Whitman County Health Department 2012 Maternal and Child Health Assessment Page 1 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 INTRODUCTION 2 KEY FINDINGS 3 METHODOLOGY 5 POPULATION 7 DEMOGRAPHICS AND SOCIAL CHARACTERISTICS 9 MATERNAL HEALTH 15 General Ferlity Rates and Births 15 Service Ulizaon 18 Medicaid 18 WIC 19 Medical Risks 20 Maternal Mortality 20 Cesarean Secon 20 Infecous Diseases and Sexually Transmied Diseases (STDs) 21 Gestaonal Diabetes 23 Previous Preterm Birth 24 High Blood Pressure 25 Group B Strep 26 Behavioral Risks 27 Maternal Smoking 27 Prenatal Care: First Trimester 28 Prenatal Care: Late or No 29 Folic Acid 30 Interpregnancy Interval 31 INFANT HEALTH—BIRTH OUTCOMES 32 Preterm Birth 32 Low Birth Weight 33 Congenital Anomalies 34 Hospitalizaon 35 Hospitalizaon Cost 35 Condions Requiring Medical Aenon 36 Newborn Intensive Care Unit (NICU) 37 Infant Mortality 38 Sudden Infant Death Syndrome (SIDS) 38 CHILD HEALTH 39 Percent WIC Enrollees 2-5 Years with BMI at or Above 85th Percenle 39 Children with Special Health Care Needs 39 INDICATOR DATA FOR WHITMAN COUNTY AND WASHINGTON STATE 41 GLOSSARY 42 REFERENCES 44 Whitman County Health Department Dr. Brad Bowman, Health Ocer Fran Marn, Director Contact Informaon: 310 N. Main Street Colfax, WA 99111 Phone: Colfax: (509) 397-6280 Pullman: (509) 332-6752 Fax: Colfax: (509) 397-6239 Pullman: (509) 334-4317 hp://WhitmanCounty.org December 2012 Prepared by: Spokane Regional Health District Disease Prevenon and Response Community Health Assessment, Planning, and Evaluaon 1101 West College Avenue #356 Spokane, WA 99201-2095 Primary author: Adrian E. Dominguez, MS Contribung author: Amy Rie, MA, MPH Report supervisor: Stacy Wenzl, MHPA Layout and graphic design: Stephanie Bultema TABLE OF CONTENTS Page 2 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 The Public Health Improvement Partnership, a collaborave network of local public health agencies, tribes, and partners, released the Agenda for Change Acon Plan to help guide local public health agencies with their program and community planning eorts. The Agenda for Change describes a strategic framework from which public health agencies in Washington State can plan their work and respond to a rapidly changing environment, which includes an uncertain economic landscape and a health care system in transion due to health care reform. The Agenda for Change denes a set of services considered to be foundaonal to a strong public health system in our state. Community health assessment is a core funcon of public health and considered to be a foundaonal capability for public health in the state of Washington. Community health assessment refers to the range of acvies that our public health system performs to learn about the health of our communies and to plan responses to local needs. Public health agencies conduct assessments by collecng, analyzing, and disseminang informaon, including stascs on health status and community health needs and strengths. Through this work public health agencies learn where, when, and how health threats are occurring. The Agenda for Change also outlines a list of crical programs considered to be necessary for a strong public health system. Maternal and child health connues to be a priority area for public health focus, since research connues to provide strong evidence linking a mother’s health, both before and during pregnancy, to the health of her infant. Eorts to promote maternal and child health are crical to establishing and maintaining good health for individuals across their lifespans. The Agenda for Change established three key objecves for maternal and child health: 1. Implement policy, environmental, and system changes that give all babies a planned, healthy start in life. 2. Implement policy, environmental, and system changes that prevent or reduce the impact of Adverse Childhood Experiences, such as abuse and neglect on children and families. 3. Implement policy, environmental, and system changes that help adults make healthy choices for themselves and their families. The purpose of this assessment is to analyze maternal and child populaon health data. The data in this assessment publicaon can be used in Whitman County to help idenfy local priories for acon. The objecves listed above can be used to help guide acon strategies for the priority areas idened in Whitman County, including program or service changes and local policy, to improve the health of women and children in the community. If counes work together to align their local priories to the statewide strategic objecves provided in the Agenda for Change, there is greater potenal for achieving long-term improvements in health outcomes across the state, despite limited public health resources. INTRODUCTION Page 3 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Demographics and Social Characteriscs  The median age was approximately 25 years.  A quarter of the populaon was 20 to 24 years of age.  Approximately 29% of the populaon were women in their reproducve years (15 to 44 years of age).  The median household income was approximately $36,368; $21,000 less than Washington State.  50% of adults had a college degree or more compared to 38% for Washington State, making it one of the more educated counes in the state.  61% of residents were employed for wages, while only 3% were unemployed.  85% of the populaon were white non-Hispanic compared to 75% for Washington State. Proporonately, Asian Pacic Islanders were the largest ethnic minority group, comprising 7% of the populaon.  Approximately one in three individuals were below 100% FPL, which was signicantly more than Washington State (13.3%).  50% of individuals were below 200% FPL compared to 30% in Washington State.  Approximately one-third of males and females were below 100% FPL; signicantly more than Washington State (one in eight).  One-third of adults 25 years or older who did not graduate from high school were below 100% FPL.  14.2% of families were below 100% FPL. Of that, 23.7% were with related children under 18 years of age.  Parcipaon in the SNAP program increased by 87% from 2001 to 2010.  Parcipaon in the Child Support Services program increased by 16% from 2001 to 2010.  Parcipaon in the TANF program and State Family Assistance decreased by 36% from 2001 to 2010.  Parcipaon in Medicaid increased by 16% from 2001 to 2010. KEY FINDINGS FOR WHITMAN COUNTY Page 4 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Maternal Health  94% of births were to women 20-39 years of age.  78.2% of births were to white non-Hispanic women.  Eight in 10 births were to mothers with an educaon level of at least some college.  55% of all births were to women with at least a four-year college degree. The proporon was two mes higher than the state.  Approximately 20% of all births were to unmarried women.  Medicaid as a primary source of insurance signicantly decreased as age increased. 85% of pregnant women 15 to 19 years of age and approximately 50% of pregnant women 20 to 29 years of age were on Medicaid.  Ulizaon of WIC services decreased as age increased. Approximately eight in 10 pregnant women 15 to 19 years of age ulized WIC services.  In 2010, 40% of births were delivered by cesarean secon.  Cesarean secon rate increased by 16% from 2006 to 2010.  Repeat cesarean secon rate increased by 67% from 2006 to 2010.  The rate of infecon among women on Medicaid was signicantly higher by 72%.  Women with a history of a previous preterm birth were 4.1 mes more likely to have another preterm birth compared to women without a history of a preterm birth.  As educaon increased, women with a previous preterm birth were more likely to have a preterm birth.  Women in their 40s were more likely to have high blood pressure during their pregnancy. Approximately one in ve births among women in this age group experienced high blood pressure during their pregnancy.  Pregnant women in their 40s were 2.4 to 4.2 mes more likely to test posive for group B strep when compared to other age groups. Approximately one in three births among women in this age group had group B strep.  College graduates had signicantly higher rates of group B strep during pregnancy than any other educaonal group. College graduates were 1.5 to 2.7 mes more likely to have group B strep when compared to other educaonal groups.  Women on Medicaid were less likely to have group B strep than women not on Medicaid.  Approximately 10% of pregnant women smoked during their pregnancy.  Compared to women who graduated from college, women who did not nish high school were 41.3 mes more likely to smoke while pregnant, and women whose highest level of educaon was high school were 21.1 mes more likely to smoke.  Pregnant women on Medicaid were 4.3 mes more likely to smoke during their pregnancy than women not on Medicaid.  Pregnant women on Medicaid were two mes less likely to begin prenatal care in the rst trimester.  Women on Medicaid were two mes more likely to delay prenatal care or not receive any prenatal care than women not on Medicaid. Infant Health—Birth Outcomes  One in 10 births were premature; a signicantly higher proporon than the state (8.8%).  Approximately one in four births among pregnant women in their 40s were premature.  The proporon of births with low birth weight decreased signicantly from 2006 to 2009 by 56%, but in 2010 the proporon increased signicantly by 97%.  Average length of stay in hospital for a newborn was three days. Among infants born prematurely, the average length of stay was 10 days.  Preterm infants were 12 mes less likely to be healthy when compared to full-term infants.  Average cost of full-term newborns was $6,409 and the average cost of preterm newborns was $35,914.  Average cost of healthy newborns was $2,008 and the average cost of unhealthy newborns was $61,020. Page 5 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Organizaon of Report This report examines the populaon, demographics, social characteriscs (includes public assistance programs), maternal concerns during pregnancy (maternal health), the health of the infant (infant health), and child health for Whitman County. Data on public assistance programs was reviewed from 2001 to 2010 by conducng a trend analysis and then compared to Washington State. Data was also aggregated for this same me period and the dierences in the aggregated data for the geographic areas were examined. Maternal and infant health indicators were reviewed from 2006 to 2010 with a trend analysis being conducted and then compared to Washington State. Aggregaon of data was then performed for this me period and results between Whitman County and Washington State were assessed. In addion, maternal and infant health characteriscs for Whitman County were examined by mother’s age group, educaon, and Medicaid status. Data for child health indicators were limited and analysis was restricted to a simple comparison of the proporons of the geographic areas. Women, Infant, and Children (WIC) data was aggregated from 2009 to 2011 for Whitman County and Washington State and compared. Data on children with special health care needs was aggregated from 2005 to 2006 and compared Washington State to the United States. A list of topics for this project was presented to Whitman County Health Department and agreed upon for inclusion in the nal report. The following indicators had limited data (small numbers): maternal mortality, sexually transmied diseases, folic acid, infant mortality, sudden infant death syndrome (SIDS), child mortality, teen suicide, and motor vehicle deaths among children. As a result of the small numbers, data was unreliable and thus analysis of these indicators was not performed. Data Sources Washington State Oce of Financial Management (OFM), Forecasng Division, Age and Historical Data, Intercensal and Postcensal Esmates of April 1 County Populaon by Age and Sex: 1980 to 2011. Behavioral Risk Factor Surveillance System (BRFSS), Washington State Department of Health (DOH), Center for Health Stascs, supported in part by Centers for Disease Control and Prevenon (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevenon, 2006 to 2010. Calculaons, analysis, and presentaon of data were conducted by Spokane Regional Health District, Community Health Assessment, Planning and Evaluaon. United States Census Bureau, Quick Facts 2006 to 2010 and American Community Survey 2009 to 2011. Washington State Department of Social and Health Services (DSHS), Research and Data Analysis, Economic Services Administraon, Temporary Assistance for Needy Families (TANF) and State Family Assistance 2001 to 2010; Supplemental Nutrion Assistance Program (SNAP) 2001 to 2010; Child Support Services 2001 to 2010; Medicaid 2001 to 2010. Calculaons, analysis, and presentaon of data were conducted by Spokane Regional Health District, Community Health Assessment, Planning, and Evaluaon Program. Birth cercates include informaon on the mother and infant on each birth in Washington State, 2006 to 2010. The data is available through the Washington State Department of Health (DOH). Calculaons, analysis, and presentaon of data were conducted by Spokane Regional Health District, Community Health Assessment, Planning, and Evaluaon Program. Washington State Department of Health, Comprehensive Hospital Abstract Reporng System (CHARS) uses coded hospital inpaent discharge informaon derived from billing systems, METHODOLOGY Page 6 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 2006 to 2010. Calculaons, analysis, and presentaon of data were conducted by Spokane Regional Health District, Community Health Assessment, Planning, and Evaluaon Program. Washington State Department of Health, Community and Family Health, Women Infant and Children Nutrion Program, Client Data, 2009 to 2011. Calculaons, analysis, and presentaon of data were conducted by Spokane Regional Health District, Community Health Assessment, Planning, and Evaluaon Program. Centers for Disease Control and Prevenon (CDC), Naonal Survey of Children with Special Health Care Needs, Data Resource Center for Child and Adolescent Health, 2005 to 2006. Data Analysis Data regarding topics in this report were analyzed using Stata version 11, or EpiInfo version 7. Linear regressions were conducted for trend analysis using Jointpoint Regression Program 3.3.1. Dierences in the data between geographic areas or between groups within a geographic area were idened using a chi-square or logisc regression test. A p-value of <0.05 was used to determine if the ndings were stascally signicant. Condence intervals were used to show the dierences in the outcomes for specic indicators displayed in bar graphs and in tables. Condence intervals are ranges of numbers used to assess the accuracy of a point esmate and measure the variability in the data. The point esmate may be a rate, such as a ferlity rate, or a frequency, such as the percent of mothers who are diabec. The condence intervals account for the uncertainty that arises from the natural variaon inherent in the world around us. Condence intervals also account for the dierence between a sample from a populaon and the populaon itself. For the analysis of this report, condence intervals were calculated at the 95% condence level. This means that 95 mes out of 100, the condence interval captures the true value for the populaon. Odds raos were calculated for some indicators and dened as the rao of the odds of an event occurring in one group to the odds of it occurring in another group. The odds rao species the likelihood or probability of a condion or event for one group compared to another group. An odds rao of one indicates that the condion or event under study is equally likely to occur in both groups. An odds rao greater than one indicates that the condion or event is more likely to occur in the rst group than the second group. An odds rao less than one indicates that the condion or event is less likely to occur in the rst group than the second group. Page 7 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 POPULATION FIGURE 1 | DISTRIBUTION OF POPULATION BY AGE AND GENDER | Whitman County, 2011 Data Source: Washington State Department of Health, Office of Financial Management, 2011 In 2011, the populaon of Whitman County was 44,800, making it the 22 nd most populated county in Washington State out of 39 counes. There were equal proporons of men and women residing in Whitman County. From 2006 to 2011, the overall populaon increased by 4.6%. The median age in Whitman County was 24.8 years of age; 12.7 years less than the median age for Washington State (37.5 years of age). A quarter of the populaon was 20-24 years of age, which made this the largest age group in Whitman County (this did not include students residing on the campus of Washington State University; it did include students residing o campus, however). Approximately 10% of the populaon were seniors (65 years of age or older). Approximately 29% of the populaon were women in their reproducve years (15-44 years of age). From 2006 to 2011, the proporon of women in their reproducve years increased by 3% for Whitman County (Figure 2). 15% 10% 5% 0% 5% 10% 15% Page 8 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Age Group 2006 2007 2008 2009 2010 2011 Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female 0-4 1,897 1,013 884 1,899 1,016 883 1,944 1,045 899 1,954 1,055 899 1,987 1,069 909 1,970 1,064 906 5-9 1,834 935 899 1,807 916 891 1,824 926 898 1,796 909 887 1,810 908 902 1,801 904 898 10-14 1,873 975 898 1,809 947 862 1,798 945 853 1,770 938 832 1,789 950 839 1,784 947 836 15-19 58,579 2,642 2,937 5,638 2,686 2,952 5,886 2,818 3,068 5,970 2,864 3,106 6,072 2,911 3,161 5,969 2,862 3,107 20-24 11,174 6,007 5,167 11,159 5,994 5,165 11,477 6,161 5,316 3,578 1,891 1,687 3,621 1,899 1,722 3,593 1,888 1,705 25-29 3,273 1,753 1,520 3,362 1,795 1,567 3,574 1,903 1,671 3,578 1,891 1,687 3,621 1,899 1,722 3,593 1,888 1,705 30-34 2,124 1,098 1,026 2,095 1,091 1,004 2,165 1,133 1,032 2,190 1,155 1,035 2,324 1,220 1,104 2,365 1,241 1,124 35-39 1,918 972 946 1,898 970 928 1,893 965 928 1,829 933 896 1,806 912 894 1,755 885 870 40-44 2,029 1,011 1,018 1,935 963 972 1,907 950 957 1,860 931 929 1,864 927 937 1,890 941 949 45-49 2,095 1,055 1,040 2,054 1,030 1,024 2,062 1,026 1,036 2,024 1,002 1,022 2,003 980 1,023 1,946 954 991 50-54 2,055 1,014 1,041 2,068 1,024 1,044 2,150 1,068 1,082 2,146 1,070 1,076 2,212 1,099 1,113 2,215 1,101 1,114 55-59 1,859 947 912 1,824 934 890 1,878 969 909 1,890 977 913 1,967 1,018 949 2,009 1,041 968 60-64 1,315 637 678 1,402 679 723 1,503 723 780 1,556 751 805 1,679 804 875 1,765 843 922 65-69 1,048 524 524 1,086 543 543 1,178 591 587 1,247 622 625 1,343 664 679 1,395 688 707 70-74 798 387 411 796 386 410 835 401 434 852 408 444 885 420 465 920 438 483 75-79 727 335 392 715 330 385 715 336 379 703 332 371 716 338 378 720 341 379 80-84 612 262 350 588 251 337 595 259 336 581 257 324 584 255 329 587 260 327 85+ 638 235 403 658 244 414 682 251 461 710 262 448 729 270 459 748 278 470 Total 42,848 21,802 21,046 42,793 21,799 20,994 44,066 22,470 21,596 44,005 22,445 21,560 44,776 22,806 21,970 44,800 22,821 21,979 15 388 195 193 375 189 186 370 188 182 352 180 172 349 178 171 339 172 167 16 439 234 205 431 229 202 438 235 203 427 230 197 425 228 197 411 220 191 17 413 202 211 413 204 209 410 203 207 395 197 198 390 197 193 373 185 187 18 1,398 621 777 1,415 634 781 1,531 690 841 1,537 689 848 1,584 716 868 1,551 701 850 19 2,941 1,390 1,551 3,004 1,430 1,574 3,137 1,502 1,635 3,259 1,568 1,691 3,324 1,592 1,732 3,296 1,584 1,712 0-9 3,731 1,948 1,783 3,706 1,932 1,774 3,768 1,971 1,797 3,750 1,964 1,786 3,788 1,977 1,811 3,772 1,968 1,804 10-17 3,113 1,606 1,507 3,028 1,569 1,459 3,016 1,571 1,445 2,944 1,545 1,399 2,953 1,553 1,400 2,906 1,524 1,381 18-24 15,513 8,018 7,495 15,578 8,058 7,520 16,145 8,353 7,792 16,145 8,345 7,800 16,302 8,470 7,832 16,214 8,430 7,785 25-34 5,397 2,851 2,546 5,457 2,886 2,571 5,5739 3,036 2,703 5,768 3,046 2,722 5,945 3,119 2,826 5,958 3,129 2,829 35-44 3,947 1,983 1,964 3,833 1,933 1,900 3,800 1,915 1,885 3,689 1,864 1,825 3,670 1,839 1,831 3,645 1,826 1,819 45-54 4,150 2,069 2,081 4,122 2,054 2,068 4,212 2,094 2,118 4,170 2,072 2,098 4,215 2,079 2,136 4,161 2,056 2,105 55-64 3,174 1,584 1,590 3,226 1,613 1,613 3,381 1,692 1,689 3,446 1,728 1,718 3,646 1,822 1,824 3,774 1,884 1,890 65+ 3,823 1,743 2,080 3,843 1,754 2,089 4,005 1,838 2,167 4,093 1,881 2,212 4,257 1,947 2,310 4,370 2,005 2,365 FIGURE 2 | POPULATION BY AGE AND GENDER | Whitman County, 2006-2011 Data Source: Washington State Department of Health, Office of Financial Management, 2006-2011 Page 9 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 DEMOGRAPHICS AND SOCIAL CHARACTERISTICS Socioeconomic status (SES) is the social standing of an individual or group in terms of their income, educaon, employment, race/ethnicity, and marital status. An individual’s income, educaon, employment status, race/ethnicity, and marital status are oen closely inter-related with one another and can ulmately impact an individual’s health. Research suggests that both physical and mental health are associated with SES. Lower SES is linked to poorer health outcomes. Poor health may decrease an individual’s capacity to work and hold a job. Consequently, this may impact a person’s ability to improve their SES. Economic hardships can lead to marital distress and disrupt an individual’s capacity to parent, creang an environment lled with stress for the enre family. Children coming from families experiencing stress and economic and social burdens may exhibit mental health and physical health problems, such as depression, substance abuse, behavior problems, and increased morbidity rates of certain ailments. 1  10% of Whitman County adults had an annual household income of less than $20,000, which was similar to Washington State.  Approximately 43% of Whitman County adults had an annual household income between $20,000 and $49,999, compared to 35% for Washington State.  The median household income for Whitman County ($36,368) was approximately $21,000 less than Washington State ($57,244).  Approximately one in four adults in Whitman County had a high school educaon or less, compared to approximately one in three for Washington State.  50% of Whitman County adults had a college degree or more, compared to 38% for Washington State, making it one of the more educated counes in the state.  61% of Whitman County residents were employed for wages, while only 3% were unemployed.  Seven in 10 adults in Whitman County were married and one in 10 were either divorced or separated.  60% of households in Whitman County did not have any children.  90% of adults in Whitman County had health care insurance.  85% of the populaon in Whitman County were white non-Hispanic, compared to 75% for Washington State. Asian Pacic Islanders were the largest ethnic minority group in Whitman County, comprising 7% of the overall populaon. [...]... Whitman County and Washington State, 2006-2010 Data Source: Birth Certificate Data, Washington State Department of Health, Center for Health Statistics, 2006-2010 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Page 18 Women, Infants, and Children (WIC) The program Women, Infants, and Children, better known as WIC, serves low-income pregnant women and families with children younger... FIGURE 9 | MEDICAID—YOUTH PARTICIPATION BY YEAR | Whitman County and Washington State, 2001-2010 Data Source: Washington State Department of Social and Health Services, Research and Data Analysis Division, 2001-2010 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Page 14 MATERNAL HEALTH General Fertility Rates and Births The fertility rate measures the number of live births... 2006-2010, ^Washington State Department of Health, Office of Financial Management, 2010 AIAN=American Indian Alaska Native, API=Asian Pacific Islander WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Page 10 Poverty The relationship between higher levels of economic wealth and optimal health, and lower levels of economic wealth and poor health, has been well documented It has... women in their 30s, and women in their 40s (Figure 20) FIGURE 20 | USE OF WIC BY MATERNAL AGE GROUP | Whitman County and Washington State, 2006-2010 Data Source: Birth Certificate Data, Washington State Department of Health, Center for Health Statistics, 2006-2010 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Page 19 Medical Risks Maternal Mortality Maternal death is defined... Medicaid for Whitman County WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Page 26 Behavioral Risks Maternal Smoking Smoking before and during pregnancy is the single most preventable cause of illness and death among mothers and infants Maternal smoking can result in complications during the delivery for the mother and her newborn, and may result in adverse outcomes for the... utilizing Child Support Services for Washington State was approximately 2.3 times higher than Whitman County (Figure 6) FIGURE 6 | CHILD SUPPORT SERVICES USE BY YEAR | Whitman County and Washington State, 2001-2010 Data Source: Washington State Department of Social and Health Services, Research and Data Analysis Division, 2001-2010 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012. .. preterm birth WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Page 24 High Blood Pressure FIGURE 29 | BIRTHS WITH MATERNAL HIGH BLOOD PRESSURE | Whitman County and Washington State , 2006-2010 Data Source: Birth Certificate Data, Washington State Department of Health, Center for Health Statistics, 2006-2010 From 2006 to 2010, the proportion of births with maternal high blood pressure... BY YEAR | Whitman County and Washington State, 2001-2010 Data Source: Washington State Department of Social and Health Services, Research and Data Analysis Division, 2001-2010 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Page 13 The proportion of the population that participated in Medicaid significantly increased overall for both Whitman County and Washington State from... WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Page 27 Prenatal Care: First Trimester Prenatal care is important to the health and future of unborn babies and can benefit every woman during her pregnancy.34 Prenatal care refers to the medical attention received by a woman before and during her pregnancy, specifically addressing her well-being during the pregnancy and caring... the different levels of education and Medicaid status (Figure 30) FIGURE 30 | HIGH BLOOD PRESSURE DURING PREGNANCY BY AGE GROUP, EDUCATION, AND MEDICAID | Whitman County, 2006-2010 Data Source: Birth Certificate Data, Washington State Department of Health, Center for Health Statistics, 2006-2010 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Page 25 Group B Strep Group B . County Health Department 2012 Maternal and Child Health Assessment Page 1 WHITMAN COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012. COUNTY HEALTH DEPARTMENT Maternal and Child Health Assessment, 2012 Service Ulizaon Medicaid Medicaid plays a key role in child and maternal health,