The Federal Interagency Forum on Child and Family Statistics (the Forum) recognizes the need to continuously review current indicators and monitor data topics to ensure that the America's Children report remains a valuable resource for federal researchers, policymakers, and the general public. The full America's Children report published every other year presents key indicators in seven domains: family and social environment, economic circumstances, healthcare, physical environment and safety, behavior, education, and health. This special issue examines a selection of existing data sources related to maternal and infant health and well-being because pregnancy, birth, and infancy are critical periods that can set future trajectories for children in the United States.

Some data topics in this section focus on social determinants of health which are the nonmedical factors that influence health outcomes. This includes safe neighborhoods, housing, transportation, freedom from violence, and health care access. The data sources supporting these topics do not meet the America's Children report criteria because they are not nationally representative, have limited or missing data, and/or do not include valid and reliable data over time. Additionally, there is concern about the inability of some data sources to determine an individual's pregnancy status for select indicators. This section will hopefully stimulate ongoing data development work as it addresses key data topics.

Physical Environment and Safety

The indicators in this special issue help to better understand and monitor the physical environment and safety of pregnant and postpartum women and their infants, but more information could provide a fuller picture, including the following:

• Housing. Homelessness is only one measure under the broader category of housing insecurity, which can also be experienced as housing cost burden, poor physical quality, or instability leading to multiple families residing in one household.. Housing insecurity poses threats to the well-being of families and challenges for measurement. A growing body of research demonstrates how this social determinant of health impacts the health and well-being of pregnant women and their infants.^{61, 62, 63} Although there are national sources of data on housing insecurity do not collect data on pregnancy status or new motherhood.⁶⁴
• Violence. America's Children provides indicators of victimization and violence to measure the physical environment and safety for children and youths. Intimate partner violence against pregnant women and fatal maternal victimization are consequential aspects of the physical environment and safety for pregnant women.⁶⁵ Research demonstrates an association between experiencing intimate partner violence and engaging in risky health behaviors, missing prenatal care visits, experiencing prenatal and postpartum depression and other mental health problems, as well as negative outcomes for infants, such as preterm birth, low birthweight, and fetal and neonatal death.⁶⁶ For children, both witnessing intimate partner violence against their mothers and fatal maternal victimization, which results in the loss of their mothers, are considered adverse childhood experiences that threaten children's future health and well-being. National data sources on violence do not collect ample data on pregnancy and postpartum status and present a need for future measurement development.
• Neighborhood safety. Living in a safe neighborhood free from violence and other health and safety risks is an important social determinant of health that is part of children's physical environment and safety. Pregnant women who feel unsafe in their neighborhood are at increased risk of perinatal depression (depression during pregnancy and postpartum, weeks after childbirth), decreased number of prenatal care visits, and having infants with low birthweight.⁶⁷ The National Survey of Children's Health (NSCH) is a nationally representative survey that includes a question about neighborhood safety for children. However, the NSCH does not collect neighborhood safety data on pregnant women or children under one year of age. The existing federal data sources provide an opportunity for further measurement development around neighborhood safety and violence that focuses on pregnant women and infancy up to the child's first birthday.
• Pollution and climate events. America's Children presents data on outdoor air quality, drinking water quality, and blood lead levels as indicators of children's physical environment and safety. Exposure to pollution and climate events, such as hurricanes, floods, fires, tornados, and excessive heat, are also a part of children's physical environment and safety. Pregnancy, like childhood, is a time during which these environmental determinants of health can have an increased impact on a person's well-being. Several government and non-government agencies have created screening and mapping tools to document and compare pollution and environmental risks for children, mothers, and pregnant women.^{68, 69, 70, 71, 72, 73} However, these measures often provide information on relative risks, rather than absolute risks, which may make interpretation difficult.In addition, some indicators are not collected more frequently than every 10 years.⁷⁴ Regular, ongoing data collection (i.e., repeatedly and more frequently than every 10 years) and measurement development that focuses on maternal and child well-being in relation to pollution and climate events are needed to create a clearer picture of the impact of environmental and climate factors on maternal, infant, and child health and well-being.

Behavior

• Maternal Substance Use. Prenatal substance use increases the risk of pregnancy-related morbidity and mortality among mothers and adverse birth outcomes among infants.⁷⁵ After birth, having a mother with substance use disorder is related to increased risky behaviors among children, such as smoking cigarettes, using alcohol or drugs, sexual activity, or committing serious violent crimes.⁷⁶ Consequently, this is an important indicator of child and family well-being. There are unique algorithms that have been developed that specifically identify substance use disorder among pregnant and birthing mothers that can be explored for measurement development to produce high-quality data at the federal level.^{77, 78, 79}

Health Care

• Health care access. America's Children presents indicators of the availability and use of needed and quality care, which are major determinants of health care access. The U.S. Department of Health and Human Services' Health Resources and Services Administration (HRSA) Bureau of the Healthcare Workforce (BHW) offers data tools on health professional shortage areas and medically underserved areas (primary healthcare services shortage) by geography and other characteristics.⁸⁰ These data tools do not currently disaggregate the facilities or providers by maternity care specialties like obstetrics and gynecology. Such information would help to understand health care before, during, and after birth.

Economic Circumstances

• Transportation Access. Transportation barriers may affect a family's economic circumstances, which is a key domain in America's Children. Transportation access impacts mothers' and pregnant women's ability to access prenatal and other health care, food security, and economic opportunities.^{81, 82, 83, 84} Some information on transportation access is available from Pregnancy Risk Assessment Monitoring System (PRAMS) and the Department of Transportation (DOT). However, PRAMS data related to transportation are not nationally representative, and the DOT data do not include information on pregnancy status. Further development of transportation measures that incorporate high-quality, nationally representative, complete, and contemporaneous data including pregnancy and family information are needed.

Conclusion

• The health and well-being of America's children are difficult to understand outside of the context of their families and caregivers. Social and environmental contexts shape all phases of life for America's families, from preconception to the prenatal and infancy periods, and on to childhood. The Forum hopes this section stimulates further discussion of additional data sources and methods that could lead to more indicators that assess and promote maternal and infant health and well-being. General areas for improvement include developing nationally representative coverage for some indicators and ensuring that pregnancy status data are collected.