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Off to the right start a look at infant and parent trends.


The circumstances and conditions under which a baby is born are an important measure of how well that child will do later in his or her life. The Right Start data compiled by the Annie E. Casey Foundation ( provides information to help better understand how children are positioned in life for significant challenges or with a greater possibility of success. As the background provided by the foundation states:

A child whose mother receives little or no prenatal care is far more likely to experience chronic health problems than other children whose mothers did receive prenatal care. A woman who smokes or drinks during pregnancy may visit long-term damage on the children she bears. An infant born into a family that is poor faces a considerably greater risk of not reaching his or her full potential.

It is no great surprise that the indicators used for the Right Start Report might help predict a child's likelihood for success in life; however, they are not definitive predictors that all children born under these circumstances will fail. The Annie E. Casey Foundation gathers the data to help policymakers, service providers, and others who work on community well-being to focus resources and actions to ensure that children will arrive in the world with the greatest chance for success. The data in this article reflect the latest report by the Casey Foundation, with 2003 data being the most current available for all indicators.

A Look at the Montana Numbers

It is encouraging to note that Montana compares well with other states in the conditions under which infants are born. Montana KIDS COUNT consistently reports the state's low ranking on many economic indicators that track the well-being of children. Thus, it is reassuring that Montana ranks in the top third when compared with other states in the following five categories:

* percentage of births to mothers with less than 12 years of education;

* percentage of births to mothers receiving late or no prenatal care;

* percentage of low birth weights of less than 5.5 pounds;

* percentage of pre-term births of less than 37 weeks of gestation; and

* percentage of births to unmarried women.

Much credit for these positive numbers should be given to public agencies and health care providers that are working to improve outcomes for infants. For the most part, programs ensuring healthy infants are being funded and supported from the community, state and federal levels.

However, there is not such good news in some of the other categories used in the Right Start Report. Data on teen mothers in Montana show the state ranks 29th in births to teens and 20th in births to teens who are already mothers. In addition, Montana ranks 44th worst in the nation for the number of women who smoke during pregnancy, with a reported 19.1 percent of all births being to mothers who smoked when pregnant.

The Annie E. Casey Foundation Right Start data uses the National Center for Health Statistics and tracks eight measures to reflect a healthy start to life. Table 1 shows these measures, comparing Montana with the U.S. average.

These eight indicators can hardly measure the full range of conditions shaping the lives of newborns, but they do reflect several important aspects relating to conditions at birth. This Ready Start data has been collected since 1990 for the nation as a whole and for each individual state, as well as for 55 of the largest cities in the United States. The data provides us with a comparison of how Montana is doing in relation to other states. Conditions in early life can give policymakers and service providers predictors of potential problems for children either at birth, in the critical 0-5 years, or even later in life. So the data gives a glimpse of future prospects for children in Montana and throughout the country. Each of these measures will be examined individually, comparing Montana to other states and to the nation as a whole.




Teen Births

Giving birth as a teenager is an accurate predictor of diminished opportunities for both mother and child. There is considerable evidence that having a baby as a teenager correlates with many negative life outcomes for the mother. Pregnancy is the No. 1 reason that teenage girls give for dropping out of high school, and nationally, only one-third of these mothers ever receive their diploma. Among young men who have fathered children, less than half complete high school; those who do are far less likely to obtain any additional education.

More importantly, as a recent study conducted by Montana KIDS COUNT shows, adolescent pregnancies have a positive and statistically significant impact on infant mortality ( The health of teen mothers and their access to adequate maternal care during the first trimester of pregnancy are crucial factors to ensure positive outcomes at birth. Teen pregnancies are usually more complicated and include common medical problems such as poor weight gain, pregnancy-induced hypertension, anemia, sexually transmitted diseases (STDs), and cephalopelvic disproportion. Many teen moms do not have regular access to health care for their babies and, as a result, the children of teen mothers receive less medical care and treatment.

Teen pregnancies reflect broader economic and social issues within a community, and unemployment rates and high school dropout rates have a positive, statistically significant impact on teen pregnancies. Counties with higher unemployment rates and with higher high school dropout rates have higher rates of teen pregnancies.

Figure 1 shows Montana compared to the U.S. average for the years 1990-2003. This graph shows that until 2001, Montana's teen birth rate was at or below the national average. Since then, Montana has risen slightly above the U.S. average, primarily because the national average continued the decline initiated in the mid-1990s, whereas Montana's teen birth rates have remained pretty much the same.


Repeat Teen Births

As discussed previously, most teen mothers are not adequately prepared to provide for one child. A second child stresses the situation even more. To be a teenager with more than one child would preclude educational opportunities, with all likelihood of not finishing high school. Lack of education ensures a limited chance in the labor market and thus limited economic well-being. It is encouraging that even though Montana's average for births to teen mothers is worse than the national average, repeat teen birth numbers are much better. As can be seen in Figure 2, Montana had an even lower repeat teen birth rate in 2003 than in 1990.

Births to Unmarried Women

Children growing up in a single-parent household are more likely to drop out of school or be dependent on welfare than those growing up in a two-parent household, according to the Annie E. Casey Foundation's recent research. Other numerous studies show that two-parent households are socially more stable and economically stronger than single-parent households.

Among other states, Montana ranks in the middle, at 18 out of 51, for births to unmarried women. The state with the most births to unmarried women was New Mexico (48.4 percent). The state with the least number of births to unmarried women was Utah (17.2 percent). Table 2 lists the seven Northwest states, among which Montana ranks second to last. In 2003, the percent of births to unmarried women in Montana, at 32.2, is somewhat similar to six of the neighboring states. Only Idaho, at 22.3 percent, is significantly lower than other states in the region.

Births to Mothers with Low Educational Attainment

The educational attainment of a child's mother is an excellent predictor of many outcomes in a child's social, economic, and cultural well-being. Much research has shown that children born to women without a high school degree face tough odds. It is reassuring that Montana ranks well in this indicator compared to other states. It is an important indicator because there is a direct correlation between the educational attainment of a mother and the likelihood of her wages being above the poverty level. Young adults without a high school diploma--even those who later return and complete their General Education Diploma (GED)--begin adulthood at a significant disadvantage. A high school diploma is the minimum requirement for most entry level jobs that have even modest growth potential. Post-secondary education, even if a degree is not actually attained, makes a huge difference in an individual's employment, earnings, and self-sufficiency prospects. For example, young adults ages 17-24 with less than a high school diploma are three times as likely to be unemployed, underemployed, or working for very low wages as those with a college degree. Even in 2000, a time of low unemployment, only half of all dropouts were employed at any given time (


Figure 3 shows that Montana is doing well in this indicator, and is in the group of states where fewer than 20 percent of mothers have less than 12 years of education at the time their baby was born. Montana's percentage is 15.7 compared to the national average of 21.6 percent.

Late or No Prenatal Care

Obviously, infants are less likely to have health problems if their mother receives timely prenatal care. This intuitive knowledge is backed up by years of research documenting that if a mother does not obtain prenatal care, the outcomes for a child can be threatened. It has been shown that mothers who lack health insurance are less likely to seek prenatal care and more likely to give birth to low-birthweight babies. Besides the outcome of low birthweight, the lack of prompt prenatal care is linked to other poor child outcomes, such as serious cognitive impairments like cerebral palsy and mental retardation, and behavioral and learning disorders, asthma, and other health problems. Prompt, continuing, high-quality prenatal care can help to detect a pregnant woman's pre-existing medical conditions and risks, provide health advice for the remainder of the pregnancy, and reduce a pregnant mother's use of cigarettes, drugs, and alcohol, thereby decreasing the chances of brain damage or other developmental problems in the infant (


The number of women receiving prenatal care has risen throughout the country since 1990, with Montana consistently doing better than the national average (Figure 4). This is a good sign that the resources are available for a mother to get prenatal care, even if she does not have health insurance through employment or other state and local programs.

Smoking During Pregnancy

Adverse outcomes have been documented for a child who is born to a mother who smoked during her pregnancy. Negative consequences for a child's health and development can be low birth weight, infant mortality, and intrauterine growth retardation. Also, despite years of public education campaigns, mothers who choose to smoke during their pregnancy reflect an unhealthy attitude to pregnancy and the well-being of the child. Montana has its worst ranking in this indicator: 44 out of 51 states. This is unfortunately not a great surprise, given that survey data show Montana teens consistently smoke more, start smoking at a younger age, and continue to smoke as older teenagers. Even though this indicator is the largest modifiable factor for low birthweight babies, somehow the message is not getting through to Montana's women. The Montana KIDS COUNT Child Mortality study showed that the percent of eighth-graders in county public schools who reported heavy smoking is one of the significant predictors of a county's infant morality rate.

In Table 3, Montana is compared to other states in the Northwest. North Dakota, South Dakota, and Wyoming run fairly closely to Montana in the percent of mothers who smoke, with Idaho being the only state in the region with an average lower than the national norm. Nationally, the state with the most mothers who smoked during pregnancy is West Virginia (26.5 percent). The states with the smallest number of mothers who smoked during pregnancy were Arizona, Hawaii, and Texas (5.9 percent) Numbers for California, Pennsylvania, and Washington were not available for 2003.


Low Birthweight Babies

Many factors lead to low birthweight babies; smoking during pregnancy, lack of prenatal care, and being a teen mother. This indicator is significant on many levels; the child's developmental outcomes can be severely compromised if a child is born weighing less than 5.5 lbs--the cutoff point below which an infant is considered low birth weight.

Being born at a low birthweight is a risk factor for developmental problems, including early problems in school. According to research, children aged 4 to 17 who were born at low birthweight are more likely to be enrolled in special education classes, to repeat a grade, or to fail school than children who were born at a normal birth weight. This finding is especially important given the ongoing debate on how to ensure children are ready to learn when they start kindergarten. Most studies on school readiness use low birth weight as a predictor of a child's ability to enter school healthy and ready to learn (

Montana is doing well compared to the U.S. average as seen in Figure 5. Over the past 13 years, Montana has had a couple of years of exceptionally low number of low birthweight babies, and seems to be bucking the national trend in the growing numbers of babies weighing below 5.5 lbs. when they are born.

Pre-Term Births

A large majority of neonatal deaths occur when a child is born pre-term, and research has shown that children born before 37 weeks of gestation are more likely to be neurologically impaired. Also associated with pre-term births are delays in motor and social development.

Doctors do not always know the cause of pre-term or low-weight babies, and, in most cases, there was probably little the doctor or mother could have done to prevent it. However, the incidence of pre-term and low-weight babies is higher among teenagers than other age groups. Again, the reasons are not clearly understood, although some doctors believe they may be poor eating habits and lack of medical care during pregnancy. Improper diet and inadequate medical care are major contributors to preterm and low-weight births ( preterm.html).


While not in the top tier of states with the lowest percentages of women having pre-term births, Montana at 11.1 percent is among the states with between 9.7 to 12.0 percent of babies being born pre-term (Figure 6). This compares favorably with the national average of 12.3 percent.


While Montana did not do well in the number of mothers who smoked during pregnancy, other measures showed that the state does better than the national average. Because of this data, it is safe to say that Montana kids are off to the right start. More information is available on the Annie E. Casey Foundation Web site at

Daphne Herling is director of community research for Montana KIDS COUNT and BBER. Christine Gordon is a research assistant for Montana KIDS Count.
Table 1
Eight Key Indicators from Ready Start Data

 U.S. Rank out of
 Montana Average 50 States

Percent of total births to teens 10.6 10.3 29
Percent of teen births to women
 who were already mothers 18.3 19.9 20
Percent of total births to
 unmarried women 32.2 34.6 18
Percent of total births to
 mothers with less than 12
 years of education 15.7 21.6 18
Percent of total births to
 mothers receiving late
 or no prenatal care 2.7 3.5 15
Percent of total births to mothers
 who smoked during pregnancy 19.1 10.7 44
Percent low-birthweight births
 (less than 5.5 lbs.) 6.8 7.9 13
Percent pre-term births (less than
 37 completed weeks of gestation) 11.1 12.3 13

Source: Annie E. Casey Foundation Ready
Start (2003)

Table 2
Births to Unmarried Women

Rank State %

 U.S. Average 34.6

2 Idaho 22.3
7 North Dakota 28.5
8 Washington 28.8
17 Oregon 31.7
18 Montana 32.2
19 Wyoming 32.6
25 South Dakota 34.2

Births to unmarried women (percent of total births to
unmarried women) is the percentage of all births occurring
to women who were unmarried at the time of the birth. In
2000 and 2001, marital status was obtained from a direct
question on the birth certificate in 48 states and the District
of Columbia. In Michigan and New York, marital status was
inferred from other information on the birth certificate.

Source: Annie E. Casey Foundation Ready Start (2003)

Table 3
Mothers who Smoked During
Pregnancy, 2003

 U.S. Average 10.7
20 Idaho 11.2
24 Oregon 12.0
33 North Dakota 16.0
43 South Dakota 18.8
4 Montana 19.0
45 Wyoming 19.3
N/A Washington N/A

Smoking during pregnancy (percent of total births to
mothers who smoked during pregnancy) is the percentage
of women who smoked during pregnancy. Birth certificates
on which information on smoking during pregnancy was not
reported were not included in this calculation.

Source: Annie E. Casey Foundation Ready Start (2003)
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Comment:Off to the right start a look at infant and parent trends.
Author:Herling, Daphne; Gordon, Christine
Publication:Montana Business Quarterly
Geographic Code:1U8MT
Date:Jun 22, 2006
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