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Social and Economic Factors

Community and Family Safety

Intimate Partner Violence Before Pregnancy*
Percentage of women with a recent live birth who experienced violence by husband or partner (current or former) in the 12 months before pregnancy
CDC, Pregnancy Risk Assessment Monitoring System, 2019
Violent Crime
Number of murders, rapes, robberies and aggravated assaults per 100,000 population
FBI, Uniform Crime Reporting Program, 2019

Economic Resources

Concentrated Disadvantage
Percentage of households located in census tracts whose averaged z-scores of family households below the poverty line, individuals receiving public assistance, female-headed households, unemployed ages 16 and older and population younger than 18 fall within the 75th percentile
U.S. Census Bureau, American Community Survey, 2015-2019
Food Insecurity
Percentage of households unable to provide adequate food for one or more household members due to lack of resources
USDA, Household Food Security in the United States in 2019, 2017-2019
Gender Pay Gap*
Women’s median annual earnings as a percentage of men’s median annual earnings for full-time, year-round civilian workers ages 16 and older
U.S. Census Bureau, American Community Survey, 2019
Poverty
Percentage of females ages 18-44 who live below the poverty level
U.S. Census Bureau, American Community Survey, 2019
Unemployment
Percentage of the female civilian workforce who are unemployed
U.S. Department of Labor, Bureau of Labor Statistics, 2019

Education

College Graduate
Percentage of women ages 25-44 with a college degree
CDC, Behavioral Risk Factor Surveillance System, 2018-2019

Social Support and Engagement

Infant Child Care Cost*
Average cost for center-based infant care as a percentage of married couple’s median income
Child Care Aware, The U.S. and the High Price of Child Care, 2018
Residential Segregation - Black/White
Index of dissimilarity with higher values indicating greater segregation between Black and non-Hispanic white households, ranging from zero (complete integration) to 100 (complete segregation)
U.S. Census Bureau, American Community Survey, 2015-2019
Voter Participation
The average of the percentage of female U.S. citizens who voted in the last presidential and the last midterm national elections
U.S. Census Bureau, Current Population Survey, Voting and Registration Supplement, 2018, 2020

Physical Environment - Women and Children

Air and Water Quality

Air Pollution
Average exposure of the general public to particulate matter of 2.5 microns or less measured in micrograms per cubic meter
EPA, 2017-2019
Drinking Water Violations
Percentage of population served by community water systems with a serious drinking water violation during the year
EPA, Enforcement and Compliance History Online, Safe Drinking Water Information System, 2021
Household Smoke
Percentage of children ages 0-17 who live in households where someone uses cigarettes, cigars or pipe tobacco
HHS, HRSA, MCHB, National Survey of Children's Health, 2019-2020
Risk-screening Environmental Indicator Score
Estimated human health-related risk from exposure to toxic chemicals based on emission data of more than 600 chemicals, with higher scores denoting elevated risk
EPA, Toxic Release Inventory National Analysis, 2019
Water Fluoridation
Percentage of population served by community water systems that receive fluoridated water
CDC, Water Fluoridation Reporting System, 2018

Climate Change

Climate Change Policies*
Number of the following state policies in place: legally binding electricity portfolio standards, carbon pricing policies, climate change action plans and economy-wide greenhouse gas emission targets
Center for Climate and Energy Solutions, 2020
Transportation Energy Use*
Amount of energy (in trillions of BTUs) consumed by the transportation of people and goods per 100,000 population
U.S. Energy Information Administration, State Energy Data System, 2019

Housing and Transportation

Drive Alone to Work
Percentage of female workers who drive alone to work
U.S. Census Bureau, American Community Survey, 2019
Housing With Lead Risk
Percentage of housing stock with potential elevated lead risk due to age of housing
U.S. Census Bureau, American Community Survey, 2019
Severe Housing Problems
Percentage of occupied housing units with at least one of the following problems: lack of complete kitchen facilities, lack of plumbing facilities, overcrowding or severely cost-burdened occupants
HUD, Comprehensive Housing Affordability Strategy, 2013-2017

Clinical Care

Access to Care

Adequate Prenatal Care
Percentage of live births in which the mother received prenatal care beginning in the first four months of pregnancy with the appropriate number of visits for the infant's gestational age
March of Dimes, Perinatal Data Center, 2019
Avoided Care Due to Cost
Percentage of women ages 18-44 who reported a time in the past 12 months when they needed to see a doctor but could not because of cost
CDC, Behavioral Risk Factor Surveillance System, 2018-2019
Publicly-funded Women's Health Services
Percentage of likely need for contraceptive services among women with a family income 250% below the federal poverty level and women younger than 20 met by publicly-funded clinics
Guttmacher Institute Publicly Supported Family Planning Services in the United States: Likely Need, Availability and Impact, 2016
Uninsured Women
Percentage of women ages 19-44 not covered by private or public health insurance
U.S. Census Bureau, American Community Survey, 2019
Women's Health Providers
Number of obstetricians, gynecologists and midwives per 100,000 females ages 15 and older
HHS, CMS, National Plan and Provider Enumeration System, Sept. 2020

Preventive Clinical Care

Cervical Cancer Screening
Percentage of women ages 21-44 who received a Pap smear within the past three years
CDC, Behavioral Risk Factor Surveillance System, 2018
Dental Visit
Percentage of women ages 18-44 who reported visiting the dentist or dental clinic within the past year
CDC, Behavioral Risk Factor Surveillance System, 2018
Flu Vaccination
Percentage of women ages 18-44 who reported receiving a seasonal flu vaccine in the past 12 months
CDC, Behavioral Risk Factor Surveillance System, 2018-2019
Postpartum Visit*
Percentage of women with a recent live birth who reported receiving a postpartum checkup
CDC, Pregnancy Risk Assessment Monitoring System, 2019
Well-woman Visit
Percentage of women ages 18-44 with a preventive medical visit in the past year
CDC, Behavioral Risk Factor Surveillance System, 2018-2019

Quality of Care

Breastfeeding Initiation*
Percentage of infants who were breastfed during the period between birth and discharge from the hospital
CDC WONDER, Natality Public Use Files, 2019
Dedicated Health Care Provider
Percentage of women ages 18-44 who reported having a personal doctor or health care provider
CDC, Behavioral Risk Factor Surveillance System, 2018-2019
Low-risk Cesarean Delivery
Percentage of singleton, head first, term (37 or more completed weeks) first births that were cesarean deliveries
CDC WONDER, Natality Public Use Files, 2019
Maternity Practices Score
Maternity Practices in Infant and Nutrition Care survey score based on seven birth facility policies and practices, with higher scores denoting better maternity care policies and practices
CDC, mPINC State Reports, 2018

Behaviors

Nutrition and Physical Activity

Exercise
Percentage of women ages 18-44 who met the federal physical activity guidelines (150 minutes of moderate or 75 minutes of vigorous aerobic activity and two days of muscle strengthening per week) in the past 30 days
CDC, Behavioral Risk Factor Surveillance System, 2019
Fruit and Vegetable Consumption
Percentage of women ages 18-44 who reported consuming two or more fruits and three or more vegetables daily
CDC, Behavioral Risk Factor Surveillance System, 2019
Physical Inactivity
Percentage of women ages 18-44 who reported doing no physical activity or exercise other than their regular job in the past 30 days
CDC, Behavioral Risk Factor Surveillance System, 2018-2019

Sexual Health

Chlamydia
Number of new cases of chlamydia per 100,000 females ages 15-44
CDC, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Atlas, 2018
High-risk HIV Behaviors
Percentage of women ages 18-44 who reported any of the following situations in the past year: injected any drug other than those prescribed for you; have been treated for a sexually transmitted disease or STD; or given or received money or drugs in exchange for sex
CDC, Behavioral Risk Factor Surveillance System, 2018-2019
Unintended Pregnancy*
Percentage of women with a recent live birth who did not want to become pregnant or wanted to become pregnant later
CDC, Pregnancy Risk Assessment Monitoring System, 2019

Sleep Health

Insufficient Sleep
Percentage of women ages 18-44 who reported sleeping, on average, fewer than seven hours in a 24-hour period
CDC, Behavioral Risk Factor Surveillance System, 2018

Tobacco Use

E-cigarette Use*
Percentage of women ages 18-44 who reported using e-cigarettes or other electronic vaping products at least once in their lifetime and now use daily or some days
CDC, Behavioral Risk Factor Surveillance System, 2018
Smoking
Percentage of women ages 18-44 who reported smoking at least 100 cigarettes in their lifetime and currently smoke daily or some days
CDC, Behavioral Risk Factor Surveillance System, 2018-2019
Smoking During Pregnancy
Percentage of mothers who reported smoking cigarettes during pregnancy
CDC WONDER, Natality Public Use Files, 2019

Health Outcomes

Behavioral Health

Drug Deaths*
Number of deaths due to drug injury (unintentional, suicide, homicide or undetermined) per 100,000 females ages 20-44
CDC WONDER, Multiple Cause of Death Files, 2017-2019
Excessive Drinking
Percentage of women ages 18-44 who reported binge drinking (four or more drinks on one occasion in the past 30 days) or heavy drinking (eight or more drinks per week)
CDC, Behavioral Risk Factor Surveillance System, 2018-2019
Frequent Mental Distress
Percentage of women ages 18-44 who reported their mental health was not good 14 or more days in the past 30 days
CDC, Behavioral Risk Factor Surveillance System, 2018-2019
Illicit Drug Use
Percentage of women ages 18-49 who misused prescription psychotherapeutics (pain relievers, tranquilizers, stimulants and sedatives) or used cocaine (including crack), heroin, hallucinogens, inhalants or methamphetamine in the past year
SAMHSA, National Survey on Drug Use and Health, 2018-2019
Postpartum Depression*
Percentage of women with a recent live birth who reported experiencing depressive symptoms
CDC, Pregnancy Risk Assessment Monitoring System, 2019

Mortality

Maternal Mortality*
Number of deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, regardless of the duration and site of the pregnancy, per 100,000 live births
CDC WONDER, Multiple Cause of Death Files, 2019
Mortality Rate
Number of deaths per 100,000 women ages 20-44
CDC WONDER, Multiple Cause of Death Files, 2019

Physical Health

Frequent Physical Distress
Percentage of women ages 18-44 who reported their physical health was not good 14 or more days in the past 30 days
CDC, Behavioral Risk Factor Surveillance System, 2018-2019
High Blood Pressure
Percentage of women ages 18-44 who reported being told by a health professional that they have high blood pressure
CDC, Behavioral Risk Factor Surveillance System, 2019
High Health Status*
Percentage of women ages 18-44 who reported that their health is very good or excellent
CDC, Behavioral Risk Factor Surveillance System, 2018-2019
Maternal Morbidity*
Number of instances in which the mother experienced admission to the ICU, a ruptured uterus, a transfusion and/or an unplanned hysterectomy per 1,000 births
CDC WONDER, Natality Public Use Files, 2017-2019
Multiple Chronic Conditions
Percentage of women ages 18-44 who have three or more of the following chronic health conditions: arthritis, asthma, chronic kidney disease, chronic obstructive pulmonary disease, cardiovascular disease (heart disease, heart attack, or stroke), cancer (excluding skin), depression or diabetes
CDC, Behavioral Risk Factor Surveillance System, 2018-2019
Obesity
Percentage of women ages 18-44 with a body mass index of 30.0 or higher based on reported height and weight
CDC, Behavioral Risk Factor Surveillance System, 2018-2019

* Not included in the composite measures.
Data appearing in this edition are the same that appeared in the last edition.

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