the infant at increased risk of SUID include sleeping with thick blankets (13%), sleeping with bumper pads (19%) and placing the baby on the side or stomach instead of on the back or using combinations of sleeping positions (22%).
Low Birth Weight and Preterm BirthsDuring 2014-2016, 8.8% of infants in New Mexico were born with low birth weight (<2500 grams) and 9.5% of the births were preterm (<37 weeks of pregnancy). African American mothers had the highest percentage of LBW infants (14.4%) and the highest percentage of preterm births (12.8%).
Risk and Resiliency FactorsIn New Mexico, 44% of mothers who gave birth in 2015 had a household income <100% of the Federal Poverty Level (FPL) and 23% had an income between 101% and 185% of FPL. Sixty-five percent of women used Medicaid or other government insurance to pay for prenatal care. In 2015, 20% of the mothers had less than a high school education and 22% had no more than a high school education. Teens aged 15 to 19 years accounted for 8.6% of the births to New Mexico women in 2015. Women residing in rural counties accounted for 42% of the births.
Health DisparitiesPoverty is a major factor affecting the health of the mother and infant. Poverty is associated with unintended pregnancy, inadequate prenatal care, teen pregnancy, and being a single mother. Mothers living in poverty are more likely to smoke, to have food insecurity, less likely to breastfeed and have lower levels of education than women with higher incomes.
Assets and Resources
- Home visiting programs during and after pregnancy help mothers prepare for their new baby and promote child development among young children. The programs include New Mexico Children Youth and Families Department Home Visiting, St. Joseph's Children Home Visiting and First Born® Program.
- WIC - Supplemental food program for Women, Infants and Children administered by USDA and NMDOH Public Health Division (PHD).
- The Early Head Start programs provide child development services to eligible low-income families with children 0 to 3 years of age and pregnant women.
- Families First - A program of the NMDOH, PHD and funded by Medicaid to provide case management to Medicaid-eligible pregnant women and children 0-3 years old. The purpose of case management is to provide a voluntary home visit, to establish a medical home, and to assist clients in gaining access to needed medical, social and educational services.
SummaryThe top challenges facing mothers and infants in New Mexico include an infant mortality rate that is not declining and poverty. Over half of infants are born into low income families where low income mothers are more likely to smoke during pregnancy, have food insecurity, have inadequate prenatal care and are less likely to initiate breastfeeding.
Source: NMDOH PRAMS
What is Being Done?
- The Baby-Friendly Hospital Initiative is a global program to change hospital policies and maternity services to support breastfeeding. Twelve birth hospitals in New Mexico are currently working to meet the criteria necessary for the Baby-Friendly designation.
- A survey, Levels of Care Assessment Tool (or LoCATe), of New Mexico birth hospitals was conducted recently assessing each hospitals level of neonatal and maternal levels of care. Currently, results are being shared with respondents and follow-up site visiting will be conducted. The data will be used to inform strategic work to address the need for adequate regionally-based risk-appropriate care to high risk mothers and newborn babies.
- The High Risk Prenatal Fund matches federal and state funding that is dispersed to clinics and hospitals in New Mexico to provide prenatal care to uninsured and insured women. Thirteen contracted sites receive funding for prenatal care related services.
- The full range of family planning services, including the most effective contraception (IUDs & implants) are available at 37 of the 44 public health offices that offer family planning clinical services. Title X clinical services are available at 14 school based health centers.
- Increased awareness from ads on social media with information on birth control and clinic locations; and BrdsNBz, a text-messaging system that offers teens free, confidential answers to sexual health questions in English or Spanish.
What Needs to be Done?
- Improve access to prenatal and birthing services in rural and less urban areas of the state.
- Provide telemedicine services to increase access to birth control for high risk populations in areas with clinician shortages.