Foreword

Maternal and infant health indicators are often used to gauge the overall health of a nation. Understanding the current state of maternal and infant well-being, health behaviors, and social determinants of health across several domains offers the opportunity to kindle ideas for interventions to improve well-being. The United States has one of the highest maternal mortality rates among developed nations. In 2022, the United States reported an increase in infant mortality from 2021 to 2022, its first year-to-year increase in over two decades. We need to reverse these troubling trends.

Maternal and infant well-being in the United States remain crucial areas of interest to the public and policymakers alike. In 2019, the National Institutes of Health established the Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) Initiative in response to improve maternal health and reduce maternal mortality. This America's Children: Maternal and Infant Health and Well-being, Special Issue, 2024 report, extends the commitment of the NIH, IMPROVE, and the Forum to the well-being of the nation.

Using the knowledge, data, and expertise of the 23 forum agencies, indicators of maternal and infant-well-being and the social and environmental contexts that contribute to well-being are explored in this volume.

Diana W. Bianchi, MD
Director
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
National Institutes of Health

About This Report

The Forum's report, America's Children, Special Issue: Maternal and Infant Health and Well-Being, 2024 features indicators across various domains. Fifteen indicators are highlighted, covering domains related to health, family and social environment, economic circumstances, health care, physical environment and safety, and behavior. The health domain covers topics such as maternal vaccination, maternal mortality, and maternal postpartum depressive symptoms. This publication provides data on maternal and infant health and mortality for all interested members of the public, including community organizations, policymakers, and students.

In addition to indicators of well-being in the report, this special issue also includes a Data Topics section with reference to social determinants of health that may be associated with maternal and infant outcomes. Explanations of the data limitations and further research needed on these measures are provided.

Additionally, the report features the At-A-Glance section, a quick reference with an update on data changes for all 41 indicators found in the Forum's full report.

Next year, the Forum will issue its customary full report, America's Children: Key National Indicators of Well-Being.

Office of Chief Statistician
U.S. Office of Management and Budget

Acknowledgments

The success of the Forum is driven by the commitment of the members of the Federal Interagency Forum on Child and Family Statistics.

The development of this report was guided by many of the Forum's principal members and other federal contributors, which include Traci Cook, Forum Staff Director; Amy Branum, National Center for Health Statistics; Juanita Chinn, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Josh DeLaRosa, National Center for Education Statistics; Susan Jekielek, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Jessica Minnaert, Maternal and Child Health Bureau; Mark Prell, Economic Research Service; Rose Kreider, U.S. Census Bureau; Grace Robiou, Office of Children's Health Protection; Jennifer Turnham, U.S. Department of Housing and Urban Development; and Anthony Nerino, U.S. Office of Management and Budget.

This report was written by the following federal staff including Sheila Franco and Ashley Woodall, National Center for Health Statistics; Adi Noiman, Ruowei Li, Christie Kim, Jian Chen, and Laurie Elam-Evans, Centers for Disease Control and Prevention/Division of Nutrition, Physical Activity, and Obesity; Denise D'Angelo and Katherine Fowler, Centers for Disease Control and Prevention/Division of Violence Prevention; Holly Shulman and Brenda Bauman, Centers for Disease Control and Prevention/Division of Reproductive Health; Katherine Kahn and Carla Black, Centers for Disease Control and Prevention/National Center for Immunization and Respiratory Diseases; Alexandra Thompson, Bureau of Justice Statistics; and Laura Hales, Economic Research Service.

Regular indicator updates were provided by the staff of the Forum, including Laura Hales, Economic Research Service; Clayton Gumber, U.S. Census Bureau; Josh DeLaRosa, National Center for Education Statistics; Brett Brown, Administration for Children and Families; Sheila Franco and Ashley Woodall, National Center for Health Statistics; Doug Richesson, Substance Abuse and Mental Health Services Administration; Thyria Alvarez and Barry Steffen, U.S. Department of Housing and Urban Development; Alexandra Thompson, Bureau of Justice Statistics; Connor Borkowski, Bureau of Labor Statistics; Mark Baldwin and Rashad Taylor, Environmental Protection Agency; Cindi Knighton, Centers for Disease Control and Prevention; Hazel Hiza, Center for Nutrition Policy and Promotion; and Jessica Cotto, National Institute on Drug Abuse.

Other federal staff members provided data, developed indicators, or wrote parts of the report. They include Kevin Barragan-Smith, Kalee Burns, Frances Chen, Justin Feathers, Nestor Hernandez, Brittany King, Emily Shrider, Timothy Smith, and David Waddington, U.S. Census Bureau; Emily Schmitt and Elaine Stedt, Administration for Children and Families; Hector Rodriquez and Shalom Williams, Bureau of Labor Statistics; Grace Robiou, Environmental Protection Agency; Mark Prell, Economic Research Service; Joseph Afful, Lara Akinbami, Yutaka Aoki, Shilpa Bengeri, Lindsey Black, Lauren Bottoms-McClain; Debra Brody, Christopher Cairns, Anne Driscoll, Nazik Elgaddal, Cheryl Fryar, Matthew Garnett, Nancy Han, Anne Mamish, Joyce Martin, Arialdi Miniño, Cynthia Ogden, Jeannine Schiller, Alan Simon, Anjel Vahratian, Xun Wang, and Julie Weeks, National Center for Health Statistics; Jennifer Tyson, National Institute of Justice; Jennifer Turnham and David A. Vandenbroucke, U.S. Department of Housing and Urban Development; and Holly Hill, Mike Underwood, and Cassandra Pingali, Centers for Disease Control and Prevention.

In addition, Susan Armstrong, Janna Cunnion, Taletha Derrington, Mariesa Hawkins, Katie Mallory, Steve Purcell, Ashley Roberts, Jason Solinsky, and Mikki Stacey (MacroSys) with the American Institutes for Research assisted Forum staff in producing the report.

Race and Ethnicity

Every effort is made to include data breakouts by race and ethnicity for regular indicators in the full America's Children report and for selected indicators in this year's special issue. Unless otherwise noted, data by race and ethnicity in this report have implemented the Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity (hereafter referred to as standards on race and ethnicity) issued in 1997 by the Office of Management and Budget (https://www.gpo.gov/fdsys/pkg/FR-1997-10-30/pdf/97-28653.pdf). The 1997 standards on race and ethnicity allow for observer or proxy identification of race but clearly state a preference for self-classification. Persons of Hispanic origin may be of any race. Data on race and Hispanic origin are collected separately and presented in the greatest detail possible considering the quality of the data, the amount of missing data, and the number of observations. Data in this report are generally presented for the following six race and Hispanic origin groups: American Indian or Alaska Native, non-Hispanic; Asian, non-Hispanic; Black or African American, non-Hispanic; Native Hawaiian or Other Pacific Islander, non-Hispanic; White, non-Hispanic; and Hispanic or Latino. In the figures, shortened labels often are used because of limited space.

The 1997 standards on race and ethnicity also offer an opportunity for respondents to select more than one of the five race groups, leading to many possible multiple-race categories. These standards allow for two basic ways of defining a race group. A group such as Black may be defined as those who reported Black and no other race (the race-alone or single-race concept) or those who reported Black regardless of whether they also reported another race (the race-alone or in-combination concept). In this report, indicators present data using the first approach (single race). Use of the single-race population does not imply that it is the preferred method of presenting or analyzing data. Generally, a small percentage of people report two or more races. When possible, estimates for this group are shown separately. All groups not shown separately are included in the totals.

On March 28, 2024, the Office of Management and Budget released new standards for the collection of race and ethnicity data (spd15revision.gov). These new standards include updated categories and require that detailed data be collected. These standards have not yet been adopted for the indicators presented in this report. When the new standards have been adopted by data systems, they will be incorporated into future America's Children reports.

Statistical Significance

Most data in this report are estimates based on a sample of the population and are therefore subject to sampling error. Differences between estimates are tested for statistical significance at either the 0.05 or 0.10 cutoff level, according to agency standards; all differences discussed in the report are statistically significant according to the standards of the agency responsible for the data. Agency details about statistical reporting standards for indicators included in the America's Children report and standard error tables for select indicators are available online at https://www.childstats.gov.

Information on the Forum

The Forum's website (https://www.childstats.gov) also includes this additional information:

• Detailed data for indicators discussed in this special issue as well as trend data and other America's Children indicators not discussed here.
• Data source descriptions and agency contact information.
• America's Children reports from 1997 to the present and other Forum reports.
• Links to Forum agencies, their online data tools, and various international data sources.
• Forum news and information on the Forum's overall structure and organization.