Maternal & Child Health Data 2016 - 2023 For Health Professionals & Providers
This data report is funded by the Southern Plains Tribal Health Board Oklahoma Area Tribal Epidemiology Center’s cooperative agreement with the Indian Health Service. The Oklahoma Area Tribal Epidemiology Center (OKTEC) is a division of the Southern Plains Tribal Health Board (SPTHB). The OKTEC receives core funding from the Indian Health Service (IHS) Cooperative Agreement with IHS Division of Epidemiology and Disease Prevention. OKTEC coverage area includes Kansas, Oklahoma, and Texas and serves the 43 federally recognized tribes within that area. As a public health authority, the OKTEC works with area tribes, state agencies, tribal organizations, academic institutions, non-profits, and many other agencies to provide a wide range of resources. The SPTHB and OKTEC promote healthy communities while strengthening tribal nations. The following data provides information related to American Indian & Alaska Native Maternal and Child Health. It contains data related to women before conception, prenatal, and postnatal care in-order to ensure a positive quality of life and to reduce morbidity and mortality in children. Suggested Citation Maternal and Child Health Data 2016-2023: For Health Professionals & Providers. Southern Plains Tribal Health Board Oklahoma Area Tribal Epidemiology Center. Updated July 2025. Acknowledgments The Southern Plains Tribal Health Board (SPTHB) Oklahoma Area Tribal Epidemiology Center (OKTEC) would like to thank and acknowledge the Maternal and Child Health Assessment Team at the Oklahoma State Department of Health. PRAMS Oklahoma Survey. Pregnancy Risk Assessment Monitoring System (PRAMS). Centers for Disease Control and Prevention and Oklahoma State Department of Health. 2016-2022.
Data Notes Data Sources: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an annual statewide study conducted by the Center for Disease Control and Prevention (CDC) and state health departments to survey birthing parents about their health and pregnancy experiences. Phase 8 of PRAMS was conducted between 2016-2022 and survey data was provided to SPTHB by the PRAMS division at the Oklahoma State Department of Health (OSDH). The data presented in this booklet are weighted to account for the sampling design of the Oklahoma PRAMS. Birth rates, population data, and sexually transmitted infection (STI) cases were sourced from OK2SHARE, a query system developed by OSDH, and the U.S. Census Bureau. Data on infant mortality was sourced from CDC WONDER. Limitations: Oklahoma PRAMS survey data for 2019 and 2020 are unavailable because response rates were below the 50% threshold for public release. As a result, we cannot provide a full picture on trends in maternal and child health indicators over time.
*OK PRAMS 2019-2020 data suppressed due to low response rates.
Maternal race data is derived from birth certificates and is provided as single race categories. Survey estimates for the American Indian and Alaska Native (AI/AN) population in this booklet include birthing parents who identify as AI/AN alone but does not include those who identify with multiple race groups. The Oklahoma overall population includes the birthing individuals of all races in Oklahoma.
Contents Chapter 1 | Population Characteristics ...................................................................... 5 Population Composition Individuals Who Delivered a Live Birth
Chapter 2 | Reproductive Health ................................................................................ 10 Birth Rate Fertility Rate Postpartum Birth Control and Family Planning Intended Pregnancy
Chapter 3 | Prenatal Care ............................................................................................. 19 Prenatal Care Visits Health Insurance and and WIC Participation HIV and STI Testing Vaccinations Multivitamin or Prenatal Vitamin
Chapter 4 | Prenatal Substance Use .......................................................................... 31 Prenatal Harmful Substances Use Prenatal Cigarette Use Prenatal Alcohol Use
Chapter 5 | Maternal Health ........................................................................................ 36 Pre-pregnancy Body Mass Index (BMI) Life Stressors Emotional & Physical Abuse Prenatal Oral Health Discussions with Healthcare Providers Gestational Diabetes Hypertension/Preeclampsia Prenatal Depression
Chapter 6 | Infant Mortality and Adverse Birth Outcomes .................................. 46 Infant Mortality Preterm Birth Low Birth Weight Sudden Unexpected Infant Death
Chapter 7 | Infant Health ............................................................................................. 49 Breastfeeding Safe Infant Sleep
Chapter 1: Population Characteristics
5
Population Composition In 2023, the total population in Oklahoma was estimated to be 3,995,260; the American Indian and Alaska Native (AI/AN) alone population in Oklahoma was estimated to be 295,365, making up 7.4% of the total population in Oklahoma.
Population Composition by Maternal and Child Health Groupings Comparing the AI/AN Population to the Overall Population in Oklahoma Population Group
Age
AI/AN alone
Overall
Children
0–4
20,154
247,646
Children
5–9
23,943
267,650
Adolescent
10–14
26,783
281,541
Women of childbearing age
15–44
65,442
791,261
Teen women
15–19
12,762
135,860
Adult women
20–44
52,680
655,401
MCH population
136,322
1,588,098
Other
159,043
2,407,162
Total Oklahoma population
295,365
3,995,260
U.S. Census Bureau, American Community Survey 5-Year Estimates, 2017–2023 6
Individuals Who Delivered a Live Birth The number of births a population has each year is an important indicator of population growth, which can impact health systems, policy decisions and the 1 economy. In 2023, there were 47,878 live births in Oklahoma; of these births, 9.2% percent were to AI/AN mothers. Those without known maternal race were excluded in this section.
Characteristics of Those Who Delivered a Live Birth, Oklahoma, 2023 Comparing the AI/AN Population to the Overall Population in Oklahoma AI/AN Population
Overall Population
Characteristic
Births
% of total
Births
% of total
10–14 years
*
*
26
0.1%
15–17 years
79
1.8%
708
1.5%
18–19 years
236
5.4%
2,146
4.5%
20–24 years
1,377
31.3%
11,912
24.9%
25–29 years
1,385
31.5%
14,787
30.9%
30–34 years
915
20.8%
11,800
24.6%
35–39 years
338
7.7%
5,320
11.1%
40–44 years
66
1.5%
1,130
2.4%
45–54 years
*
*
49
0.1%
Age
Oklahoma Vital Statistics System, OK2SHARE *Data Values Suppressed due to Small Sample Size (Births < 5)
7
Individuals Who Delivered a Live Birth Characteristics of Those Who Delivered a Live Birth, Oklahoma, 2023 Comparing the AI/AN Population to the Overall Population in Oklahoma AI/AN Population
Overall Population
Characteristic Births
% of total
Births
% of total
0–8 years
47
1.1%
1,400
2.9%
9–11 years
519
11.8%
5,121
10.7%
12 years
1,742
39.7%
15,204
31.8%
13–15 years
1,387
31.6%
14,071
29.5%
≥ 16 years
696
15.9%
11,944
25.0%
Married
1,930
43.9%
26,482
55.3%
Not Married
2,468
56.1%
21,413
44.7%
Education
Marital Status
Oklahoma Vital Statistics System, OK2SHARE
8
Individuals Who Delivered a Live Birth Characteristics of Those Who Delivered a Live Birth, Oklahoma, 2023 Comparing the AI/AN Population to the Overall Population in Oklahoma AI/AN Population
Overall Population
Characteristic Births
% of total
Births
% of total
Central
492
11.2%
13,670
28.6%
North East
1,665
37.9%
9,781
20.4%
North West
201
4.6%
5,005
10.5%
South East
1,117
25.4%
5,246
10.9%
South West
449
10.2%
5,578
11.7%
Tulsa
471
10.7%
8,583
17.9%
Region of Residence
Oklahoma Vital Statistics System, OK2SHARE
9
Chapter 2: Reproductive Health
10
Birth Rate The crude birth rate is the number of live births per total number of people in the population. Live births rates (per 1,000) for AI/AN individuals and Oklahoma overall were on a decreasing trend from 2016 - 2023.
Live Birth Rates per 1,000 Oklahoma Residents, 2016-2023
Live Birth Rate per 1,000
20
15
10
5
0
2016
2017
2018
2019
2020
2021
2022
2023
Year Oklahoma Vital Statistics System, OK2SHARE
11
Birth Rate Live births rates (per 1,000) for AI/AN individuals were on a decreasing trend for all regions in Oklahoma from 2016 - 2023.
AI/AN Live Birth Rates per 1,000 by Region of Residence AI/AN Oklahoma Residents, 2016-2023
Live Birth Rate per 1,000
20
15
10
5
0
2016
2017
2018
2019
2020
2021
2022
2023
Year Oklahoma Vital Statistics System, OK2SHARE 12
Fertility Rate A fertility rate is the number of babies born to women of childbearing age in a given population. Sustained low fertility rates may indicate that the population is aging; 1 sustained high fertility rates may predict a younger population. For both AI/AN individuals and the Oklahoma population, there was a decreasing trend in fertility rates (per 1,000) from 2016-2023. This group includes mothers aged 15-44 years old.
Fertility Rates per 1,000 Oklahoma Residents, 2016-2023
Fertility Rate per 1,000
80
60
40
20
0
2016
2017
2018
2019
2020
2021
2022
2023
Year Oklahoma Vital Statistics System, OK2SHARE 13
Fertility Rate Among AI/AN individuals, there was a decreasing trend in fertility rates (per 1,000) for all regions in Oklahoma from 2016-2023. This includes mothers aged 15-44 years old.
AI/AN Fertility Rates per 1,000 by Region of Residence AI/AN Oklahoma Residents, 2016-2023
100
Fertility Rate per 1,000
80
60
40
20
0
2016
2017
2018
2019
2020
2021
2022
2023
Year Oklahoma Vital Statistics System, OK2SHARE
14
Postpartum Birth Control & Family Planning One method of increasing the time interval between births is to use birth control shortly after giving birth (the postpartum period). The risk of negative outcomes for pregnant individuals and their babies such as infant mortality, low birth weight, preterm birth, stillbirth, miscarriage, and maternal morbidity can increase in shorter (less than 18 2 months) and long inter-pregnancy intervals (greater than 59 months). According to the American College of Obstetricians and Gynecologists, “given the complex history of sterilization abuse and fertility control among marginalized women, care should be taken to ensure that every woman is provided information on the full range of contraceptive options so that she can select the method best suited to her needs”. 3
Postpartum Birth Control Use OK PRAMS Respondents, 2016-2022*
Percent Reporting Birth Control Use
100%
80%
60%
40%
20%
0%
2016
2017
2018
2019*
Year
2020*
2021
2022 15
Postpartum Birth Control & Family Planning Method of Birth Control Being Used to Prevent Future Pregnancies OK PRAMS Respondents, 2016-2022*
24% 26%
Condoms Birth Control Pills
20% 20%
15% 16% 13% IUD 10% 13% Tubes Tied/Blocked 9% 12% Abstinence 10% 8% Injections 6% 5% Contraceptive Implant 6% 3% Vasectomy 4% 3% Natural Family Planning 4% 1% Contraceptive Ring or Patch 2% 2% Other 2% 0% 5% 10% 15% 20% Withdrawal
25%
30%
Percent of Responses (Check All that Apply)
16
Postpartum Birth Control & Family Planning Respondent Reasoning for Not Using Any Pregnancy Prevention Methods OK PRAMS Respondents, 2016-2022*
10%
Did Not Want to Use
10% 10%
Side Effects from Birth Control
10% 5%
Wants to Get Pregnant
4% 5%
Abstinence
5% 4%
Other
5% 2%
Partner Does Not Want to Use
2% 2%
Tubes Tied/Blocked
1% 1%
Currently Pregnant
1% 1%
Cannot Afford Birth Control
1% 0%
2%
4%
6%
8%
10%
Percent of Responses (Check All that Apply)
17
Intended Pregnancy Feelings Towards Pregnancy Timing OK PRAMS Respondents, 2016-2022*
22.0%
Wanted Later
20.9% 10.5%
Wanted Sooner
11.9% 39.5%
Wanted Then
41.5% 7.2%
Did Not Want Then or in the Future
7.3% 20.5%
Unsure
18.0% 0%
10%
20%
30%
40%
50%
Percent of Responses
18
Chapter 3: Prenatal Care
19
Prenatal Care Visits According to the American College of Obstetricians and Gynecologists, “prenatal care is one of the most common preventive services in the United States; it is designed to improve the health and well-being of pregnant and birthing individuals and their children through evidence-based services.” 4 Gaps in prenatal care may be associated with adverse pregnancy outcomes; however, understanding of this association has been limited by confounders such as social and structural drivers of health and prenatal care quality. 5 Native, pregnant individuals in the United States experience barriers specifically related to prenatal care, including lack of access, dissimilar communication styles, and inconsistent continuity of care. Providing culturally appropriate prenatal care is the key to reducing maternal and newborn morbidity and mortality. 6
Request SPTHB’s Patient Education Booklet by emailing info@spthb.org.
20
Prenatal Care Visits Healthcare Visits within 12 Months Prior to Most Recent Pregnancy OK PRAMS Respondents, 2016-2022*
55% 58%
Health Care Visit 13% 13%
Visit For Family Planning
28% 29%
Checkup With Doctor 14% 12%
Visit For Illness 4% 3%
Visit For Injury
12% 10%
Visit For Anxiety/Depression
30% 34%
Checkup With OB/GYN 10% 10%
Other 0%
10%
20%
30%
40%
50%
60%
Percent of Responses (Check All that Apply)
21
Prenatal Care Visits Question Topics Asked During Any Prenatal Appointment OK PRAMS Respondents, 2016-2022*
93%
Plan to Breastfeed
88% 93%
Prescription Meds
93% 89%
Using Drugs
81% 87%
Plan to use birth control postpartum
82% 86%
If down/depressed
75% 84%
Emotional/Physical Abuse
70% 54%
Want HIV Test
49% 0%
20%
40%
60%
80%
100%
Percent of Responses (Check All that Apply)
22
Health Insurance & WIC Participation Lack of health insurance is one of many factors associated with the level of prenatal care accessed during pregnancy. However, there are services to support pregnant and breastfeeding individuals, parents of newborns (6 months old or younger), and young children (less than 5 years old) to eat healthy, stay fit, and learn about good nutrition, called the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). They provide vouchers to purchase healthy foods, assistance with finding health 7 care, breastfeeding support, nutrition counseling, and other community services.
Percent of Respondents that Participated in WIC
WIC Participation During Pregnancy OK PRAMS Respondents, 2016-2022* 100%
80%
60%
40%
20%
0%
2016
2017
2018
2019*
2020*
2021
2022
Year
23
Health Insurance & WIC Participation Mother's Insurance Before Pregnancy OK PRAMS Respondents, 2016-2022*
67%
IHS
11% 28%
Job
40% 24%
Medicaid
21% 9%
Parent
9% 6%
State Specific Other Plan
5% 6%
No Insurance
21% 3%
Health Care Exchange TRICARE/Military Other
4% 1% 4% 1% 2% 0%
10% 20% 30% 40% 50% 60% 70% Percent of Responses 24
HIV Testing Comprehensive prenatal care should include screening for certain risk factors and conditions such as Human Immunodeficiency Virus (HIV) infection and Syphilis. It is recommended by the Centers for Disease Control and Prevention (CDC) that pregnant women should be screened for HIV infection because it can be transmitted to their infants. It is important to note that not all mothers are familiar or aware of HIV tests done during the prenatal period. Testing for HIV should occur as early as possible, preferably at the first prenatal visit. The earlier HIV is diagnosed and treated, the more effective HIV medicines can be at preventing transmission and improving the health outcomes of both the pregnant individual and their child. 8
Individuals Reporting Being Tested for HIV Before Pregnancy OK PRAMS Respondents, 2016-2022*
Percent of Respondents that Reported Testing
50%
40%
30%
20%
10%
0%
2016
2017
2018
2019* Year
2020*
2021
2022 25
Syphilis Infections According to the National Vital Statistics System, the overall rate of syphilis in those giving births in the United States more than tripled from 2016 to 2022, rising from 87.2 to 280.4 per 100,000 births. The largest increase was for American Indian and Alaska Native non-Hispanic birthing individuals (from 159.7 to 1,410.5 per 100,000 births). 9 Oklahoma has also seen increases in the number of syphilis cases in pregnant individuals. In the pregnant AI/AN population, the number of syphilis cases went from below 10 cases a year from 2016-2019, to increasing every year to a total of 47 cases in 2023.
Syphilis Infections Reported in Pregnant AI/AN Individuals Oklahoma Residents, 2016-2023** 50 Syphilis Cases
40 30 20 10 0
2016*
2017*
2018*
2019*
2020
2021
2022
2023
Year Oklahoma Vital Statistics System, OK2SHARE **Case Numbers for 2016-2019 were less than 10 and therefore suppressed due to privacy concerns.
26
Chlamydia & Gonorrhea Infections Chlamydia Infections Reported in Pregnant AI/AN Individuals Oklahoma Residents, 2016-2023 250
Chlamydia Cases
200 150 100 50 0
2016
2017
2018
2019
2020
2021
2022
2023
Year
Gonorrhea Infections Reported in Pregnant AI/AN Individuals Oklahoma Residents, 2016-2023 60
Gonorrhea Cases
50 40 30 20 10 0
2016
2017
2018
2019
2020
2021
2022
2023
Year
Oklahoma Vital Statistics System, OK2SHARE
27
Flu Vaccinations The flu can be more severe in pregnant individuals and those who recently gave birth due to changes in their immune system, heart, and lungs during pregnancy. To protect pregnant people and their newborn babies, the CDC recommends that pregnant individuals get a flu shot during any trimester of their pregnancy. 10
Percent of Respondents that Received Vaccine
Individuals Reporting Receiving a Flu Vaccine During Pregnancy OK PRAMS Respondents, 2016-2022*
100%
80%
60%
40%
20%
0%
2016
2017
2018
2019*
2020*
2021
2022
Year
28
Tdap Vaccinations Another serious disease that can be deadly for babies is whooping cough. The CDC recommends that pregnant women get the whooping cough vaccine, called Tdap, during the 27th through 36th week of each pregnancy, preferably during the earlier part of this time period. 10
Individuals Reporting Receiving a Tdap Vaccine Right Before or During Pregnancy
Percent of Respondents that Received Vaccine
OK PRAMS Respondents, 2016-2022*
100%
80%
60%
40%
20%
0%
2016
2017
2018
2019*
2020*
2021
2022
Year
29
Multivitamin or Prenatal Vitamins Vitamin Use Frequency During the Month Before Most Recent Pregnancy OK PRAMS Respondents, 2016-2022* 70%
67%
60%
57%
40% 31%
30% 23% 20%
10%
6%
6%
3%
6%
D ay Ev er y
W ee k a 46
Ti m es
a Ti m es 13
Ta ke
An y
W ee k
0%
D id n' t
Percent of Responses
50%
Vitamin Use Frequency 30
Chapter 4: Substance Use
31
Prenatal Harmful Substance Use Research shows that use of tobacco, alcohol, or illicit drugs or misuse of prescription drugs by pregnant individuals can have severe health consequences for infants due to these substances passing easily through the placenta. Carbon monoxide and nicotine from tobacco smoke may interfere with the oxygen supply to the fetus. Nicotine also readily crosses the placenta, and concentrations of this drug in the blood of the fetus can be as much as 15 percent higher than in the pregnant individual. Smoking during pregnancy increases the risk for certain birth defects, premature birth, miscarriage, and low birth weight. Alcohol use while pregnant can result in Fetal Alcohol Spectrum Disorders (FASD), a general term that includes Fetal Alcohol Syndrome, partial Fetal Alcohol Syndrome, 11 alcohol-related disorders of brain development, and alcohol-related birth defects.
Substance Use In The Past 2 Years OK PRAMS Respondents, 2016-2022* Cigarettes
Alcohol
E-Cigarettes
26%
2016
64%
10% 26%
2017
61%
9% 26%
2018
63%
12% 18%
2021
68%
15% 17%
2022
63%
21%
0%
10%
20%
30%
40%
50%
60%
70% 32
Cigarette Use
Percent Reporting Cigarette Use
Cigarette Use During Any Trimester of Pregnancy OK PRAMS Respondents, 2016-2022* 20% 15% 10% 5% 0%
2016
2017
2018
2019*
2020*
2021
2022
Year
Smoking Status Before and After Pregnancy OK PRAMS Respondents, 2016-2022* 30%
Smoked 3 Months Before Pregnancy
Smoked in the Last 3 Months
20% 13% 10%
Percent Reporting Cigarette Use
33
E-Cig Use
E-Cig Use per Week
Reported E-Cig Use per Week 3 Months Before Pregnancy OK PRAMS Respondents, 2016-2022*
3%
1 Day or Less
2% 2%
2-6 Per Week
1% 1% 1%
Once A Day More Than Once A Day 0%
1%
2%
3%
4%
5% 5% 5% 6%
7%
8%
9% 10%
Percent of Reporting E-Cig Use
E-Cig Use per Week
Reported E-Cig Use per Week in the 3 Months After Last Pregnancy OK PRAMS Respondents, 2016-2022*
1.4%
1 Day Or Less
0.5%
2-6 Days
0.5% 1.0% 0.6% 0.4%
Once A Day
1.3% 1.5%
More Than Once A Day 0%
1%
2%
3%
4%
Percent of Reporting E-Cig Use
5% 34
Alcohol Use Reported Drinks per Week 3 Months Before Pregnancy OK PRAMS Respondents, 2016-2022*
11% 10% 28% 29%
Less than 1 15% 16%
1-3 Drinks 6% 6%
4-7 Drinks 2% 3% 1% 14 Or More Drinks 1% 0% 5%
8-13 Drinks
10%
15%
20%
25%
30%
Percent of Responses
Reported Drinking 3 Months After Pregnancy OK PRAMS Respondents, 2016-2022*
Percent Reporting Drinking
Drinks per Week
Didn't Drink Then
60% 50% 40% 30% 20% 10% 0%
2016
2017
2018
2019* Year
2020*
2021
2022
35
Chapter 5: Maternal Health
36
Pre-Pregnancy Body Mass Index (BMI) Pre-pregnancy Body Mass Index (BMI) can be divided into four categories: underweight (less than 18.5), normal (18.5-24.9), overweight (25-29.9), and obese (30 or greater).
Pre-Pregnancy Body Mass Index (BMI) Categorizations OK PRAMS Respondents, 2016-2022*
2%
BMI Category
Underweight
4% 34%
Normal
38% 26%
Overweight
26% 37%
Obese
29% 0%
10%
20%
30%
40%
Percent of Responses
37
Emotional & Physical Abuse The physical and emotional health of the pregnant person, the infant, and the whole family can be affected by experiencing stressful events during pregnancy.
Reported Emotion and/or Physical Abuse OK PRAMS Respondents, 2016-2022*
3% Before Pregnancy 2%
Timing of Abuse
2% During Pregnancy 2% 4% Before Pregnancy (Ex-Partner) 3% 2% During Pregnancy (Ex-Partner) 2% 0%
2%
4%
6%
8%
10%
Percent of Reporting Abuse
38
Life Stressors Life Stressors in the 12 Months Prior to New Baby Being Born OK PRAMS Respondents, 2016-2022*
29%
Family Member Was Ill
24% 10% 8%
Divorce
41% 39%
Moved Partner Lost Their Job
13% 12%
I Lost My Job
12% 12% 6% 6%
Partner Was Away
21% 22%
Argue A Lot With Partner 7% 6%
Partner Didn't Want Pregnancy
17% 17%
Couldn't Pay Bills 6% 5%
Partner/I Were In Jail
19%
Someone Close to Me Had Problems with Drugs and/or Alcohol
13% 26% 22%
Someone Close To Me Had Died 0%
10%
20%
30%
Percent of Responses
40% 39
Prenatal Oral Health Dental Care During Most Recent Pregnancy OK PRAMS Respondents, 2016-2022*
Dental Visit Service
31% Visit With Dentist 34%
32% Teeth Cleaned 36% 0%
10%
20%
30%
40%
50%
Percent of Responses
40
Discussions with Healthcare Providers The Oklahoma Pregnancy Risk Assessment Monitoring System (OK PRAMS) asks Oklahoma residents who recently delivered a live birth about healthrelated discussions that they had with their healthcare providers prior to their pregnancies. This information can be used to assess the level of prevention and screening that the pregnant individual received from their healthcare providers. It is very important for healthcare professionals to incorporate prevention practices during doctor visits. Prevention strategies and screening can help improve the health of those who are planning to be pregnant to get them ready for their pregnancies and reduce any risk of complications during pregnancy and delivery. In Oklahoma from 2016 - 2023, the five most common topics discussed by health professionals monitoring AI/AN individuals prior to pregnancy were cigarette use (45%), feelings of depression (39%), physical or emotional abuse (38%), occupation (33%), and birth control (26%). Notably, the least discussed topics included controlling current health conditions, testing for HIV/STIs, and improving health before pregnancy. Many American Indian and Alaska Native individuals find it hard to trust health care professionals. They may have experienced challenges getting the care they need, including experiences of racism and discrimination in health care settings. The history of forced sterilization and infant separation policies has also made it hard for these individuals to trust health care professionals and the government. Understanding and respecting the unique needs and cultural practices of each patient is an important part of building trust and providing medical care. Culturally appropriate care can include taking the time to understand if there are cultural practices that are important to the patient you're serving and acknowledging the use of traditional medicine that is based on indigenous knowledge. 41
Discussions with Healthcare Providers Pre-Pregnancy Discussions with Healthcare Providers OK PRAMS Respondents, 2016-2022*
If I Was Being Hurt Emotionally/Physically
38%
27%
Test Me For HIV
15% 13%
Improving My Health Before Pregnancy
15% 16% 21% 24%
Desire To Have Kids If I Was Feeling Down/Depressed
39%
31% 9% 9%
Controlling Health Conditions
26% 26%
Birth Control To Prevent Pregnancy
45% 43%
If I Smoked Cigarettes 15% 14%
Talk About STIs
15% 18%
Taking A Vitamin With Folic Acid
33% 33%
What Kind Of Work I do Maintaining A Healthy Weight 0%
10%
19% 19% 20%
30%
40%
50%
Percent Reporting Discussion 42
Gestational Diabetes Historically, the Native population is disproportionately affected by gestational diabetes mellitus (GDM). GDM is associated with increased risk for perinatal death, obesity, and subsequent type 2 diabetes in the child and post-partum type 2 diabetes in the birthing parent.12 This trend is reflected in the higher percentage of AI/AN respondents being told they had GDM during pregnancy than the percentage reported by all races of respondents in Oklahoma.
Individuals Receiving a Gestational Diabetes Diagnosis During Pregnancy
Percent of Respondents that Reported Diagnosis
OK PRAMS Respondents, 2016-2022*
25%
20%
15%
10%
5%
0%
2016
2017
2018
2019*
2020*
2021
2022
Year
43
Hypertension/Preeclampsia While studies are limited, it is believed that the Native population is disproportionately affected by preeclampsia, likely due to well-established clinical risk factors for preeclampsia such as obesity, diabetes, and chronic hypertension that also disproportionately affect Native populations.13 This trend is reflected in the higher percentage of AI/AN respondents being told they had preeclampsia during pregnancy than the percentage reported by all races of respondents in Oklahoma.
Individuals Receiving a Hypertension/Preeclampsia Diagnosis During Pregnancy
Percent of Respondents that Reported Diagnosis
OK PRAMS Respondents, 2016-2022*
25%
20%
15%
10%
5%
0%
2016
2017
2018
2019*
2020*
2021
2022
Year 44
Prenatal Depression According to the Centers for Disease Control and Prevention (CDC), depression during and after pregnancy can result in negative outcomes for pregnant and postpartum individuals and their babies. Professional and clinical organizations recommend that all 14 adults, including pregnant and postpartum individuals, be screened for depression.
Individuals Receiving a Depression Diagnosis During Pregnancy
Percent of Respondents that Reported Diagnosis
OK PRAMS Respondents, 2016-2022*
30% 25% 20% 15% 10% 5% 0%
2016
2017
2018
2019*
2020*
2021
2022
Year
45
Chapter 6: Infant Mortality & Adverse Birth Outcomes
46
Infant Mortality Infant Mortality Rate per 1,000 Babies Born to Oklahoma Residents, 2017-2023
Mortality Rate per 1,000
10 8 6 4 2 0
2017
Year
2018
2019
2020
AI/AN Population
2021
2022
2023
Overall Population
Deaths
Rates
Deaths
Rates
2017
47
9.23
391
7.79
2018
40
8.12
353
7.09
2019
35
6.93
344
7.00
2020
28
5.89
281
5.90
2021
42
8.35
345
7.13
2022
25
5.23
333
6.89
2023
37
8.09
341
7.21
CDC Wonder 47
Adverse Birth Outcomes Sudden Unexpected Infant Death (SUIDs) Rate per 1,000 Babies Born to Oklahoma Residents, 2016-2023 AI/AN Population
Overall Population
Deaths
Rates
Deaths
Rates
39
1.14
260
0.76
CDC Wonder
Preterm Births and Low Birth Weight by Year Babies Born to Oklahoma Residents, 2016-2023 Year
Preterm Births
Low Birth Weight
AI/AN
Oklahoma
AI/AN
Oklahoma
2016
582
5,597
379
4,110
2017
538
5,592
353
4,085
2018
526
5,670
342
4,115
2019
549
5,646
369
4,045
2020
470
5,316
316
3,972
2021
565
5,772
384
4,253
2022
566
5,462
391
4,085
2023
495
5,279
334
4,117
CDC Wonder
48
Chapter 7: Infant Health
49
Breastfeeding According to the 2018 National Immunization Survey of the CDC, the average national 15 breastfeeding initiation rate for the total US population is 83.9%. This figure represents any breastfeeding, not exclusive breastfeeding.
Breastfed Baby for Any Duration OK PRAMS Respondents, 2016-2022*
Percent of Respondents that Breastfed
100%
80%
60%
40%
20%
0%
2016
2017
2018
2019*
2020*
2021
2022
Year
50
Breastfeeding The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth.
Breastfeeding Duration OK PRAMS Respondents, 2016-2022*
16%
Did Not Breastfeed
13% 6%
Less Than 1 Week
5% 24%
1-8 Weeks
20% 14%
9+ Weeks
15% 35%
Still Breastfeeding
45% 0%
10%
20%
30%
40%
50%
Percent of Responses
51
Safe Infant Sleep The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. 16
Percent of Respondents that Reported Back Placement
Baby Placed on Back for Sleep OK PRAMS Respondents, 2016-2022* 100%
80%
60%
40%
20%
0%
2016
2017
2018
2019*
2020*
2021
2022
Year
52
Safe Infant Sleep Baby Sleeping Positions OK PRAMS Respondents, 2016-2022*
Percent of Responses
80%
79%
78%
60%
40%
20%
12%
11% 5%
0%
Back
Side
7% Stomach
Sleeping Position (Check All That Apply)
53
Safe Infant Sleep When asked “How did your new baby usually sleep in the past 2 week?” most parents had answered that they put their baby in a crib, bassinet, or a pack and play (84% for AI/AN parents; 88% for overall) and that the newborn had slept in the same room as the parents (75% for AI/AN parents; 71% for overall).
Baby Sleeping Locations OK PRAMS Respondents, 2016-2022*
84% 88%
Crib/Bassinet/Play Yard
75% 71%
In Room with Parent 55% 48%
With Blanket
41% 41%
In Car Seat or Swing On Twin Mattress or Larger Bed
34% 30%
In Sleeping Sack or Wearable Blanket
30% 34%
With Crib Bumper Pads
14% 15%
On Couch/Chair/Sofa
13% 9%
With Toys/Cushions/Pillows
10% 9% 0%
20%
40%
60%
80%
100%
Percent of Responses (Check All That Apply)
54
Additional Sources 1. Grundy E, Murphy M. Demography and public health. In: Detels R, Gulliford M, Karim QA, Tan CC, editors. Oxford textbook of global public health. 6th ed. Oxford, England: Oxford University Press, 718–35. 2015. 2. Hamley, GE., Hutcheon, JA., Kinniburg, BA. et al. Inter-pregnancy Interval and Adverse Pregnancy Outcomes. The American College of Obstetricians and Gynecologists 2017; 129:3. 3. Harris LH . Sterilization of Women: Ethical Issues and Considerations . Committee Opinion No. 695 . Obstet Gynecol 2017 ; 129 : e109 – 16. 4. National Women’s HealthNetwork , SisterSong Women of Color Reproductive Justice Coalition . Long-acting reversible contraception statement of principles . Washington, DC : NWHN ; 2017. 5. Neerland C, Slaughter-Acey J, Behrens K, Claussen AM, Usset T, Bilal-Roby S, et al. An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review. Obstet Gynecol 2024; 143: 383– 92. doi: 10.17226/25467. 6. Johnson MB. Prenatal Care for American Indian Women. MCN Am J Matern Child Nurs. 2020 Jul/Aug;45(4):221-227. doi: 10.1097/NMC.0000000000000633. 7. U.S. Department of Agriculture Food and Nutrition Service. WIC: USDA's Special Supplemental Nutrition Program for Women, Infants, and Children. July 2025. https://www.fns.usda.gov/wic. 8. Centers for Disease Control and Prevention. HIV, Viral Hepatitis, STD & Tuberculosis Prevention in Pregnancy. 9. Centers for Disease Control and Prevention. Trends and Characteristics in Maternal Syphilis Rates During Pregnancy: United States, 2016–2022. NCHS Data Brief No. 496, February 2024. 10. Centers for Disease Control and Prevention. Pregnancy and Vaccination. 11. NIDA. Substance Use While Pregnant and Breastfeeding. January 2025. https://nida.nih.gov/publications/research-reports/substance-use-in-women/substance-usewhile-pregnant-breastfeeding. 12. Moore KR, Stotz SA, Terry MA, et al. Respecting tribal voices in the development of a gestational diabetes risk reduction preconception counseling program for American Indian/Alaska Native adolescent females: a qualitative study. BMC Pregnancy Childbirth 2023; 23:552. https://doi.org/10.1186/s12884-023-05850-9. 13. Johnson JD, Louis JM. Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature. American Journal of Obstetrics and Gynecology 2022; 226(2): S876-S885. 14. Centers for Disease Control and Prevention. CDC Activities: Improving Maternal Mental Health Care. May 2024. 15. Centers for Disease Control and Prevention. National immunization Survey. 2018. 16. Moon RY, Carlin RF, Hand I. Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths. Pediatrics July 2022; 150 (1): e2022057991. 10.1542/peds.2022-057991.
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