2021 Edition - Quality of Care: Maternal Health and Childbirth C A L I F O R N I A H E A LT H C A R E A L M A N A C J U LY 2 0 2 1 Jen Joynt, Independent Health Care Consultant Over the last few decades, the measurement and reporting of health care quality outcomes has grown significantly. As health care evolves, it is important to continue to monitor and report on the quality of care delivered to patients in California and across the US. This is part of a series of measures CHCF is publishing on the quality of care in the state. Topics range from maternal to end-of-life care, and include measures on behavioral health, chronic conditions, and providers. This set of quality measures focuses on maternal health and childbirth. California's low-risk, first-birth cesarean rate declined from 2013 to 2019. California's low-risk, first-birth cesarean (c-section) rate has been declining since 2013 and has been below the Let's Get Healthy California target since 2018. C-sections, while sometimes necessary, increase the risk of postsurgical complications, including bleeding, infections, and organ damage.1 Low-Risk, First-Birth Cesarean Rates, California, 2013 to 2019 Notes: Percentage of cesarean deliveries among first-time mothers delivering a single baby in a head-down position after 37 weeks gestational age. Let's Get Healthy California, which was launched in 2012, aims to achieve the triple aim of better health, better care, and lower costs with 10-year improvement targets for a range of indicators. Source: Custom data request, California Maternal Quality Care Collaborative, received March 25, 2021. CALIFORNIA HEALTH CARE FOUNDATION www.chcf.org/publication/2021-edition-quality-care-maternal-childbirth | 1 2021 Edition - Quality of Care: Maternal and Childbirth Black infants were more likely to be born preterm or at a low birthweight than infants of other races/ethnicities. In 2019, approximately 12% of Black infants were born preterm or with a low birthweight. Infants born preterm or with a low birthweight have increased risk for lifelong health problems or dying before their first birthday. Preterm Births, by Race/Ethnicity, California, 2019 Low Birthweight Births, by Race/Ethnicity, California, 2019 Notes: Preterm is less than 37 weeks of gestation based on the obstetric estimate. Low birthweight is less than 2,500 grams. AIAN is American Indian and Alaskan Native. AANHPI is Asian American / Native Hawaiian and Pacific Islander. Source: CDC WONDER Online Births Database, Centers for Disease Control and Prevention. CALIFORNIA HEALTH CARE FOUNDATION www.chcf.org/publication/2021-edition-quality-care-maternal-childbirth | 2 2021 Edition - Quality of Care: Maternal and Childbirth Black birthing people reported higher rates of prenatal and postpartum depressive symptoms than people of other races/ethnicities. Many Californians suffer from prenatal or postpartum depression, which can negatively impact the birthing person and child. About one in four Black birthing people reported experiencing symptoms of prenatal depression, and more than one in six reported experiencing symptoms of postpartum depression, in 2018 and 2019. Prenatal Depressive Symptoms, by Race/Ethnicity, California, 2018 and 2019 Postpartum Depressive Symptoms, by Race/Ethnicity, California, 2018 and 2019 Notes: Data from a population-based survey of 12,208 California resident women with a recent live birth; 2018 and 2019 data were combined. Percentage of women who had a live birth who always or often reported feeling down, depressed, or hopeless, or who reported having little interest or little pleasure in doing things you usually enjoyed during pregnancy (prenatal) or since most recent live birth (postpartum). AANHPI is Asian American / Native Hawaiian and Pacific Islander. Source: Custom data request, Maternal and Infant Health Assessment (MIHA), California Dept. of Public Health, received February 23. 2021. CALIFORNIA HEALTH CARE FOUNDATION www.chcf.org/publication/2021-edition-quality-care-maternal-childbirth | 3 2021 Edition - Quality of Care: Maternal and Childbirth Black infants had a higher mortality rate than infants of other races/ethnicities. Black infants in California had a mortality rate (8.3) that was two times higher than the Let's Get Healthy California target of 4.0 (not shown) and nearly two times higher than the California average (4.2). Infant Mortality Rates, by Race/Ethnicity, California, 2017 Note: Infant deaths within one year of birth. Source: Custom data request, California Dept. of Public Health (CDPH), received February 23, 2021. The companion Excel data file, which provides these data and more, is available for download at www.chcf.org/publication/2021-edition-quality-care-maternal-childbirth. These materials are part of CHCF's California Health Care Almanac, an online clearinghouse for key data and analyses describing the state's health care landscape. See our entire collection of current and past editions of Quality of Care at www.chcf.org/collection/quality-care-almanac. Endnotes 1. "My Birth Matters," California Maternal Quality Care Collaborative. CALIFORNIA HEALTH CARE FOUNDATION www.chcf.org/publication/2021-edition-quality-care-maternal-childbirth | 4