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U.S. Preterm Birth Rate Hits Healthy People 2020 Goal Seven Years Early

November 14, 2014 Comments off

U.S. Preterm Birth Rate Hits Healthy People 2020 Goal Seven Years Early
Source: March of Dimes

The national preterm birth rate fell to 11.4 percent in 2013 – the lowest in 17 years — meeting the federal Healthy People 2020 goal seven years early. Despite this progress, the U.S. still received a “C” on the 7th annual March of Dimes Premature Birth Report Card because it fell short of the more-challenging 9.6 percent target set by the March of Dimes, the group said today.

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Millions of US women are not getting screened for cervical cancer

November 7, 2014 Comments off

Millions of US women are not getting screened for cervical cancer
Source: Centers for Disease Control and Prevention

Key findings:

  • In 2012, 11.4 percent of women reported they had not been screened for cervical cancer in the past five years; the percentage was larger for women without health insurance (23.1 percent) and for those without a regular health care provider (25.5 percent).
  • The percentage of women not screened as recommended (www.cdc.gov/cancer/cervical/basic_info/screening.htm) was higher among older women (12.6 percent), Asians/Pacific Islanders (19.7 percent), and American Indians/Alaska Natives (16.5 percent).
  • From 2007 to 2011, the cervical cancer incidence rate decreased by 1.9 percent per year while the death rate remained stable.
  • The Southern region had the highest rate of cervical cancer (8.5 per 100,000), the highest death rate (2.7 per 100,000), and the largest percentage of women who had not been screened in the past five years (12.3 percent).

International Comparisons of Infant Mortality and Related Factors: United States and Europe, 2010

November 7, 2014 Comments off

International Comparisons of Infant Mortality and Related Factors: United States and Europe, 2010 (PDF)
Source: National Center for Health Statistics

Infant mortality is an important indicator of the health of a nation because it is associated with a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions, and public health practices (1–3). After a plateau from 2000 to 2005 (4), the U.S. infant mortality rate declined from 6.87 infant deaths per 1,000 live births in 2005 to 6.07 in 2011 (5,6). Yet, the United States’ infant mortality rate remains higher than for most other developed countries (7). This report compares infant mortality rates between the United States and selected European countries and assesses the impact on infant mortality differences of the percentage of preterm births and gestational age-specific infant mortality rates.

State Considers Amendment to Protect Human Life at Any Stage of Development, CRS Legal Sidebar (October 30, 2014)

November 3, 2014 Comments off

State Considers Amendment to Protect Human Life at Any Stage of Development, CRS Legal Sidebar (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Next week, voters in North Dakota will consider a proposal that would amend the state constitution to address the right to life. If adopted, the North Dakota constitution would state: “The inalienable right to life of every human being at any stage of development must be recognized and protected.” The amendment was proposed by state Senator Margaret Sitte, who has indicated that the amendment “is intended to present a direct challenge to Roe v. Wade.” Whether such an amendment would have an impact on a woman’s ability to terminate a pregnancy, however, is not certain. Similar federal legislation that would recognize the right to life for the unborn has been criticized by legal scholars who have maintained that Congress cannot displace the Supreme Court’s interpretation of the U.S. Constitution.

Provision of No-Cost, Long-Acting Contraception and Teenage Pregnancy

October 30, 2014 Comments off

Provision of No-Cost, Long-Acting Contraception and Teenage Pregnancy
Source: New England Journal of Medicine

We found that pregnancy, birth, and abortion rates were low among teenage girls and women enrolled in a project that removed financial and access barriers to contraception and informed them about the particular efficacy of LARC methods. The observed rates of pregnancy, birth, and abortion were substantially lower than national rates among all U.S. teens, particularly when compared with sexually experienced U.S. teens. Stratification according to factors known to be associated with sexual behavior and pregnancy risk (age and race)21 showed that this was true among both older teens (18 to 19 years of age) and younger teens, as well as among both white and black teens.

Airports in the United States: Are They Really Breastfeeding Friendly?

October 27, 2014 Comments off

Airports in the United States: Are They Really Breastfeeding Friendly?
Source: Breastfeeding Medicine

Introduction:
State and federal laws have been enacted to protect the mother’s right to breastfeed and provide breastmilk to her infant. The Patient Protection and Affordable Care Act requires employers to provide hourly waged nursing mothers a private place other than a bathroom, shielded from view, free from intrusion. Minimum requirement for a lactation room would be providing a private space other than a bathroom. Workplace lactation accommodation laws are in place in 24 states, Puerto Rico, and the District of Columbia. These requirements benefit the breast-pumping mother in an office, but what about the breast-pumping mother who travels? Of women with a child under a year, 55.8% are in the workforce. A significant barrier for working mothers to maintain breastfeeding is traveling, and they will need support from the workplace and the community. This study aimed to determine which airports offer the minimum requirements for a breast-pumping mother: private space other than a bathroom, with chair, table, and electrical outlet.

Study Design:
A phone survey was done with the customer service representative at 100 U.S. airports. Confirmatory follow-up was done via e-mail.

Results:
Of the respondents, 37% (n=37) reported having designated lactation rooms, 25% (n=25) considered the unisex/family restroom a lactation room, 8% (n=8) offer a space other than a bathroom with an electrical outlet, table, and chair, and 62% (n=62) answered yes to being breastfeeding friendly.

Conclusions:
Only 8% of the airports surveyed provided the minimum requirements for a lactation room. However 62% stated they were breastfeeding friendly. Airports need to be educated as to the minimum requirements for a lactation room.

Note: Full text free online until November 27, 2014.

Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National US Hospital Discharge Database

October 23, 2014 Comments off

Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National US Hospital Discharge Database
Source: PLoS Medicine

Background
Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women’s clinical diagnoses.

Methods and Findings
Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project—a 20% sample of US hospitals—we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status.

The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age.

Conclusions
Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight the need for more comprehensive or linked data including parity and gestational age as well as examination of other factors—such as hospital policies, practices, and culture—in determining cesarean section use.

See also: Variation in Caesarean Section Rates in the US: Outliers, Damned Outliers, and Statistics

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