Various maternal behaviors and experiences are associated with adverse health outcomes for both the mother and the infant. These behaviors and experiences can occur before, during, and after pregnancy. Information regarding maternal behaviors and experiences is needed to monitor trends, to enhance understanding of the relationship between behaviors and health outcomes, to plan and evaluate programs, to direct policy decisions, and to monitor progress toward Healthy People 2010 objectives.

The Pregnancy Risk Assessment Monitoring System (PRAMS) is part of an initiative by the Centers for Disease Control and Prevention (CDC) to reduce infant mortality and low birthweight. PRAMS is an ongoing, population-based surveillance system that was designed to identify and monitor selected self-reported maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver a live-born infant.

This report is a compilation of data on 32 maternal and child health (MCH) indicators from the PRAMS surveillance system. CDC collaborated with the states that participate in PRAMS to choose the indicators included in this report. States with data included in this report had fully implemented PRAMS data collection procedures and achieved weighted response rates of at least 70% in 2002. Twenty-seven states met this criterion with weighted response rates ranging from 70.1% to 88.0%: Alabama, Alaska, Arkansas, Colorado, Florida, Hawaii, Illinois, Louisiana, Maine, Maryland, Michigan, Minnesota, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Rhode Island, South Carolina, Utah, Vermont, Washington, and West Virginia.

The indicators in the report cover a variety of topics, including unintended pregnancy; multivitamin use; prenatal care; prenatal care counseling; Medicaid coverage for prenatal care; participation in the U.S. Department of Agriculture (USDA) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); physical abuse; alcohol use; tobacco use; pregnancy-related complications; breastfeeding; infant sleeping position; postbirth follow-up and well-baby care; and contraceptive use. Many of the PRAMS indicators are consistent with Healthy People 2010 objectives, which include objectives for improving the health of mothers and children.¹ As presented in Appendix C, other indicators are measures of state-negotiated or core performance objectives for the Title V Maternal and Child Health Block Grant, the major funding source for state MCH programs.²

The PRAMS questionnaire is revised periodically to reflect changing priorities and emerging issues. Each revision is referred to as a phase. The data highlighted in this report were collected using questions common to Phase 2, Phase 3, and Phase 4 versions of the core questionnaire (see Methodology).

This is the eighth report to present comprehensive data from PRAMS states. It is similar in format and scope to the most recent publicly available PRAMS surveillance report.³ The 2002 report includes the following sections: an overview of PRAMS, multistate exhibits, state exhibits, detailed summaries, and appendixes.

The overview section presents a summary of the background, purpose, history, and methodology of PRAMS.

In the multistate exhibits section, we present background information for each set of indicators, as well as state-level estimates of 2002 prevalence and trends for each indicator.

In the state exhibits section, for each state we present social and demographic data for the PRAMS-eligible population (women delivering a live infant in their state of residence) and for PRAMS respondents. We then present, again for each state, subgroup analyses by age, race, ethnicity, education, Medicaid status, and (where available) income for the following nine MCH indicators: unintended pregnancy, multivitamin use, physical abuse during pregnancy, smoking during pregnancy, pregnancy-related complications, hospital discharge of infants within 48 hours, 1-week checkup for infants discharged within 48 hours, sufficient well-baby care, and postpartum contraceptive use.

Finally, the detailed summaries present 2002 state prevalence estimates for each of the 32 indicators by selected maternal characteristics. These tables allow for easy comparison across states and expand the usefulness of the report.

In the past, states have used data from PRAMS to generate legislative support for MCH programs. Legislature appropriation for unintended pregnancy, a 5-year funded statewide smoking cessation campaign, and increased domestic violence screening for pregnant women are just a few examples of how states use their PRAMS data to understand the magnitude and scope of MCH concerns and to take action.⁴ We view dissemination of these data as a key step in the translation of PRAMS data into public health action, which is a primary goal for PRAMS. We hope this report will continue be a valuable reference in public health planning and policy development.

References

1. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd Edition. Washington, DC: U.S. Government Printing Office; 2000.
   
   
2. Health Resources and Services Administration (HRSA) (Web site). States' 2005 Title V Block Grant Applications. 2005. Available at https://perfdata.hrsa.gov/mchb/mchreports/search/search.asp.
   
   
3. Williams LM, Morrow B, Beck LF, Barfield W, D'Angelo D, Helms K, Johnson CH, Lipscomb LE, Whitehead N. PRAMS 2000 Surveillance Report. Atlanta, GA: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2005.
   
   
4. D'Angelo D, Colley Gilbert B. From Data to Action: Using Surveillance to Promote Public Health. Examples from the Pregnancy Risk Assessment Monitoring System (PRAMS). Atlanta, GA: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002.