Quality and consistent preventive health care, beginning even before birth, gives children the best chance to grow up to be healthy and productive adults.
Adequate levels of immunization, public health efforts to prevent disease and disability, and support for maternal health and positive birth outcomes are examples of measures that help children now and later. Good health, both physical and behavioral, is an essential element of a productive and fulfilling life.
According to this year’s ‘Kids Count in Nebraska’ report, there were 26,932 live births to Nebraska residents in 2009. The largest majority of those births were to women age 30 and over - 35 percent. Only 8.3 percent of those births were to mothers age 19 and under.
That number actually declines in 2010, with only 7.6 percent of the 25,916 babies born in Nebraska to mothers age 19 and under. Women age 30 and over made up for 35. 2 percent of the 2010 births.
Custer County saw 109 births in 2010, with less that 1 percent of those to mothers under the age of 18.
Many of the factors that determine outcomes for pregnant women and infants occur very early in pregnancy, often before women enter prenatal care or even know they are pregnant. During the first weeks of pregnancy, exposure to alcohol, tobacco and other drugs; lack of essential vitamins; workplace hazards; and other factors can adversely affect fetal development.
Preconception care identifies risks and improves the health of women, children and families. Prenatal care monitors pregnancy progress and identifies potential problems before they become serous for either mom or baby. Women who see a health care provider regularly during pregnancy have healthier babies and are less likely to deliver prematurely or to have other serious problems related to pregnancy.
In 2010, 3,551 (13.7 percent) of Nebraska births were recorded to mothers who reported inadequate prenatal care. The number of mothers reporting adequate or ‘adequate plus’ prenatal care in 2010, increased to 73.5 percent - up from 72.2 percent in 2009.
Uninsured women face greater barriers to prenatal care than insured women, even in the presence of strong institutions that are well known in their communities for providing care to the uninsured. Other commonly cited barriers to adequate prenatal care among low-income women are a lack of transportation, no knowledge of where to find care, not liking the way they were treated at the clinic, language barriers, ignorance as to the importance of prenatal care, and uncertainty about whether they wanted the baby or ambivalence about pregnancy.
Infant mortality rates are frequently used as an indicator of the standard of well being in a community. In 2009 and 2008, the Nebraska infant mortality rate (deaths per 1,000 births) was 5.4, which represents a decrease from the 2007 rate of 6.8 and is tied with the 2003 infant mortality rate as the lowest ever recorded in Nebraska.
A total of 145 infant deaths occurred in Nebraska in 2009, one less than in 2008. In Custer County there have been 12 infant deaths between 2000 and 2009.
Low birth weight
The highest predictor of death and disability among infants in the United States is low birth weight. A newborn weighing less than 5.5 pounds is considered of low birth weight, and a newborn weighing less than 3.3 pounds is considered of very low birth weight.
Smoking is an attributable cause of low weight births. pregnant women who smoke cigarettes are nearly twice as likely to have a low birth weight baby as women who do not smoke. The percentage of women in Nebraska who reported smoking during pregnancy was 14 percent in 2009, and 13.3 percent in 2010.
The percentage of low weight births in Nebraska stayed the same in 2010 as 2009 - 7.1 percent, or 1.843 births statewide. There was only one low weight birth reported in Custer County in 2010.
Access to health care
Access to health care is critical. Most uninsured children have working parents whose jobs do not provide access to insurance. Most often in these cases the employer does not offer insurance, the insurance offered is too expensive or the insurance does not cover the necessary medical needs of the family.
In 2010, there were 47,000 uninsured children, ages 17 and under, in Nebraska.
Among low-income children ages 18 and under, 30,000 were uninsured in 2010. Many of these uninsured low-income children are eligible for Kids Connection. This program was expanded in 2009 to provide low-cost health care coverage for children living in families at or below 200 percent of the federal poverty level, up from 185 percent.
Kids Connection refers to the Children’s Health Insurance Program (CHIP) which provided health coverage for a monthly average of 26,319 Nebraska children ages 18 and under in state fiscal year 2010. Medicaid provided health coverage for a monthly average of 127,387 children in 2010.
In Custer County, 918 children were enrolled in Medicaid or CHIP programs in 2010. There were 55 in Blaine, 45 in Thomas, 35 in, Hooker, 43 in Loup and 169 in Garfield.
Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act was signed into law in March 2010. The goal of this new federal law is to provide affordable health insurance to all Americans. Several changes have already been made based on this law, including a prohibition against denying children insurance coverage due to pre-existing conditions and allowing young adults to remain on their parents’ health insurance plan up to age 26. Another key feature of this new law will be the establishment of a health insurance exchange that will act as a marketplace where individuals and small business can purchase insurance coverage.
Nebraska is currently studying the possibility of creating and running its own health insurance exchange. This would mean that the exchange would be run and managed by state government and the state would make choices about how to structure the exchange to best meet our state’s needs.
People who lack other affordable health insurance options and have incomes up to 400 percent of the Federal Poverty Level will receive tax subsidies to help with the cost of insurance. Another benefit to an exchange is that coverage will not always need to be tied to employment. This would mean that families can continue to have health insurance if they change or lose their jobs.
The law requires that all exchanges, whether state or federal, be set up and officially open Jan. 1, 2014. At that time, all Americans will also be required to carry health insurance. In order for this process to be successful, individuals and families will have time between Oct. 1, 2013 through Feb. 28, 2014, to understand the new system and make their choices on coverage.
The risk of having children with adverse birth outcomes, such as low birth weight and infant mortality, are greater for unmarried mothers than for married mothers.
The number of unwed mothers in Nebraska decreased in 2010, after growing in 2009. Nebraska children living with single parents were more likely to live in poverty than children living in married-couple households. The likelihood that a mother will be married upon the birth of the child increases with the age of the mother.
Between 2001 and 2010, there were 274 out-of-wedlock births reported in Custer County. four in Blaine, two in Thomas, 11 in Hooker, five in Loup and 24 in Garfield.
Improving the Odds
Several successful programs and policies are linked to improved birth outcomes - and success in later life. For instance, nutrition programs including the Supplemental Feeding Program for Women, Infants and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) have reduced instances of low birth weight.
This is significant because adults who were born at low weight have worse outcomes in academic attainment, earnings and overall socioeconomic status. Further, girls born at low weight are more likely as adults to deliver low birth-weight babies, especially if living in a low-income neighborhood.
In June 2010, 333 children age 18 and under were participating in the SNAP program in Custer County. In September 2010, there were 275 Custer County residents participating in the WIC program. This is no evidence of the need of such programs in our area.
Young children ages 0-8 in Nebraska comprise almost a third of SNAP participants. Not only does SNAP improve access to nutritional food, it is an effective tool toward overcoming poverty. In 2010, SNAP moved 13 percent of participating households in the U.S. above the poverty line.
Aid to Dependent Children
The program Aid to Dependent Children (ADC), known as the state’s cash welfare program, assisted a monthly average of 13,255 children ages 0 to 8 in 2010.
There were 22 families in Custer County on ADC in 2010. Unfortunately, the number of children served falls short of the number of children in need.
Based on Kids Count calculations, about 44,720 children ages 0 to 8 were in poverty in 2010. This age group represented 50 percent of ADC’s participants.
There were 682 children under the age of 5 living in Custer County in 2010. Between 2005 and 2010, 9.4 percent of Custer County’s residents under the age of 5 lived in poverty; 7.3 percent of the county’s children under the age of 17 were living in poverty during those same years.
Child care is one of the largest expenses many Nebraska families have. Costs for child care can rise to as much as one-third to one-half of a family’s budget.
Despite the toll child care places on working families, Nebraska’s eligibility cutoff for assistance amounted to 120 percent of the poverty level in 2011, or just over $22,000 for a family of three - leaving struggling families with no help in ensuring their children are safely cared for while they were at work.
Further, Nebraska reimburses child-care providers less than the 75th percentile of market rates, the guideline per federal recommendations. When rates are low, child-care providers may be less likely to accept low-income children into care.
Although budgets for assistance programs are strapped at the state and federal level, ensuring that all families - particularly those with young and otherwise vulnerable children - receive the supports they need to move out of poverty and maintain employment is smart policy.
Because we know that children who are born into and experience poverty through their early years are highly likely to be poor as adults, it only makes sense to intervene now to avoid future human and economic costs.
* We will continue our Kids Count series next week when we look at Education on the state and local level.