Report on New Mexico Navajo Mothers and Their Infants ......Report on New Mexico Navajo Mothers and Their Infants, 2005-2011. Foreword. T. he epidemiological report, entitled “Report

PREGNANCY

RISK

ASSESSMENT

MONITORING

SYSTEM

NEW MEXICO

N e w M e x i c oN a t i v e M o t h e r s f o r

P R A M S

New Mexico PRAMSFamily Health Bureau

NM Department of Health2040 S. Pacheco

Santa Fe, NM 87505

1-800-743-8548Email: [emailprotected]

QUESTIONS?

PARTNERSHIPS

Based on New Mexico Pregnancy Risk Assessment Monitoring System Data

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Foreword

The epidemiological report, entitled “Report on New Mexico Navajo Mothers and Their Infants 2005-2011” presents the analysis of the data received from 2005-2011, and updates the 2000-2004 report. The 2005-2011 report is one of many other pub-

lished reports to come from the Navajo Epidemiology Center (NEC) and Navajo Pregnancy Risk Assessment Monitoring System (PRAMS) Workgroup. The report focuses on Navajo mothers living in New Mexico and intends to inform public health decision makers and health care providers about the health of Navajo mothers and infants in New Mexico.

Reports such as these are routinely published by the state health departments and public health agencies. They are invaluable tools for making key public health decisions and taking action based on epidemiological data. Mothers and their infants constitute an important population and surveys such as the New Mexico PRAMS survey helps broaden our un-derstanding of the successes and identify areas we can improve maternal and child health services.

The NEC has catalogued maternal and child health reports from other public health agen-cies that contains public health data relevant to Navajo mothers and infants. However, to date this is the only publication of its own pregnancy risk assessment specific to Navajo mothers and infants. This report, focusing on New Mexico, is a partial fulfillment of the goal to publish risk assessment reports for all Navajo mothers and infants in the three states bordering the Navajo Nation: Arizona, New Mexico and Utah.

The report is the result of a continuing collaboration between the Navajo Epidemiolo-gy Center, New Mexico PRAMS/Maternal and Child Health Epidemiology Program, Navajo Department of Health, Navajo Women, Infants and Children (WIC) Pro-

gram, Navajo Area Indian Health Service, Albuquerque Area Southwest Tribal Epidemiolo-gy Center, Utah PRAMS Program, Arizona Department of Health Services, Centers for Dis-ease Control and Prevention, and University of New Mexico Center for Native American Health. The contributions of the following individuals to this report and toward the cause of enhancing the health of Navajo mothers and infants is acknowledged and applauded:

Acknowledgments

Adele King (Retired), Navajo Women, Infants and Children Program

Antoinette Kleiner, Navajo Medical Center, Indian Health Service

Carmelita Sorrelman (Retired), Northern Navajo Medical Center, Indian Health Service

Christine Benally, Navajo Area Indian Health Service

Del Yazzie, Navajo Epidemiology Center

Diana Contreras, Arizona Department of Health Services

Diana Hu, Tuba City Regional Health Care Corporation, Indian Health Service

Donna Tepsich-Stolfa, Navajo Women, Infants and Children Program

Dorin Sisneros, New Mexico Department of Health, PRAMS Program

Dornell Pete, Albuquerque Area Southwest Tribal Epidemiology Center

Eirian Coronado, New Mexico Department of Health, PRAMS Program

Gayle Dinè-Chacon, University of New Mexico Center for Native American Health

Harry Bowman, Navajo Women, Infants and Children Program

Hondo Louis, PRAMS Media Consultant

Jean Howe, Northern Navajo Medical Center, Indian Health Service

Joan Agostinelli, Arizona Department of Health Services

Katherine Jim, Navajo Epidemiology Center, Navajo PRAMS Outreach

Laurie Baksh, Utah Department of Health, Utah PRAMS Program

Mary Shepherd, New Mexico Department of Health, PRAMS Program

Ramona Antone-Nez, Navajo Department of Health

Rebecca Garcia, New Mexico Department of Health, PRAMS Program

Samuel Swift, New Mexico Department of Health

Susie John, Northern Navajo Medical Center, Indian Health Service

Timothy Flood, Arizona Department of Health Services

Table of Contents

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Executive summary

Introduction

Demographics

Preconception

Prenatal

PostPartum

Discussion

Conclusion and

Recommendations

Appendix

PRAMS Survey

Special Thanks 5

We acknowledge and thank the New Mexico PRAMS/Maternal and Child Health Epidemiology program staff for their willingness to share data on Navajo moth-ers and infants. We also thank the mothers who participated in the New Mexico

PRAMS. Without their support and assistance, this and many other reports could not be published.

Based on New Mexico Pregnancy Risk Assessment Monitoring System Data

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

The report highlights stages of pregnancy in three sections: preconception, prenatal and postpartum. The areas identified of most concern are presented below.

Preconception

Three preconception health factors needing improvement were identified.

• Pregnancy planning and contraception – 62% of Navajo mothers who said they were not trying to get pregnant were not using contraception. Over half (52%) of Navajo mothers did not intend to become pregnant, and 16% did not want to become pregnant.

• Multivitamins to prevent birth defects – 61% of Navajo mothers did not take a multivitamin or prenatal vitamin before pregnancy, and only 24% took a daily multivitamin.

• Weight – 57% of Navajo mothers’ BMI (body mass index) was above the healthy range. A BMI below 18.5 is considered underweight; 18.5 to 24.9 is considered healthy; 25 to 29.9 is considered overweight; 30 or higher is considered obese.

Prenatal

Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes.

• Diabetes: 3% of Navajo mothers reported having pre-existing diabetes, and 14% developed diabetes during pregnancy (gestational diabetes).

Postpartum

Postpartum depression was common among Navajo mothers.

• Symptoms of depression after delivery were reported by 20% of Navajo mothers.

Changes Over Time

In comparison to the previously published Navajo PRAMS Report 2004-2005, there were some statistically significant changes between 2000-2004 and 2005-2011 in the percentage of women reporting certain health behaviors and services.

• The percentage of Navajo mothers receiving home visiting services doubled over time for visits during pregnancy and for visits after delivery. Home visits during pregnancy in-creased from 7% to 14% of Navajo mothers in 2000-2004 and 2005-2011, respectively. Similarly, home visits after delivery increased from 12% of mothers in 2000-2004 to 34% in 2005-2011.

• Oral health services during pregnancy also increased between the two report periods. In 2000-2004, 24% of women went to a dentist or dental clinic during pregnancy increasing to 37% in 2005-2011. The percentage of Navajo mothers who had their health care pro-vider discuss how to care for teeth and gums during pregnancy also increased significantly from 29% in 2000-2004 to 53% in 2005-2011.

• There was an increase in Medicaid coverage among Navajo mothers. Medicaid coverage for prenatal care increased from 59% in 2000-2004 to 70% in 2005-2011.

• Navajo mothers were more likely to place their infants in a safe sleep position in 2005-2011 compared to 2000-2004. The percentage placing their infants on their back to sleep increased from 78% to 85%.

• Maternal stress decreased over time in two domains (partner-related stress and traumatic stress). Although not included in the previous report, partner-related stress during preg-nancy decreased from 48% of women in 2000-2004 to 37%, and traumatic stress de-creased from 40% to 34%.

Executive Summary

5 6

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

What is PRAMS?

Navajo PRAMS Workgroup

Navajo Epidemiology Center

The Navajo Epidemi-ology Center (NEC) was established in

September 2005 with the intention of identifying high priority Navajo health status objectives, developing disease surveillance systems, and implementing disease control and prevention programs across the Navajo Nation. The NEC is a program within the Navajo Department of Health, which serves one of the largest Native American tribes in the United States. The Navajo Nation has a population of approximately 155,000 Navajos living within the Navajo Nation boundaries (see map below of Navajo Nation ‘agencies’), plus approxi-mately another 175,000 living in border towns and metropolitan areas. It serves an area of 27,000 square miles in the southwest United States. Portions of Arizona, New Mexico, and Utah extend into the Navajo Nation lands, necessitating working relationships with the “three-states” on a number of fronts, including public health. The Navajo Department of Health (previously known as Division of Health since 1977) was established in November 2014 through legislation enacted into law by the President of the Navajo Nation. The legislation is an unprecedented exercise of tribal sovereignty. It establishes the Navajo Department of Health as the first tribally operated state-like health department. The Nava-jo Department of Health administers health programs across the Navajo Nation, in-cluding:

• Navajo Epidemiology Center • Navajo Health Education Program

• Department of Behavioral Health Services • Community Health Representatives Program • Kayenta Public Health Nursing • Office of Environmental Health • Navajo Area Agency on Aging • Breast and Cervical Cancer Prevention Program • New Dawn Program • Public Health Emergency Preparedness Program

• Food Distribution Program • Office of Uranium Workers

• Women, Infants and Children Program • Navajo Special Diabetes Program

• Office of Planning, Research and Evaluation

• Management Information Systems Program

PRAMS is a multi-year, population-based surveillance system developed and sponsored by the Centers for Disease Control and Prevention (CDC) in 40 U.S. states (includes New Mexico and Utah and excludes Arizona) representing approximately 78% of all U.S. live

births. The New Mexico PRAMS program monitors the health status, behaviors and experi-ences of New Mexico mothers before, during and after the birth of a child. Developed and first administered in 1997, New Mexico PRAMS program uses a state-wide survey instrument to query mothers on a variety of pregnancy risk factors, including prenatal care, counseling, multivitamin use, intimate partner abuse, teen pregnancy, home visiting, unintended and unwanted pregnancies, and other factors associated with pregnancy and birth outcomes.

In 1996, the New Mexico PRAMS program initiated a working relationship with the Navajo Department of Health to enhance surveillance data collection on Navajo moth-ers and their infants who reside in New Mexico. This collaboration between the New

Mexico PRAMS and Navajo Department of Health led to the establishment of the Nava-jo PRAMS Workgroup, which is comprised of the following organizations (see photo of workgroup members above. Not all pictured):

• Navajo Epidemiology Center• Navajo Nation Division of Health• New Mexico Pregnancy Risk Assessment Monitoring System Survey• New Mexico Department of Health• Arizona Department of Health Services• Utah Department of Health• Centers for Disease Control and Prevention• Albuquerque Area Southwest Tribal Epidemiology Center• Navajo Women, Infants and Children Program• Indian Health Service• Center for Native American Health• Utah PRAMS

Legend

Western Agency Northern Agency Central Agency Ft. Defiance Agency Eastern Agency

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

PRAMS Methodology

Legend

Metropolitan Counties

Micropolitan Counties

Rural Counties

The report presents the results of the New Mexico PRAMS data analysis for Navajo mothers and infants residing in New Mexico. Mothers who

self-identified themselves as Navajo on their infants’ birth certificates were considered eligible to be included in the report. While Arizona and Utah fulfill many maternal and child health functions, this report does not include data for Navajo mothers residing in Arizona and Utah. The need to overcome this significant limitation is currently being addressed. The following sections describe in greater detail the PRAMS methodology undertaken by New Mexico and CDC, which was used to collect the survey data included in this report.

Population and Sample

The eligible New Mexico PRAMS population included all New Mexico resident mothers giving birth in New Mexi-co. Women who delivered out-of-state or gave their infants for adoption were not eligible for this survey. Information was collected on only one infant from each multiple birth. Because of these exclusions, the eligible New Mexico PRAMS population size was smaller than the number of live births reported by the New Mexico Bureau of Vital Records and Health Statistics. Each month, a stratified sample of eligible New Mexico mothers was randomly drawn (approxi-mately 200 new mothers) from eligible birth certificates at the New Mexico Bureau of Vital Record and Health Statistics. In 2000, New Mexico PRAMS over-sampled low birth weight infants. From 2001 to 2010, New Mexico PRAMS sampled eligible new mothers equally across the five public health regions, and starting in 2011, sampling was stratified by race/ethnicity. Approximately one out of every 12 mothers residing in New Mexico with a recent live birth was selected to receive a survey. PRAMS Data Collection

According to New Mexico PRAMS data collection proce-dures, each year those new mothers who were sampled to re-ceive a survey were mailed a survey up to three times between two to six months after delivery. The survey participation was voluntary. Survey recipients were asked to complete the survey and mail it back to the New Mexico PRAMS program. The mailed survey included a cover letter, questionnaire booklet, a return envelope with postage, a question and answer sheet about PRAMS, a list of community resources for families and newborns, an incentive, and an offer of a reward for participa-tion. Those mothers who did not return the survey were called and asked to complete the survey by telephone and were also given a toll-free number to call at any time. The mailings started two to six months after birth, and telephone inter-

views ended 90 days after the first mailing. After data collec-tion for the birth year ended the survey data were submitted to CDC for cleaning and statistical weighting. The CDC then returned the weighted data to New Mexico PRAMS, which then analyzed and published New Mexico PRAMS surveil-lance reports; the latest New Mexico PRAMS report covered births from the years 2009-2010.

The PRAMS Questionnaire

The CDC coordinates the PRAMS questionnaire that consists of two parts: a core portion that was the same for all partici-pating states and a state-specific portion that was tailored to New Mexico’s needs. Topics of the core portion included:

• Barriers to and content of prenatal care• Early infant care and breastfeeding• Economic status• Health status• Maternal stress• Maternal use of alcohol and cigarettes• Nutrition• Obstetric history

PRAMS Questionnaire Phases and Changes

Every 3-5 years the CDC reviews its PRAMS instrument, adding, deleting, and/or modifying the survey instrument. In some cases when questions are not considered productive or relevant, those questions are dropped, clarified, or modified. States can also recommend additional state-specific questions for inclusion in the questionnaire. In the period from 2004 to 2008, New Mexico PRAMS administered the Phase 5 CDC PRAMS questionnaire, and from 2009-2011, the Phase 6 questionnaire was used. The surveillance reports and versions of the survey can be accessed at: http://archive.nmhealth.org/phd/prams/reports.shtml" http://archive.nmhealth.org/phd/prams/reports.shtml

The instrument changes may account for differences when comparing the two multi-year comparisons for the following questions:

• Question 3 on multivitamin use, which began “In the month before…” in Phase 4, was changed to “During the month before…” in Phase 5. Also, “Pre-natal vitamin” was added to Question 3 in Phase 5.

• The write-in option for the question on smoking before and during pregnancy was removed in Phase 5 and replaced with an option to select from categories of the number of cigarettes smoked.

• In Phase 5 the options “Norplant” and “Shots” [De-poProvera]” were removed in question 12 (contracep-tion at conception and postpartum), and “Cervical ring” was added as an option.

• The definition of Binge Drinking was changed in Phase 6. In Phase 5 it was defined as having 5 or more alcoholic drinks in one sitting and in Phase 6 it was defined as having 4 or more alcoholic drinks in one sitting.

• The questions on symptoms of postpartum depres-sion were added in Phase 5 and were changed in Phase 6. The Phase 5 survey asked 1) how often the mother has felt down, depressed, or hopeless, and 2) how often she has had little interest or little pleasure in doing things. In Phase 6, the survey asked 1) If

the mother felt down, depressed, or sad, 2) if she felt hopeless, 3) if she felt slowed down.

• Household income was asked as an open-ended question in Phase 4. In Phase 5, respondents chose one of seven income range categories, and in Phase 6, respondents chose one of nine income ranges.

• Questions on diabetes have changed over time. In Phase 4, mothers were asked if they had high blood sugar (diabetes) during pregnancy. In Phase 5, moth-ers were asked two separate questions: 1) did you have high blood sugar (diabetes) that started before this pregnancy, 2) did you have high blood sugar (diabetes) that started during this pregnancy. And in Phase 6, mothers were asked: 1) before you got pregnant with your new baby, were you ever told by a doctor, nurse, or other health care worker that you had Type 1 or Type 2 diabetes, 2) during your most recent pregnancy, were you told by a doctor, nurse, or other health care worker that you had gestational diabetes (diabetes that started during this pregnancy).

Data Limitation and Bias

As with all surveys, self-selection is an inherent bias. In addition, when response rates are not high, there is a concern that bias may result from non-response. That is, participants may be different from non-participants, calling into question the degree to which the information collected applies to the entire population being sampled (in this case, to all New Mexico Navajo mothers). Many studies have demonstrated the differences between participants and non-participants that can result in bias. The overall response rate for Navajo mothers participating in New Mexico PRAMS for 2005-2011 was 53.3% (see table above), which falls below the CDC recommended response rate of at least 65% in order to make statistically valid inferences from the sampled population. As a result, the data presented in this report may not be represen-tative of all Navajo mothers living in New Mexico. Still, the data are weighted so that the Navajo mothers who participat-ed in this survey do provide important information about the Navajo maternal population residing and giving live birth in New Mexico from 2005-2011.

New Mexico PRAMS Response Rates of Navajo Women, 2005-2011Year of

Infant’s Birth 2005 2006 2007 2008 2009 2010 2011 2005-2011

Number of Responses 83 87 73 66 95 87 107 598

Target Number Sample 133 165 134 154 206 169 161 1122Percent

Responded 62.4% 52.7% 54.5% 42.9% 46.1% 51.5% 66.5% 53.3%

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Data Analysis

The report contains mainly descriptive analyses of the sur-vey data. We (Navajo PRAMS Workgroup) report the New Mexico Navajo mothers’ answers to the survey questions and stratify their answers by seven demographic factors (called “Maternal characteristics” in the tables); age, education, mar-ital status, residence, income, WIC enrollment, and prenatal care payer. We also tested whether or not there were statisti-cally significant associations (or relationships) between each question and these same seven demographic factors using the Rao-Scott Chi-Square test. The Chi-Square test generates a

Definition of FactorsBinge Drinking Having 4/5 or more alcoholic beverages on one occasion (the definition was 5+ from 2005-2008, and 4+ from 2009-2011).

Cigarette Smoking

The smoking of any cigarettes. If the mother said she did not know how many cigarettes she smoked, she was coded as a smoker.

Diabetes, Pre-existing Type 1 or Type 2 diabetes that was diagnosed before pregnancy.

Diabetes, Gestational Diabetes that started during pregnancy.

Families FIRSTFamilies FIRST provide prenatal and postpartum case management support to Medicaid-eligible women and their families. Services include comprehensive psychosocial assessment, support with Medicaid enrollment and education on prenatal health and infant care. Home visiting is offered for both expecting and newly-delivered moms and their families.1

Frequent Alcohol Use Having seven or more drinks in one week.2

Intention of Pregnancy

Mothers were asked how they felt about being pregnant at the time of conception. Mothers could respond that they wanted to be pregnant either 1) sooner, 2) later, 3) then, or 4) not then or at any time. “Later” responses meant a mistimed pregnan-cy; “Not then or at any time” referred to an unwanted pregnancy. Mothers who selected either of these two responses (a mistimed or unwanted pregnancy) were categorized overall as having an “Unintended pregnancy.”3

Kotelchuck Index

Also called the Adequacy of Pregnancy Care Utilization Index. The index is used to measure prenatal care levels. The Ko-telchuck Index is derived from a ratio of actual to recommended number of visits, according to the infant’s gestational age at delivery. Women with adequate prenatal care began prenatal visits during the 1st trimester and had an appropriate number of prenatal care visits according to infant gestational age.1

Low Birth Weight Low Birth Weight Infants who weigh less than 2500 grams at birth.

Overweight BMI (Body Mass Index) was calculated from the mother’s self-reported pre-pregnancy weight and height and was determined by dividing her weight (in kg) by height square (in meters). A mother with a BMI of 25 or more was classified as being over-weight.4

Payer of Prenatal Care

Mother could choose up to 6 options for the payer of their prenatal care, including Indian Health Service (IHS) with or without other payers, Medicaid with or without other private insurance but without IHS, private insurance only, or none of the payers (i.e., no insurance at all).

Postpartum After childbirth.

Preconception Preconception Before conception/pregnancy.

Prenatal renatal The period of time between conception and birth (usually 9 months).

Preterm Birth Preterm Birth Infants with gestational age less than 37 completed weeks.

Stress, Emotional Stress, emotional The mother answered “yes” to any of the following: A close family member was very sick and had to go into the hospital; Someone very close to her died.

Stress, Financial Stress, financial The mother answered “yes” to any of the following: She had a lot of bills she couldn’t pay; Her husband/part-ner lost his job; She lost her job; She moved to a new address.

Stress, Part-ner-related

Stress, partner-related The mother answered “yes” to any of the following: She was separated/divorced from husband/part-ner; She argued with husband/partner more than usual; Husband/partner said he didn’t want her to be pregnant.

Stress, Traumatic The mother answered “yes” to any of the following: Someone close to her had a problem with drinking or drugs; Husband/partner went to jail; She was in a physical fight; She was homeless.

Notes:1. New Mexico Pregnancy Risk Assessment Monitoring System Surveillance Report 2004-2005 Births.2. Naimi TS, Brewer RD, Mokdad AH, Denny C, Serdula M, Marks JS. Binge drinking among adults. JAMA 2003; 289:0-75.3. CDC definition of pregnancy: "http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/index.htm" http://www.cdc.gov/reproductivehealth/Unintended-

Pregnancy/index.htm4. CDC BMI guidelines: "http://www.cdc.gov/nccdphp/dnpa/obesity/defining.htm" http://www.cdc.gov/nccdphp/dnpa/obesity/defining.htm

How to Read the Tables

What is a confidence interval? In the tables, the confidence interval is depicted by “Error bars” on each bar graph (the dark line drawn through the gray bar graph). As with all surveys, there is some uncertainty associated with the results because not every New Mexico Navajo mother completed the survey. This uncertainty is represented by error bars or confidence inter-vals. Confidence intervals will vary between narrow inter-vals (more precise) and wide intervals (less precise). The tables in this report are based on a 95% confidence interval with the width of the interval indicating how much “Confi-dence” we have that the inter-val contains true values. For example, in the sample page at right we are 95% confident that the actual percentage of all New Mexico Navajo mothers whose pregnancy was unintended falls between 47.3% and 55.8%. A very wide interval is depicted by strikethroughs in the tables and indicates that the value is less precise, therefore, must be used with caution. A narrow con-fidence interval indicates that the data are considered more precise, therefore, more trustworthy. Determination of which intervals are narrow and which are wide is based on several statistical factors, including the number of respondents.

What is the p-value or statistical significance? For this re-port the Rao-Scott Chi-Square statistic was used to test the association between a maternal characteristic and a maternal health topic. The Chi-Square test results in a p-value that de-termines if the association between the maternal characteristic and the maternal health topic was “statistically significant.” If the calculated p-value was less than 0.05 (<0.05), then the association was considered to be statistically significant, in other words, the percentage value of the maternal health topic is different for the levels of the maternal characteristic. In this sample table, the Chi-Square tested the association between “Unintended pregnancy resulting in live birth” (Maternal health topic) and “Age” (Maternal characteristic). The calcu-lated p-value for this test was <0.05, making it statistically significant. Therefore, “Unintended pregnancy” is significantly

p-value, which indicates how much confidence we can have that the association is real and not due to chance alone. In this report, we use a p-value of 0.05 as the cut-off point for statistical significance; that is, a p-value less than 0.05 (which is the same as 5%) indicates that a statistically significant association has been found.

Definition of Factors

The following factors and definitions were used in the New Mexico PRAMS survey:

different depending on the “Age” of the mother. In this case, the younger the mother, the higher the percentage of unin-tended pregnancies.

Data Comparisons

The following data (on the next two pages) are from mothers who participated in the 2005-2011 New Mexico PRAMS survey, including Navajo mothers, and the 2008 national PRAMS data.1 The New Mexico data were sub-grouped into: 1) New Mexico Navajo mothers, 2) New Mexico other Native Americans (Non-Navajo) mothers, and 3) New Mexico all mothers. The national PRAMS data included mothers from 29 states.

The purpose of the table is to summarize and compare mater-nal behaviors and experiences between New Mexico Navajo mothers and other mothers in New Mexico and the U.S. Comparisons such as these can show us if Navajo mothers’ experiences are different and to identify and target needs.

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

data comparisonsMaternal Behaviors and Experiences of Women who Participated in the

New Mexico PRAMS (2005-2011) and National PRAMS (2008) Surveys

Maternal Behavior/Experience

NM Navajo Mothers(N=598)

(%)

NM Native AmericanMothers who are not

Navajo(N=386)

(%)

NM All Mothers(N=9091)

(%)

National PRAMS2008

(N=41,709)(%)

Alcohol UseFrequent or binge alcohol use in the 3 months before pregnancy 16.5 25.8 20.5 19.2

Alcohol Use in last Trimester of Pregnancy 4.3 6.5 6.2 6.5

BreastfeedingEver breastfed- initiation 83.8 86.8 85.6 75.7

Breastfed for at least 2 months duration 60.8 66.4 60.1 DNC

Breastfeeding class after delivery 11.5 18.8 15.5 DNCContraception Use

Did not use contraception at time of conception (among those not

trying to get pregnant)61.6 59.7 50.8 DNC

Postpartum contraception use 76.6 80.4 84.9 82.4Diet and Nutrition

Prepregnancy overweight 56.9 52.7 43.7 DNCDiabetes that started

before pregnancy 2.8 5.0 2.5 2.4

Diabetes that started during pregnancy 13.6 11.3 8.6 9.7

Food insufficiency - sometimes or often did not have enough food

to eat20.4 15.9 13.2 DNC

WIC services during pregnancy 69.5 66.3 56.1 46.7Families FIRST Services

Families FIRST services during pregnancy 5.4 3.7 8.4 DNC

Families FIRST services after delivery 4.4 5.3 7.0 DNC

Folic Acid/Multivitamin UsePreconception daily

multivitamin use 24.2 23.7 27.5 29.5

Home Visiting ServicesHome visiting services during

pregnancy 13.5 14.8 7.4 DNC

Home visiting services after delivery 34.4 25.0 13.9 DNC

Infant Sleep PositionUsually placed their infant to sleep

on his/her back 94.9 84.9 70.1 67.1

Neonatal Intensive Care Unit (NICU)Baby was put in neonatal intensive

care after birth 9.5 10.3 11.6 20.5

Maternal Behaviors and Experiences of Women who Participated in theNew Mexico PRAMS (2005-2011) and National PRAMS (2008) Surveys

Maternal Behavior/Experience

NM Navajo Mothers(N=598)

(%)

NM Native AmericanMothers who are not

Navajo(N=386)

(%)

NM All Mothers(N=9091)

(%)

National PRAMS2008

(N=41,709)(%)

Oral HealthOral health discussion during

pregnancy 52.8 56.6 44.7 DNC

Oral health services during pregnancy - went to dentist or

dental clinic37.3 44.5 39.1 DNC

Phyiscal AbusePhysical abuse by husband or part-ner in the year before pregnancy 8.2 7.6 5.0 3.8

Physical abuse by husband or part-ner in the year before baby’s birth 7.0 6.2 4.0 2.7

Postpartum DepressionSymptoms of postpartum

depression 20.1 14.7 15.4 DNC

Prenancy IntentionAn unintended pregnancy

resulting in live birth 51.5 56.1 45.3 41.6

An unwanted pregnancy 16.4 18.2 10.9 10.2Prenatal Care

Medicaid Coverage for prenatal care 70.3 69.6 52.1 41.6

Late (after 1st trimester) or no prenatal care reported from birth

certificate43.1 35.9 24.8 17.4

Adequate prenatal care (Ko-telchuck Index) - see definitions 49.4 49.3 64.6 72.6

Stress During PregnancyEmotional stress 34.9 41.0 31.4 30.8Financial stress 56.2 49.1 54.8 49.8

Partner-related stress 36.6 42.6 34.2 31.6Traumatic stress 33.7 32.6 23.7 19.5

Tobacco/Cigarette UseCigarette smoking in the 3 months

before pregnancy 16.8 17.5 21.6 23.9

Cigarette smoking in the last trimester of pregnancy 4.3 6.4 8.5 14.3

Cigarette smoking after delivery 7.7 9.7 14.1 18.9Smoking cessation program

during pregnancy 1.8 0.5 1.4 DNC

Smoking cessation program after delivery 0.7 1.3 1.1 DNC

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

DemographicsDemographics are the characteristics of a population. For this report, the population is comprised of the 598 Navajo mothers who participated in the New Mexico PRAMS survey from 2005-2011. The demographics collected were age, level of education, marital status, county of residence, income, Women, Infants and Children (WIC) program enrollments, and health insurance coverage. The graphs below show the following about the New Mexico Navajo mothers in this report.

the graphs below show the following about the new mexico navajo mothers in this report:

• Most had at least a high school education.• Most were between 20-34 years of age.• Most were not married.• Most lived in either McKinley or San Juan coun-

ties.• Most had incomes below 185% of the Federal Pov-

erty Level

level of education

marital status county of residence

<20 years20-24 years25-34 years35+ years

17.1%

31.5%

42.6%

8.9%

married not married

27.8%

40.5

31.7%

25.8%

74.3%

less than high school high school graduate

more than high school

mckinley/san juanother nm counties

74.1%

25.9%

age group

The majority of the 598 Navajo mothers who participated in the New Mexico PRAMS survey were (42.6%) 20-34 years old, 40.5% had at least a high school education but not college, 74.3% were not married, 25.9% resided in McKinley/San Juan counties (the two major New Mexico counties overlapping the Navajo Nation), and 6.3% had a low level of income. The ma-jority of mothers was enrolled in the WIC program during pregnancy, and had Medicaid as the major payer of prenatal care.

1615

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

wic enrollment during pregnancy

preconception insurance coverage

prenatal insurance coverage

100% or lower101-185%186% or higher

63.0%

19.0%

18.1%

noyes

30.2%

69.8%

medicaid/ not ihsmedicaid with ihsihs/ not medicaidother none

22.4%

17.9%

33.1%

4.7%

21.9%medicaid/ not ihsmedicaid with ihsihs/ not medicaidother none

41.3%

29.0%

20.9%

6.7%2.1%

income as percent of federal poverty level

Compared to the previous Navajo PRAMS Report from 2000-2004, there was a higher percentage of respondents in the 2005-2011 report that had incomes under the Federal Poverty Level (64% vs. 52%), a higher percentage were enrolled in Med-icaid before pregnancy (40% vs. 30%), a higher percentage were enrolled in Medicaid during pregnancy (68% vs. 59%), and a smaller percentage reported I.H.S. as a payer of prenatal care (48% vs. 56%).

Key Findings

Preconception

• A high prevalence of Navajo mothers did not use contraception at conception. 62% of Navajo mothers who said they were not trying to get pregnant were not using contraception.

• Unintended pregnancy. Over half of Navajo mothers (52%) did not intend to get pregnant. Navajo moth-ers who were younger and unmarried were more like-ly to report an unintended pregnancy.

• Low multivitamin use during the month before preg-nancy. 61% of Navajo mothers did not take a multi-vitamin or prenatal vitamin; only 24% took a mul-tivitamin daily during the month before pregnancy.

• Overweight. The data indicate that BMI was too high for 57% of Navajo mothers. The mothers who were overweight were older, had higher levels of education, and were married.

• 3% of Navajo mothers reported having pre-exist-ing diabetes, and 14% developed diabetes during pregnancy (gestational diabetes). Navajo women who were married, older, and reported I.H.S. as a pay-er of prenatal care were significantly more likely to have gestational diabetes.

Preconception is the period before pregnancy. The health of women during preconception is important for conception and for healthy births. Unhealthy behaviors and experiences before pregnancy can put the mother and child at risk for adverse birth and health outcomes.

The New Mexico PRAMS survey assessed for the preconception period were multivitamin use (folic acid), unintended and unwanted pregnancy, contraception use, prepregnancy weight and diabetes, alcohol and tobacco use, and physical abuse.

The data collected in the preconception period here identify four major health areas that we can work to improve: 1) contra-ception use/unintended pregnancy, 2) multivitamin use, 3) prepregnancy weight, and 4) diabetes.

17 18

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Preconception Multivitamin useBy maternal characteristic Percent of mothers who took a multivitamin or prenatal vitamin daily during the month before pregnancy

2005-2011All NM Navajo Mothers (n=593)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidNone

% Lower Upper24.2 20.9 27.9

28.9 20.8 38.7

26.1 20.1 33.0

21.9 17.2 27.5

20.2 11.9 32.2

26.0 19.9 33.3

25.6 20.4 31.6

19.3 14.3 25.6

22.9 16.9 30.4

24.7 20.8 29.0

26.1 22.2 30.5

19.0 13.4 26.3

24.2 19.9 29.0

21.7 14.9 30.4

23.8 16.5 33.0

20.6 17.4 32.0

25.5 21.4 30.1

23.9 17.4 32.0

31.8 23.6 41.4

23.2 17.7 29.9

20.2 14.1 26.0

0 5 10 15 20 25 30 35 40 45 50

Folic acid is a B-vitamin. Taking a multivitamin containing folic acid before pregnancy can help prevent Neural Tube Defects (NTD), that is a birth defect characterized by mal-formations of the spine and brain. A quarter, 24% of Navajo mothers took a prenatal or multivitamin daily in the month before pregnancy, an increase from 20% percent in the

2000-2004 report. The table also indicates that this behavior did not vary significantly by the demographic characteristics shown in the table, including age, education, marital status, region of residence, income, WIC enrollment, or payer of preconception care.

No Preconception Multivitamin UseBy maternal characteristic Percent of mothers who did not take a multivitamin or prenatal vitamin during the month before pregnancy

2005-2011All NM Navajo Mothers (n=584)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidNone

% Lower Upper61.0 56.8 65.1

60.5 50.2 70.0

61.4 53.9 68.3

60.8 54.3 66.8

61.5 46.0 75.0

58.1 50.1 65.6

65.3 58.6 71.4

59.0 51.4 66.1

58.1 49.7 66.0

62.0 57.1 66.6

58.7 53.8 67.9

67.6 59.4 74.8

62.7 57.2 67.9

63.4 53.6 72.3

56.3 46.2 66.0

58.2 50.3 65.6

62.6 57.6 67.4

61.3 52.3 69.7

54.1 43.9 64.1

63.4 56.2 70.1

63.5 54.5 71.7

0 10 20 30 40 50 60 70 80 90 100

Almost two-thirds, 61%, of Navajo mothers did not take a multivitamin or prenatal vitamin before conception and was unchanged from the previous report on data from 2000-

2004. The percentage did not vary significantly by demo-graphic characteristics of the mother.

19 20

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Unintended Pregnancy Resulting in Live BirthBy maternal characteristic Percent of mothers who wanted to be pregnant at a later time or not at all

2005-2011All NM Navajo Mothers (n=584)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidNone

% Lower Upper51.5 47.3 55.8

67.8 57.6 76.6

49.2 41.8 56.6

50.1 43.7 56.6

35.0 22.4 50.2

58.3 50.2 65.9

52.4 45.7 59.1

44.3 37.0 51.9

39.4 31.5 47.9

55.6 50.6 60.4

51.7 46.7 56.6

51.1 42.7 59.5

54.0 48.4 59.5

49.3 39.0 59.6

40.9 31.5 51.1

49.7 42.0 57.4

52.8 47.7 57.9

56.4 47.5 65.0

56.7 46.3 66.6

45.3 38.1 52.7

52.8 43.7 61.7

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Unwanted PregnancyBy maternal characteristic Percent of mothers who did not want to be pregnant then or at any time in the future

2005-2011All NM Navajo Mothers (n=584)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidNone

% Lower Upper16.4 13.5 19.8

13.8 8.3 22.2

12.0 8.0 17.8

22.5 17.4 28.7

9.0 4.1 18.7

18.3 13.0 25.1

16.0 11.6 21.8

14.8 10.2 21.1

13.4 8.6 20.4

17.4 13.9 21.4

16.7 13.3 20.7

15.5 10.4 22.6

16.8 13.0 21.4

13.4 7.8 22.2

16.6 10.2 25.8

21.9 16.1 29.0

14.1 10.9 18.1

20.1 14.1 27.8

16.9 10.2 26.6

11.7 7.9 17.0

18.9 12.6 27.4

0 10 20 30 40 50

* p < 0.05

In the previous table on “Unintended pregnancy,” Navajo mothers indicated wanting to be pregnant later or not at all. In this table on “Unwanted pregnancy,” Navajo mothers indicated not wanting to be pregnant then or at any time in the future. According to this table, 16% (16% from previous

report) of Navajo mothers said their pregnancy was unwanted. Navajo mothers aged 25-34 years were significantly more likely to have had unwanted pregnancies, as were mothers who were not enrolled in the WIC program during pregnancy.

21 22

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Not Using Contraception

By maternal characteristicAmong mothers who said they were not trying to get pregnant,

percent who were not using contraception at conception

2005-2011All NM Navajo Mothers (n=584)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidNone

% Lower Upper61.6 56.4 66.6

54.5 42.7 65.8

64.3 55.3 72.5

61.4 52.8 69.4

73.4 53.0 87.1

68.3 59.0 76.3

62.0 53.8 69.5

53.2 42.8 63.4

66.8 53.8 77.7

60.6 54.8 66.1

61.2 55.0 67.0

62.8 52.4 72.2

65.5 58.9 71.6

60.5 47.2 72.4

48.1 34.4 62.1

53.1 43.3 62.6

65.2 59.0 71.0

70.6 59.8 79.5

44.6 33.0 56.8

68.0 58.6 76.1

60.1 48.8 70.4

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Among Navajo mothers who would have liked to delay their pregnancy, 62% (65% previous report) were not using any method of contraception when they became pregnant. Navajo women with a higher level of education were somewhat more likely to use contraception, as were women with higher

Overweight During PreconceptionBy maternal characteristic Percent of mothers whose Body Mass Index (BMI) was above a healthy range

2005-2011All NM Navajo Mothers (n=584)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidNone

% Lower Upper56.9 52.6 61.1

23.4 15.4 34.0

57.2 49.8 64.3

67.9 61.8 73.6

66.2 49.5 79.6

46.5 38.7 54.6

58.3 51.5 64.9

65.4 58.1 72.0

65.0 56.7 72.4

54.2 49.3 59.1

56.7 51.7 61.5

57.5 49.1 65.6

56.7 51.2 62.1

59.4 49.0 69.0

60.6 50.4 70.0

58.9 51.0 66.4

56.0 50.9 61.0

50.9 41.9 59.7

57.1 46.6 67.0

62.5 55.2 69.2

57.1 47.9 65.8

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Over one-half, 57% (54% from previous report), of Navajo mothers reported being overweight before pregnancy. Navajo

income. However, the only statistically significant association was between contraceptive use and payer of preconception health care. Navajo women receiving Medicaid benefits and I.H.S. healthcare services were more likely to be using contra-ception.

women were significantly overweight if they were older, had more than high school education, or were married.

23 24

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Pre-Existing DiabetesBy maternal characteristic Percent of mothers with diabetes before pregnancy

2005-2011All NM Navajo Mothers (n=584)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidNone

% Lower Upper2.8 1.7 4.4

2.3 0.9 6.0

3.1 1.5 6.0

8.3 3.4 18.7

1.2 0.3 4.7

3.5 1.8 6.9

3.4 1.7 6.9

4.1 1.9 8.8

2.3 1.3 4.2

3.0 1.8 5.0

2.2 0.7 6.5

1.9 0.9 4.0

1.0 0.2 6.8

5.8 2.6 12.4

3.9 1.9 8.0

2.3 1.2 4.2

1.8 0.5 6.7

3.7 1.4 9.6

3.0 1.4 6.5

2.0 0.7 6.2

0 5 10 15 20

Pre-existing diabetes appears to be higher among Navajo mothers who were older and had a higher income level, but none of the maternal characteristics were statistically signifi-

Frequent or binge alcohol use in the 3 months before pregnancyBy maternal characteristic Percent of mothers who had 5+ drinks in one sitting or drank 7 or more times per week

2005-2011All NM Navajo Mothers (n=584)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidNone

% Lower Upper16.5 13.5 19.9

6.6 3.2 14.4

20.9 15.0 28.3

20.2 15.6 25.8

4.9 1.6 14.4

17.3 12.2 23.9

12.4 8.3 18.3

21.1 15.7 27.9

15.6 10.3 22.8

16.8 13.4 20.8

14.0 10.9 18.0

23.2 17.0 30.7

17.1 13.4 21.5

15.4 8.4 26.5

16.1 10.0 25.0

20.3 14.9 27.2

14.7 11.3 18.8

12.1 7.5 19.0

14.2 8.9 21.9

19.9 14.4 27.0

15.5 10.0 23.3

0 5 10 15 20 25 30 35 40 45 50

* p < 0.05

Sixteen percent (16% from previous report) of Navajo moth-ers reported that they were frequent or binge alcohol drinkers before becoming pregnant. Women who were in the 20-34

cantly associated with pre-existing diabetes. Overall, 3% of Navajo mothers reported having pre-existing diabetes.

years old age group, or did not live in McKinley or San Juan counties were statistically significantly more likely to drink frequently or binge drink.

25 26

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Cigarette smoking in the 3 months before pregnancyBy maternal characteristic Percent of mothers who smoked before they were pregnant

2005-2011All NM Navajo Mothers (n=585Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidNone

% Lower Upper16.8 14.0 20.0

16.6 10.6 25.0

19.5 14.5 25.8

17.6 13.4 22.9

5.1 1.6 14.8

21.0 15.5 28.0

15.1 11.1 20.1

15.7 11.2 21.7

10.2 6.1 16.4

19.0 15.6 22.9

15.5 12.4 19.1

20.5 14.8 27.7

17.5 13.9 21.8

15.1 9.3 23.4

17.6 11.3 26.3

20.2 14.9 26.7

15.5 12.3 19.3

13.5 8.6 20.5

17.7 11.5 26.1

19.5 14.5 25.7

12.9 8.4 19.5

0 5 10 15 20 25 30 35 40 45 50

* p < 0.05

Approximately 17% (14% previous report) of Navajo moth-ers smoked before becoming pregnant. Navajo women who

Physical abuse by husband or partner in the year before pregnancyBy maternal characteristic Percent of mothers who were slapped, hit, kicked, punched, or choked

2005-2011All NM Navajo Mothers (n=585Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidNone

% Lower Upper8.2 6.1 10.9

5.0 2.1 11.4

6.8 4.0 11.4

10.9 7.3 16.0

7.1 2.6 17.6

5.1 2.7 9.6

9.0 5.7 13.9

9.0 6.1 11.6

7.4 3.9 13.6

8.4 6.1 11.6

9.8 7.1 13.2

3.9 2.0 7.7

11.1 8.0 15.2

5.8 2.8 11.8

3.3 1.2 8.5

8.3 5.2 13.1

8.1 5.6 11.6

9.4 5.3 16.2

9.6 4.6 18.9

9.6 6.1 14.8

5.0 2.4 9.9

0 5 10 15 20 25 30 35 40 45 50

* p < 0.05

Approximately 17% (14% previous report) of Navajo moth-ers smoked before becoming pregnant. Navajo women who

were not married were significantly more likely to smoke than were married women.

27 28

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Prenatal

This section describes behaviors and experiences during pregnancy. The New Mexico Navajo mothers’ data in this survey identified four areas of concern during pregnancy were late prenatal care, gestational diabetes, physical abuse, and food insufficiency.

Key Findings

• 43% of Navajo mothers did not receive prenatal care beginning in the first trimester, and only half (49%) received adequate or adequate-plus pre-natal care. Younger Navajo mothers and those who were not married were less likely to receive time-ly prenatal care.

• 14% of Navajo mothers developed diabetes during pregnancy. This puts their health and the health of their baby at risk. Being overweight is a risk factor for gestational diabetes. Excess sugar in the blood causes the baby to put on too much weight which can result in problems during deliv-ery, as well as weight problems throughout life. Mothers age 25 and above had the highest rates of gestational diabetes.

• 8% of Navajo mothers experience physical abuse during the prenatal period, reporting that they were slapped, hit, kicked, punched, or choked by their husband or partner during pregnancy.

• 20% of Navajo mothers reported that they did not always have enough food to eat during pregnancy. Navajo mothers with a lower level of education and low income mothers were more likely to not always have sufficient food to eat.

Late (after 1st trimester) or no prenatal care

By maternal characteristicPercent of mothers with no prenatal care or with prenatal care starting after the

first trimester ( as calculated on the NM birth certificate

2005-2011All NM Navajo Mothers (n=585Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper43.1 38.8 47.4

55.8 45.6 65.6

45.2 37.6 53.1

37.7 31.4 44.4

35.0 21.7 51.2

43.4 35.6 51.6

46.4 39.7 53.3

37.6 30.3 45.5

29.9 22.5 38.6

47.2 42.3 52.3

44.5 39.6 49.5

38.7 26.0 46.3

43.8 38.3 49.5

40.8 30.9 51.6

35.5 30.4 47.7

45.1 37.4 53.1

42.2 37.1 47.5

42.9 36.3 49.8

43.2 34.8 52.0

42.7 33.8 52.0

46.4 30.4 63.3

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Approximately 43% (41% previous report) of Navajo moth-ers received prenatal care after the first trimester or received no prenatal care. Younger Navajo mothers and those who

were not married were significantly more likely to obtain late or no prenatal care.

29 30

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Adequate prenatal care (Kotelchuck Index)By maternal characteristic Percent of mothers who receive an adequatel level of prenatal care

2005-2011All NM Navajo Mothers (n=585Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper49.4 45.0 53.7

40.0 30.3 50.5

45.2 37.7 52.9

54.2 47.5 60.7

59.1 43.2 73.3

46.0 38.0 54.2

44.6 38.0 51.4

59.6 51.7 67.0

65.7 57.2 73.3

44.1 39.2 49.1

50.2 45.2 55.1

46.8 38.1 55.6

46.2 40.7 51.9

56.4 45.7 66.5

60.9 50.3 70.5

47.6 39.9 55.4

50.3 45.1 55.6

47.5 40.7 54.3

51.5 42.9 60.0

46.3 37.3 55.6

47.9 31.7 64.7

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Approximately 50% (52% previous report) of Navajo moth-ers received adequate or adequate-plus prenatal care according to the Kotelchuck Index, which is a ratio of actual to recom-mended number of visits based upon the infant’s gestational age at delivery (see definition of factors on page 12). Navajo

Alcohol use in last trimester of pregnancyBy maternal characteristic Percent of mothers who had one or more drinks during the last three months of pregnancy

2005-2011All NM Navajo Mothers (n=590)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper4.3 3.0 6.2

2.7 0.9 7.8

6.5 3.7 11.1

3.6 2.0 6.6

3.6 0.9 13.4

5.3 2.9 9.5

4.3 2.4 7.8

3.5 1.7 7.3

2.6 1.0 6.6

4.9 3.3 7.3

4.4 2.8 6.8

4.1 2.1 7.9

5.4 3.5 8.2

1.4 0.4 5.3

4.1 1.6 10.2

6.6 3.8 11.3

3.4 2.1 5.6

7.0 4.4 11.1

1.1 0.3 4.2

2.8 0.9 8.1

6.7 2.2 18.9

0 2 4 6 8 10 12 14 16 18 20

* p < 0.05

Four percent (5% previous report) of Navajo mothers said they consumed alcohol during the last 3 months of pregnan-

mothers with education beyond high school, married wom-en, and those with a higher level of income were statistically significantly more likely to receive adequate/adequate-plus prenatal care.

cy. Navajo mothers receiving health care through I.H.S. were significantly less likely to report alcohol use in late pregnancy.

31 32

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Cigarette smoking in the last trimester of pregnancyBy maternal characteristic Percent of mothers who smoked cigarettes during the last trimester of pregnancy

2005-2011All NM Navajo Mothers (n=585Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper4.3 3.0 6.1

4.8 2.0 11.2

6.1 3.6 10.1

3.4 1.7 6.4

1.5 0.2 9.6

6.1 3.3 10.9

4.4 2.5 7.5

2.6 1.2 5.6

1.5 0.5 4.5

5.2 3.5 7.6

4.7 3.2 7.0

3.1 1.3 6.9

5.7 3.8 8.6

1.5 0.4 5.7

1.2 0.2 7.5

4.2 2.1 8.0

4.4 2.8 6.7

4.4 2.4 7.8

4.8 2.5 9.1

4.6 2.1 9.8

3.6 0.9 13.1

0 2 4 6 8 10 12 14 16 18 20

* p < 0.05

Approximately 4% (4% previous report) of Navajo mothers reported smoking cigarettes during their last trimester of preg-nancy. Navajo mothers who were not married were signifi-

Physical abuse by husband or partner during pregnancyBy maternal characteristic Percent of mothers who were slapped, hit, kicked, punched, or choked

2005-2011All NM Navajo Mothers (n=590Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper7.0 5.0 9.6

2.7 0.9 8.0

5.9 3.3 10.3

9.9 6.3 15.1

5.8 1.9 16.5

6.2 3.5 10.9

6.1 3.3 10.9

9.0 5.4 14.7

6.9 3.5 13.3

7.0 4.8 10.0

7.5 5.2 10.8

5.3 2.7 10.2

8.5 5.8 12.3

6.5 2.8 14.1

3.2 1.2 8.2

6.0 3.4 10.4

7.3 4.8 10.7

6.7 4.0 11.1

8.6 4.7 15.2

9.2 5.0 16.2

0.0 0.0 0.0

0 5 10 15 20 25 30 35 40 45 50

Approximately 7% (11% previous report) of Navajo mothers reported that they were physically abused by their husband or partner during pregnancy. A higher proportion of low income

cantly more likely to report cigarette smoking, as were women with lower income.

Navajo mothers experienced physical abuse compared with higher income mothers, although income was not found to be statistically significant.

33 34

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Oral health discussion during pregnancyBy maternal characteristic Percent of mothers who recalled that a health care worker talked about care of teeth and gums during pregnancy

2005-2011All NM Navajo Mothers (n=586)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper52.8 48.5 57.0

60.5 49.9 70.2

53.1 45.7 60.4

47.1 40.7 53.6

62.6 47.7 75.4

48.2 40.3 56.2

57.4 50.6 63.9

50.1 42.6 57.5

46.1 38.0 54.5

54.9 50.0 59.8

49.5 44.6 54.4

61.9 53.5 69.7

53.0 47.5 58.4

48.7 38.5 58.9

54.7 44.6 64.3

52.5 44.7 60.2

52.6 47.4 57.6

58.0 51.4 64.4

53.7 45.4 61.7

44.5 35.7 53.8

45.6 29.7 62.5

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Approximately 53% (29% previous report) of Navajo moth-ers recalled discussion with a health care worker about how to care for their teeth and gums during pregnancy. Navajo

Oral health service during pregnancy By maternal characteristic Percent of mothers who went to a dentist or dental clinic during pregnancy

2005-2011All NM Navajo Mothers (n=589)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper37.3 33.2 41.5

47.9 37.8 58.3

32.0 25.2 39.7

37.8 31.8 44.2

33.0 21.2 47.3

34.6 27.4 42.6

36.5 30.1 43.3

40.2 33.1 47.7

38.3 30.6 46.6

36.9 32.3 41.8

36.2 31.6 40.8

40.2 32.2 48.6

35.4 30.3 58.4

33.9 24.8 44.5

51.0 41.0 61.0

34.7 27.8 42.4

37.8 32.9 42.9

37.0 30.8 43.6

39.1 31.2 47.6

34.3 26.3 43.3

41.1 25.9 58.2

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Over a third, 37% (24% previous report), of Navajo mothers reported that they went to a dentist or dental clinic during pregnancy. Navajo mothers with a higher income level were significantly more likely to visit a dentist. The table and the

mothers not living in McKinley or San Juan counties were statistically significantly more likely to report such discussion.

previous table show marked improvement over time in dental care during pregnancy, but further education and access to dental services is needed.

35 36

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

WIC service during pregnancyBy maternal characteristic Percent of mothers who received prenatal services from the Women, Infants and

Children (WIC) program during pregnancy

2005-2011All NM Navajo Mothers (n=589)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper69.5 65.5 73.3

73.7 64.2 81.4

77.6 71.0 83.1

64.2 57.7 70.2

59.6 44.0 73.5

70.5 62.8 77.1

72.0 65.4 77.7

64.8 57.2 71.8

63.6 55.1 71.3

71.5 66.8 75.7

69.6 64.8 73.9

69.5 61.2 76.8

75.3 70.2 79.8

76.0 66.8 83.2

42.4 32.9 52.4

0.0100.0

78.3 72.5 83.1

78.8 70.8 85.0

60.0 50.6 68.7

40.2 25.5 56.8

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Most Navajo mothers 70 % (70% previous report) received prenatal WIC services. This table shows that younger Navajo mothers, those with low income levels, and those enrolled in

Home visiting services during pregnancyBy maternal characteristic Percent of mothers who received prenatal home visiting services

2005-2011All NM Navajo Mothers (n=584)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper13.5 10.8 16.7

23.6 15.8 33.7

11.3 7.3 16.9

11.7 8.2 16.3

9.5 4.0 21.0

16.1 12.7 23.3

15.4 11.3 20.7

8.9 5.6 13.9

14.1 9.3 20.8

13.3 10.3 17.0

16.1 12.7 20.0

6.3 3.4 11.5

15.1 11.6 19.3

11.3 5.9 20.7

11.0 6.0 19.3

12.0 7.9 17.7

14.1 10.8 18.0

11.9 8.2 17.1

9.5 6.0 14.7

24.8 17.7 33.8

9.1 2.9 25.1

0 5 10 15 20 25 30 35 40 45 50

* p < 0.05

In this table, we see that 14% (7% previous report) of Navajo mothers had home visiting services during pregnancy. Navajo mothers who were younger, or lived in McKinley/San Juan

Medicaid were more likely to receive WIC services; all three factors were statistically significant.

counties, or received services through I.H.S. and were not enrolled in Medicaid were statistically significantly more likely to receive these visits.

37 38

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Smoking cessation program during pregnancy By maternal characteristic Percent of mothers who participated in a smoking cessation class or support group during pregnancy

2005-2011All NM Navajo Mothers (n=569)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper1.8 0.9 3.4

1.2 0.2 7.6

1.2 0.3 4.9

2.9 1.3 6.3

0.0

2.9 1.1 7.3

0.7 0.2 2.6

2.3 0.7 6.9

1.3 0.3 5.0

1.9 0.9 4.0

1.7 0.8 3.6

1.9 0.5 7.3

2.4 1.2 5.0

0.02.0 0.5 7.6

1.1 0.3 4.3

1.8 0.8 4.0

2.3 0.9 6.0

2.6 1.0 6.8

0.7 0.1 4.7

0.0

0 1 2 3 4 5 6 7 8 9 10

Approximately 2% (1% previous report) of Navajo mothers participated in a prenatal smoking cessation class or support group during pregnancy. Seventeen percent of Navajo moth-ers reported smoking before pregnancy (see page 32, Precon-

Families first services during pregnancyBy maternal characteristic Among Medicaid-eligible mothers, percent who received services from the Families FIRST program

2005-2011All NM Navajo Mothers (n=449)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper5.4 3.6 8.0

5.1 1.9 12.7

2.2 0.7 6.7

7.4 4.2 12.7

7.5 2.4 21.3

5.2 2.5 10.6

5.7 3.2 9.8

4.6 1.7 12.3

4.9 1.7 13.2

5.5 3.6 8.5

3.8 2.1 6.6

9.3 5.3 16.0

6.5 4.2 10.1

4.0 1.3 11.8

2.7 0.4 16.1

6.0 2.8 12.2

4.9 3.0 8.0

6.8 4.1 11.1

3.3 1.4 7.8

7.5 1.9 25.0

7.9 1.2 38.8

0 2 4 6 8 10 12 14 16 18 20

* p < 0.05

Five percent (5% previous report) of Navajo mothers enrolled in Medicaid participated in Families FIRST case manage-ment (a New Mexico state program for Medicaid-eligible pregnant women and their families) during pregnancy.

ception Tobacco Use). These data may indicate an unmet need for smoking cessation support services among pregnant Navajo mothers.

Women residing outside of McKinley or San Juan counties were significantly more likely to receive Families FIRST ser-vices, as were women under 100% of the federal poverty level.

39 40

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Gestational diabetesBy maternal characteristic Percent of mothers who developed diabetes during pregnancy

2005-2011All NM Navajo Mothers (n=584)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper13.6 10.9 16.9

5.5 2.5 12.0

9.9 6.2 15.3

18.3 13.6 24.0

21.0 11.1 36.1

9.6 5.9 15.2

15.3 10.7 21.3

14.6 10.1 20.6

19.0 13.0 26.8

11.9 9.0 15.5

13.9 10.7 17.8

12.9 8.3 19.5

15.2 11.5 19.8

17.7 11.2 26.7

7.2 3.6 19.5

12.6 8.4 18.4

14.1 10.8 18.3

9.3 6.4 13.5

18.5 12.7 26.1

18.3 11.6 27.7

7.4 2.4 21.2

0 5 10 15 20 25 30 35 40 45 50

* p < 0.05

Fourteen percent of Navajo mothers developed diabetes during pregnancy (also called gestational diabetes). Older mothers were significantly more likely to develop gestational

Emotional stress during pregnancyBy maternal characteristic Percent of mothers who experience emotional stress during pregnancy

2005-2011All NM Navajo Mothers (n=591)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper34.9 30.9 39.1

46.2 36.3 56.4

31.9 25.4 39.2

32.7 26.9 39.2

32.4 19.1 49.2

43.7 35.9 51.7

30.0 24.0 36.7

32.1 25.5 39.7

30.7 23.4 39.2

36.2 31.6 41.1

35.1 30.5 40.1

34.1 26.6 42.4

41.2 35.8 46.8

22.9 15.5 32.6

27.0 19.0 36.7

39.7 32.3 47.6

33.0 28.3 38.0

38.0 31.7 44.7

33.1 25.7 41.6

40.6 31.8 50.1

19.2 9.7 34.5

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Over one-third of Navajo mothers experienced emotional stress during pregnancy. In the PRAMS survey instrument, the mothers are asked of whether a close family member was very sick and had to go into the hospital, or someone very

diabetes, as were married mothers, and those receiving prenatal care through I.H.S.

close to her died. Those with less than a high school education and those with incomes below the federal poverty level were significantly more likely to experience emotional stress during pregnancy.

41 42

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Financial stress during pregnancy By maternal characteristic Percent of mothers who experienced financial stress during pregnancy

2005-2011All NM Navajo Mothers (n=593)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper56.2 52.0 60.4

53.7 43.5 63.6

54.7 47.2 62.1

56.9 50.4 63.1

63.6 48.9 76.2

60.8 52.9 68.2

51.2 44.5 58.0

58.1 50.6 65.3

54.0 45.7 62.0

57.0 52.0 65.3

56.4 51.5 61.2

55.8 47.3 63.9

60.5 55.1 65.7

51.1 40.9 61.3

47.0 37.1 57.0

53.0 45.3 60.6

57.7 52.6 62.6

59.3 52.7 65.6

59.2 50.8 67.2

61.5 52.4 69.9

40.3 25.5 57.2

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Partner-related stress during pregnancyBy maternal characteristic Percent of mothers who experienced partner-related stress during pregnancy

2005-2011All NM Navajo Mothers (n=592)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper36.6 32.6 40.8

36.1 27.1 46.2

34.2 27.5 41.5

40.8 34.6 47.3

27.7 15.3 44.8

35.3 28.1 43.2

36.2 29.9 43.1

37.6 30.6 45.2

30.0 23.0 38.1

38.7 34.0 43.7

35.0 30.4 39.8

41.1 33.0 49.6

41.8 36.4 47.4

35.0 26.1 45.1

23.1 15.8 32.4

38.4 31.0 46.3

35.6 30.8 40.6

35.9 29.8 42.6

39.3 31.4 47.7

36.1 27.8 45.3

32.5 19.3 49.2

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Over one-third (37%) of Navajo mothers experienced partner-related stress during pregnancy. This percentage was significantly lower than the 48% of Navajo mothers with

close to her died. Those with less than a high school education and those with incomes below the federal poverty level were significantly more likely to experience emotional stress during pregnancy.

partner-related stress in 2000-2004. Navajo mothers with lower income had significantly higher levels of partner-related stress.

43 44

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Traumatic stress during pregnancyBy maternal characteristic Percent of mothers who experienced traumatic stress during pregnancy

2005-2011All NM Navajo Mothers (n=592)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper33.7 29.8 38.0

38.0 28.4 48.6

31.8 25.2 39.1

33.6 27.7 40.0

33.2 19.8 49.9

37.9 30.3 46.0

28.6 22.7 35.4

35.8 28.9 43.3

30.9 23.7 39.2

34.7 30.0 39.6

34.9 30.3 39.9

30.5 23.3 38.9

36.3 31.0 41.9

33.2 24.1 43.6

28.0 20.1 37.4

36.7 29.4 44.6

32.5 27.8 37.6

33.4 27.3 40.2

34.7 27.2 43.1

40.6 31.8 50.1

18.2 9.1 33.2

0 10 20 30 40 50 60 70 80 90 100

One-third (34%) of Navajo mothers experienced the trau-matic stress of a loved one who had a problem with alcohol or drug abuse, a husband/partner was incarcerated, she was in a physical fight, or was homeless while pregnant.

Food Insufficiency

By maternal characteristic Percent of mothers who said their family often or sometimes did not have enough to eat in the 12 months before taking the survey

2005-2011All NM Navajo Mothers (n=589)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper20.4 17.2 24.1

26.8 18.8 36.7

16.6 11.8 22.7

18.6 14.1 24.1

28.7 16.6 44.9

27.1 20.6 34.7

20.2 15.2 26.4

13.4 9.2 19.2

17.2 11.8 24.2

21.5 17.7 25.8

21.9 18.1 26.3

16.2 11.0 23.3

26.0 21.4 31.2

13.6 8.4 21.3

9.1 4.9 16.3

21.0 14.9 28.8

20.0 16.4 24.2

21.8 17.5 26.7

20.7 13.1 31.2

21.6 14.7 30.6

14.2 4.8 35.5

0 5 10 15 20 25 30 35 40 45 50

* p < 0.05

Twenty percent (26% in previous report) of Navajo mothers reported that their families did not have sufficient food in the 12 months before completing the survey, which would have

This was significantly less than the 40% of Navajo mothers in the 2000-2004 report who experienced traumatic stress during pregnancy.

included the time when she was pregnant. Navajo mothers with fewer years of education were significantly more likely to suffer from insufficient food, as were low income mothers.

45 46

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Breastfeeding initiationBy maternal characteristic Percent of mothers who ever breastfed their new baby

2005-2011All NM Navajo Mothers (n=573)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper83.8 80.1 87.0

88.9 81.0 93.8

81.4 73.9 87.2

84.0 78.6 88.3

81.3 62.0 92.1

78.5 71.2 84.4

82.9 75.9 88.2

90.3 84.8 93.9

89.6 83.6 93.6

82.0 77.4 85.8

83.9 79.5 87.5

83.6 75.9 89.2

83.3 78.4 87.3

80.7 69.6 88.4

90.7 82.6 95.3

84.3 76.6 89.8

83.4 78.9 87.1

82.4 76.6 87.0

78.5 69.5 85.5

92.4 85.2 96.3

82.5 65.4 92.2

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Approximately 84% (84% previous report) of Navajo moth-ers who ever breastfed their infants, exceeded the Healthy People 2020 target of at least 81.9% for breastfeeding initiation. Navajo mothers with a higher level of education,

Postpartum

After pregnancy the health and behavior of mothers remain important for both the mother and child. For instance, breastfeeding is the optimal way to nourish and nurture infants, especially during the first 6 months of life. Infants that are breastfed have a decreased risk of asthma, Type 1 and 2 diabetes, and obesity. In addition, mothers who

breastfeed have a reduced risk of ovarian and breast cancers.

Other behaviors known to benefit mother and child are: 1) the use of contraception after pregnancy to help mothers prevent unintended pregnancy and space out pregnancy if women want to become pregnant in the future; 2) putting infants on their back to sleep in order to decrease the risk of SIDS (Sudden Infant Death Syndrome); and 3) the use of support services to educate and inform mothers of ways to improve their health and that of their child.

Behaviors and experiences assessed in the New Mexico PRAMS survey during postpartum were: breastfeeding, contraception use, infant sleep position, cigarette smoking, neonatal intensive care unit admission, postpartum depression, and support programs.

Key findings

• Breastfeeding initiation and duration are associ-ated with education level and marital status. From 2005-2011, 60.8% of Navajo mothers reported that they breastfed for at least 2 months. Navajo moth-ers with less education and who were not married were less likely to engage in this healthy behav-ior.

• Neonatal intensive care unit admissions were high-er (14%) for babies born to Navajo mothers re-siding elsewhere in New Mexico compared to those residing in McKinley or San Juan counties (8%).

• Postpartum depression was common among Navajo mothers, with 20% reporting symptoms of depres-sion after delivery. The percentages were similar among all the subgroups, except those not enrolled in WIC during pregnancy had a significantly higher rate of 26%.

• After pregnancy, the use of support services var-ied for Navajo mothers. The most widely used pro-grams were home visiting services at 34%, breast-feeding class at 11.5% or support group at 12%. The least used programs were smoking cessation programs at 0.7%, and Families FIRST case manage-ment at 4%.

those who were married, and those who received prenatal care through I.H.S. without Medicaid coverage were statistically significantly more likely to have breastfed their baby at least once.

47 48

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Breastfeeding duration By maternal characteristic Percent of mothers who breastfed for at least 2 months

2005-2011All NM Navajo Mothers (n=573)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper60.8 56.5 65.0

62.9 52.2 72.4

58.4 50.7 65.8

61.9 55.5 68.0

59.4 43.7 73.4

50.7 42.6 58.7

61.8 54.7 68.4

69.3 62.1 75.8

70.0 62.0 77.0

57.8 52.8 62.7

61.1 56.1 65.9

60.1 51.4 68.1

57.4 51.7 62.8

60.1 49.4 69.9

70.1 60.2 78.4

64.4 56.3 71.8

59.4 54.2 64.4

59.5 53.7 65.1

52.0 41.9 62.0

67.7 58.1 76.0

82.2 62.8 92.6

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Approximately 61% (58% previous report) of Navajo moth-ers continued breastfeeding their infants for at least 2 months following initiation. The maternal characteristics that showed a significant effect are education, marital status, and payer

Postpartum contraception use

By maternal characteristic Percent of women who were using any form of contraception at time of survey (2 to 6months postpartum

2005-2011All NM Navajo Mothers (n=584)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper76.6 72.7 80.1

81.9 72.0 88.9

77.8 71.1 83.2

76.9 71.0 81.9

61.7 45.3 75.8

68.7 60.8 75.7

79.6 73.0 84.8

79.4 72.6 84.9

71.1 62.8 78.2

78.4 73.9 82.4

75.9 71.3 80.0

78.5 70.8 84.7

75.5 67.2 81.8

80.9 71.2 87.9

76.3 66.2 84.1

75.2 67.2 81.8

77.3 72.7 81.3

73.0 64.6 80.0

78.6 67.3 86.8

79.4 72.8 84.8

76.4 56.9 88.9

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Approximately 77% (78% previous report) of Navajo moth-ers were using contraception 2 to 6 months after giving birth. The high percentage indicates that Navajo Mothers may be more careful about an immediate pregnancy after delivery.

of prenatal care. Navajo mothers with more education were significantly more likely to breastfeed their infants for at least 2 months, as were married Navajo mothers and those with no Medicaid coverage.

Use of contraception postpartum for these Navajo mothers was significantly lower among those with less than a high school education.

49 50

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Infant sleep positionBy maternal characteristic Percent of mothers who placed their baby on their back to sleep

2005-2011All NM Navajo Mothers (n=576)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper84.8 81.6 87.5

84.2 75.6 90.2

87.2 81.7 91.2

83.5 78.3 87.6

85.2 71.9 92.8

79.7 72.8 85.2

88.5 83.9 91.9

84.6 78.4 89.3

78.3 70.8 84.4

86.9 83.4 89.7

87.1 83.7 89.9

78.4 70.7 84.5

85.9 81.9 89.1

84.6 76.2 90.4

83.9 75.1 90.0

84.0 77.7 88.7

85.3 81.5 88.5

83.1 78.6 86.8

85.5 78.0 90.8

90.0 82.7 84.4

81.6 58.6 93.3

0 10 20 30 40 50 60 70 80 90 100

* p < 0.05

Most, 85% (78% previous report), of Navajo mothers placed their babies on their back to sleep which is the safest position for a sleeping infant, exceeding the Health People 2020 goal of 75.9%. Married Navajo women were significantly less likely than unmarried Navajo women to place their babies on

Cigarette smoking after deliveryBy maternal characteristic Percent of mothers who were currently smoking cigarettes

2005-2011All NM Navajo Mothers (n=586)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper7.7 5.8 10.1

8.6 4.6 15.5

8.2 5.2 12.7

7.8 4.9 12.1

3.7 0.9 13.7

9.9 6.2 15.6

6.6 4.2 10.4

7.1 4.2 11.8

5.5 2.6 11.3

8.3 6.2 11.2

7.5 5.4 10.3

8.0 4.6 13.7

7.0 4.9 10.1

13.0 7.6 21.4

4.6 1.8 11.4

9.2 5.8 14.2

7.0 4.9 10.0

8.2 5.7 11.7

6.6 3.3 12.9

8.3 4.2 15.8

8.0 2.0 27.1

0 5 10 15 20 25 30

Eight percent of Navajo mothers residing in New Mexi-co were smoking cigarettes after delivery (7% in previous report). There were no significant differences by maternal

their back to sleep. Women residing in McKinley or San Juan counties (in or near the Navajo Nation) were more likely to place their babies on their back than women residing in other regions of the state of New Mexico.

characteristics, but the percentages were higher among Navajo mothers under the age of 35 years.

51 52

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Infant in Neonatal Intensive Care Unit (NICU)By maternal characteristic Percent of mothers with a baby who was admitted to NICU

2005-2011All NM Navajo Mothers (n=588)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper9.5 7.3 12.3

11.1 5.9 19.9

7.0 3.8 12.4

11.5 8.1 16.0

5.8 2.2 14.5

11.8 7.5 18.0

7.1 4.5 11.0

10.1 6.2 16.0

10.4 6.4 16.4

9.2 6.7 12.5

7.8 5.7 10.6

14.0 8.8 21.5

9.3 6.5 13.1

9.5 4.9 17.6

10.2 5.9 17.1

9.4 6.1 14.1

9.7 6.9 13.3

11.0 7.8 15.3

9.1 5.0 16.0

6.0 2.9 12.0

9.4 3.1 25.5

0 5 10 15 20 25 30 35 40 45 50

* p < 0.05

Ten percent of infants born to Navajo mothers were admitted to a neonatal intensive care unit (NICU) after delivery. While this measure was not reported in the previous report, the

Postpartum depressionBy maternal characteristic Percent of mothers who had symptoms of postpartum depression

2005-2011All NM Navajo Mothers (n=598)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper20.1 16.9 23.9

20.9 13.6 30.9

13.9 9.5 19.7

24.4 19.2 30.4

20.8 10.0 38.3

20.6 14.8 27.9

20.2 15.0 26.7

19.6 14.4 26.2

20.0 14.2 27.4

20.2 16.4 24.6

19.7 16.0 24.1

21.3 15.1 29.0

20.9 16.5 26.1

13.6 8.0 22.2

26.0 18.3 35.5

25.8 19.3 33.5

17.5 13.9 21.8

17.1 13.2 21.9

22.5 14.4 33.3

25.3 17.8 34.6

22.3 9.5 43.7

0 5 10 15 20 25 30 35 40 45 50

* p < 0.05

Twenty percent of Navajo mothers reported symptoms of postpartum depression. The questions on symptoms of depression after delivery were first included in the PRAMS

percentage for the 2000-2004 report was 11%. Babies born to Navajo mothers residing outside of McKinley and San Juan counties had a higher rate of NICU admission.

survey in 2004, so there is no estimate from the previous report. Navajo women who were not enrolled in WIC were more likely to report symptoms of postpartum depression.

53 54

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Families FIRST services after delivery

By maternal characteristic Among Medicaid-eligible mothers, percent who received services from the FamiliesFIRST program after delivery

2005-2011All NM Navajo Mothers (n=440)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper4.4 2.8 6.6

5.7 2.4 12.9

3.1 1.3 7.1

3.5 1.7 7.3

10.7 4.0 25.7

5.5 2.7 10.7

4.7 2.5 8.5

2.6 0.9 7.8

3.2 1.0 9.2

4.7 2.9 7.3

4.3 2.6 7.2

4.4 2.1 9.0

5.2 3.2 8.2

2.2 0.6 8.1

4.6 1.2 16.2

3.1 1.1 8.2

4.7 3.0 7.5

4.5 2.5 7.9

3.4 1.5 7.5

6.2 1.5 22.0

8.6 1.3 41.1

0 2 4 6 8 10 12 14 16 18 20

Four percent of Navajo mothers received Families FIRST high-risk case management services after delivery (4% in

Home visiting services after deliveryBy maternal characteristic Percent of mothers who received home visiting services after delivery

2005-2011All NM Navajo Mothers (n=580)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper34.4 30.5 38.6

37.3 28.1 47.5

29.5 23.2 36.6

36.0 30.1 42.5

38.5 24.5 54.7

31.2 24.3 38.9

39.2 32.7 46.1

32.2 25.7 39.4

33.2 25.8 41.6

34.8 30.2 39.7

42.9 38.0 47.9

11.0 6.8 17.2

36.0 30.8 41.6

34.7 25.9 44.7

29.6 21.5 39.3

36.9 29.5 44.9

33.4 28.8 38.4

24.2 19.0 30.3

37.4 29.6 45.8

57.4 48.1 66.1

22.1 11.2 38.9

0 10 20 30 40 50 60 70 80 90 100

Approximately one-third, 34% (12% previous report), of Navajo mothers received home visits by a health worker after giving birth. A higher percentage of women living in McKin-ley or San Juan counties received home visiting services than

* p < 0.05

previous report). The percentages did not vary significantly by maternal characteristics.

those living in other New Mexico counties, as did those wom-en who were not enrolled in Medicaid and received prenatal care through I.H.S.

55 56

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Smoking cessation program after delivery

By maternal characteristic Percent of mothers who participated in a smoking cessation class or support group after delivery

2005-2011All NM Navajo Mothers (n=569)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper0.7 0.3 1.8

1.2 0.2 7.8

0.4 0.1 2.4

0.9 0.2 2.4

0.0

1.5 0.4 5.7

0.6 0.2 2.4

0.0

0.00.9 0.3 2.4

0.6 0.2 2.0

0.8 0.1 5.3

1.2 0.4 3.1

0.00.0

0.01.0 0.4 2.6

1.1 0.3 4.3

0.5 0.1 3.2

0.6 0.1 4.0

0.0

0 1 2 3 4 5 6 7 8 9 10

Less than one percent of Navajo mothers participated in a smoking cessation class of support group after giving birth. Because the number of mothers included in this table is small

Breastfeeding class after deliveryBy maternal characteristic Percent of mothers who participated in a postpartum breastfeeding class after delivery

2005-2011All NM Navajo Mothers (n=571)Age

<20 years20-24 years25-34 years35 or more years

Level of EducationLess than High SchoolHigh School graduateMore than High School

Marital StatusMarriedNot married

ResidenceMcKinley/San Juan CountiesOther NM Counties

Income as a Percent of Poverty100% or lower101-185%186% or higher

Enrolled in WIC during PregnancyNoYes

Payer of Prenatal CareMedicaid/not IHSMedicaid with IHSIHS/ not MedicaidOther

% Lower Upper11.5 9.1 14.5

13.2 7.8 21.6

14.5 9.8 20.9

8.7 5.8 13.0

11.3 5.1 23.1

7.6 4.4 12.8

9.9 6.6 14.6

16.2 11.2 22.7

13.7 9.0 20.3

10.8 8.1 14.3

9.7 7.2 13.0

16.4 11.1 23.6

9.7 6.9 13.5

13.0 7.5 21.5

16.4 10.2 25.1

7.7 4.4 13.1

13.3 10.3 17.1

9.7 6.4 14.6

14.3 9.6 20.9

12.1 7.3 19.4

10.3 3.9 24.9

0 5 10 15 20 25 30 35 40 45 50

* p < 0.05

Twelve percent (10% previous report) of Navajo mothers participated in a breastfeeding class or a support group after giving birth. The characteristics found to be significantly asso-ciated with participation were level of mother’s education and

(with only 1% of mothers in the survey saying “yes” to this question), it is not surprising that none of the maternal char-acteristics were significantly associated with participation.

region of residence. Navajo mothers with education beyond high school were more likely to have participated in a breast-feeding class, and mothers residing outside of the McKinley/San Juan County region.

57 58

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Discussion

The results in this report can be used to compare and monitor changes from the previous report (2000-2004) in behav-iors and experiences of Navajo mothers over the course of pregnancy. The results identified important health issues to address during each pregnancy period.

Preconception Behavior and experiences• Women who plan their pregnancy have been shown to have more healthy outcomes.

However, approximately two-thirds (62%) of Navajo mothers who were not trying to get pregnant failed to use contraception. Over half (52%) of Navajo mothers did not intend to become pregnant

• Most vitamins contain folic acid, an adequate intake of folic acid has been proven to be effective in reducing the occurrence of neural tube defects (defects of the brain, spine, or spinal cord). However, approximately two-thirds (61%) of Navajo mothers did not take a multivitamin or prenatal vitamin before pregnancy.

• In addition to addressing risk behaviors, an aim of preconception care is to identify and provide appropriate management of chronic health conditions that may affect the moth-er’s health during and after pregnancy and that may have a lifetime negative impact on infants. Among the pre-pregnancy health conditions assessed, the prevalence of being overweight was high (57%) among Navajo mothers. As a result a substantial proportion of Navajo mothers were at increased risk of pregnancy complications and experience negative pregnancy outcomes.

Prenatal behaviors and experiences

• Prenatal care gives mothers the opportunity to learn about screening for birth defects, safe medications, breastfeeding and unhealthy behaviors. However, 43% of Navajo mothers did not receive prenatal care beginning in the first trimester, and only half (49%) received adequate prenatal care. These results underscore the need to increase efforts to ensure that mothers enter prenatal care early and receive adequate care. Navajo mothers with less edu-cation were at particular risk of receiving late-term or no care.

• Good oral health and dental visits help reduce the number of preterm births and low birth weight infants.1 However, only approximately one-third (37%) of Navajo mothers discussed oral health with their providers or sought dental care during pregnancy.

• Physical abuse during pregnancy not only causes trauma to the mother and fetus but also results in high levels of stress that can put the mother at risk for adverse health and preg-nancy outcomes. Unfortunately, physical abuse was experienced by some Navajo mothers in the survey, and the prevalence of physical abuse did not change substantially from pre-conception to pregnancy (from 8% to 7%). Younger Navajo mothers appeared to be more likely to be abused and remain in unsafe environments after becoming pregnant.

• Medical guidelines advise against any alcohol and tobacco use during pregnancy. Alcohol use puts a mother at risk of having an infant with Fetal Alcohol (FAS), and tobacco use leads to adverse health effects such as restricted uterine growth, stillbirth and low birth weight. Although the reported prevalence for both alcohol and tobacco use were less than 10% in this survey, Navajo mothers still need to be made aware of the risks of using alco-hol and tobacco during pregnancy and to be given more opportunities to enter cessation programs.

Notes:

Jeffcoat M, Geurs N, Reddy M, Cliver S, Goldenberg R, Hauth J. Periodontal infection and preterm birth: results of a prospective study. J Am Dent Association. 2001 July; 132(7); 875-80.

• In addition to addressing risk behaviors, an aim of prenatal care is to identify and provide appropriate management of chronic health conditions that may affect the mother’s health during and after pregnancy and that may have a lifetime negative impact on infants. Among the pre-pregnancy health conditions assessed, the prevalence of pre-existing dia-betes was high about 3% among Navajo mothers. As a result a substantial proportion of Navajo mothers were at increased risk of pregnancy complications and negative pregnancy outcomes.

• Sufficient supply of nutritious food during pregnancy is essential to the health of the mother and child. However, 20% of Navajo mothers reported food insufficiency during pregnancy. This finding indicates that these Navajo mothers may not have sufficient nu-tritional intake during pregnancy. Navajo mothers with a lower level of education and low income mothers were more likely to not always have sufficient food to eat.

Postpartum behavior and Experiences• The consistent and proper use of contraception is essential to prevent unintended and

unwanted pregnancies. Contraceptive use increased from 32% before pregnancy to 77% postpartum among Navajo mothers who did not want to be pregnant. This finding sug-gests that Navajo mothers may have greater awareness of or access to contraception after pregnancy compared to before pregnancy.

• As described before, breastfeeding offers many health benefits to the mother and child. Breastfeeding initiation among Navajo mothers was high (84%). However, only 61% continued to breastfeed for at least 2 months. These results indicate that, in addition to encouraging Navajo mothers to begin breastfeeding, mothers should also be encouraged to prolong breastfeeding, especially Navajo mothers with less education.

• In general, support programs focus on improving maternal experiences and behaviors. However, Navajo mothers reported low participation in support programs that aim to reduce family violence and use of alcohol, drugs and cigarettes. The most widely used pro-grams were home visiting services at 34%, breastfeeding class or support group at 12%. The least used programs were smoking cessation programs at 0.7%, and Families FIRST case management at 4%. These findings identify the important need of determining why Navajo mothers did not participate in such programs, or why these programs might not be available.

• In general, babies are admitted to neonatal intensive care unit (NICU) to receive addi-tional specialized medical care. Reasons for NICU admissions include preterm birth, birth defects, breathing and feeding problems, infections, or other medical conditions. NICU admissions were higher (14%) for babies born to Navajo mothers residing elsewhere in New Mexico compared to those residing in McKinley or San Juan counties (8%).

• Postpartum depression (PPD) affects mothers within the first year after giving birth. Younger mothers and those experiencing partner-related stress or physical abuse might be more likely to develop PPD. PPD was common among Navajo mothers, with 20% re-porting symptoms of depression after delivery. The percentages were similar among all the subgroups, except those not enrolled in WIC during pregnancy had a significantly higher rate of 26%.

59 60

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Conclusions and Recommendations

The results discussed in the report identify important maternal and child health indicators that need to be targeted to promote healthy pregnancy and birth outcomes. These findings indicate that many Navajo mothers did not engage in healthy behaviors and/or experienced unhealthy outcomes throughout pregnancy.

In light of the results, targeted and accessible public health services, education and interventions are needed. The following recommendations constitute a framework that public health and health care providers can use to improve the health of Nava-jo mothers and their infants.

• Increase education about the benefits of folic acid and multivitamin consumption, partic-ularly before pregnancy. Conduct research to identify the barriers to taking multivitamins and folic acid regularly.

• Increase education efforts to make Navajo mothers more aware of and guide them to programs that help make better lifestyle decisions. Healthy foods must also be made accessible, and public health and health care programs must strategize on how to increase physical activity among at-risk mothers.

• Increase collaborations between tribal health programs and healthcare professionals to identify barriers to early prenatal care and strategize to reduce or eliminate these barriers.

• Increase efforts to educate mothers on the importance of oral health, including the risks of poor oral health during pregnancy. Oral health education programs targeted at pregnant mothers are needed.

• Increase provider screening for domestic abuse during prenatal care and refer at-risk moth-ers to appropriate services and resources. Improve education and access to contraception methods to prevent unintended and unwanted pregnancies.

• In 2008, the Navajo Nation passed legislation in support of breastfeeding in the work-place, allowing mothers greater opportunity to breastfeed. Health professionals need to ensure that mothers receive the resources needed to feel confident and comfortable with breastfeeding.

• Increase awareness of programs that provide nutritious food to pregnant mothers and their infants, thereby addressing the issue of food insufficiency.

• Increase referrals of mothers to effective and culturally relevant support services to improve unhealthy situations and behaviors. Tribal health programs and healthcare professionals must work together and support research to determine why mothers do not use available support programs as well as why programs might not be available.

• Increase initiatives that encourage family planning. Women who plan their pregnancy are more likely to enter pregnancy in better health, have their chronic health conditions under control, and be aware of unhealthy behaviors and experiences than can adversely affect their health and the health of their unborn child.

• Inform the Navajo Nation Council to advocate for funds on behalf of Navajo mothers and their children to address the needs stated above and establish policies accordingly.

• Eliminate legislation loopholes in the public safety and judicial systems to provide a safe environment for women and children by enforcing violent perpetrators with penalties.

BEFORE PREGNANCY

First, we would like to ask a few questionsabout you and the time before you gotpregnant with your new baby.

1. At any time during the 12 months before yougot pregnant with your new baby, did you doany of the following things? For each item,circle Y (Yes) if you did it or circle N (No) ifyou did not.

No Yesa. I was dieting (changing my eating

habits) to lose weight . . . . . . . . . . . . . N Yb. I was exercising 3 or more days

of the week . . . . . . . . . . . . . . . . . . . . . N Yc. I was regularly taking prescription

medicines other than birth control . . . N Yd. I visited a health care worker to

be checked or treated for diabetes. . . . N Ye. I visited a health care worker to

be checked or treated for highblood pressure . . . . . . . . . . . . . . . . . . . N Y

f. I visited a health care worker tobe checked or treated for depressionor anxiety . . . . . . . . . . . . . . . . . . . . . . N Y

g. I talked to a health care workerabout my family medical history . . . . N Y

h. I had my teeth cleaned by a dentistor dental hygienist. . . . . . . . . . . . . . . . N Y

} Go to Page 2,Question 5

2. During the month before you got pregnantwith your new baby, were you covered byany of these health insurance plans?

� Health insurance from your job or the job of your husband, partner, orparents

� Health insurance that you or someone elsepaid for (not from a job)

� Medicaid or Salud! � TRICARE or other military health care � Indian Health Service (IHS) � State Coverage Insurance (SCI) � Indigent Health Care � Other source(s) Please tell us:

� I did not have any health insurance beforeI got pregnant

3. During the month before you got pregnantwith your new baby, how many times aweek did you take a multivitamin, aprenatal vitamin, or a folic acid vitamin?

� I didn’t take a multivitamin, prenatal vitamin, or folic acid vitamin at all

� 1 to 3 times a week� 4 to 6 times a week� Every day of the week

4. What were your reasons for not takingmultivitamins, prenatal vitamins, or folicacid vitamins during the month before yougot pregnant with your new baby?

� I wasn’t planning to get pregnant� I didn’t think I needed to take vitamins� The vitamins were too expensive� The vitamins gave me side effects

(such as constipation)� Other Please tell us:

Check all that apply

Please mark your answers. Follow thedirections included with the questions. If no directions are presented, check thebox next to your answer or fill in theblanks. Because not all questions willapply to everyone, you may be asked toskip certain questions.

PRAMS_NM_11_25_Eng_v1.qxd 12/10/08 2:26 PM Page 1AppendixPhase 6 New Mexico Pregnancy Risk Assessment Monitoring System Survey

DURING PREGNANCY

The next questions are about the prenatalcare you received during your most recentpregnancy. Prenatal care includes visits toa doctor, nurse, or other health care workerbefore your baby was born to get checkupsand advice about pregnancy. (It may help tolook at the calendar when you answer thesequestions.)

16. How many weeks or months pregnant wereyou when you were sure you were pregnant?(For example, you had a pregnancy test or adoctor or nurse said you were pregnant.)

Weeks OR Months

� I don’t remember

17. How many weeks or months pregnant wereyou when you had your first visit forprenatal care? Do not count a visit that wasonly for a pregnancy test or only for WIC (theSpecial Supplemental Nutrition Program forWomen, Infants, and Children).

Weeks OR Months

� I didn’t go for prenatal care Go to Page 4, Question 19

14. When you got pregnant with your newbaby, were you or your husband or partnerdoing anything to keep from gettingpregnant? (Some things people do to keepfrom getting pregnant include not having sexat certain times [natural family planning orrhythm] or withdrawal, and using birth controlmethods such as the pill, condoms, vagin*lring, IUD, having their tubes tied, or theirpartner having a vasectomy.)

� No� Yes

15. What were your reasons or your husband’sor partner’s reasons for not doing anythingto keep from getting pregnant?

� I didn’t mind if I got pregnant � I thought I could not get pregnant at that

time � I had side effects from the birth control

method I was using � I had problems getting birth control when

I needed it � I thought my husband or partner or I was

sterile (could not get pregnant at all) � My husband or partner didn’t want to use

anything� Other Please tell us:

Check all that apply

Go to Question 16

{

Go to Page 4, Question 18

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Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

5. Just before you got pregnant with your newbaby, how much did you weigh?

Pounds OR Kilos

6. How tall are you without shoes?

Feet Inches

OR Meters

7. What is your date of birth?

Month Day Year

8. Before you got pregnant with your newbaby, were you ever told by a doctor, nurse,or other health care worker that you hadType 1 or Type 2 diabetes? This is not thesame as gestational diabetes or diabetes thatstarts during pregnancy.

� No� Yes

9. Before you got pregnant with your newbaby, did you ever have any other babieswho were born alive?

� No� Yes

Go to Question 12

10. Did the baby born just before your new one weigh more than 5 pounds, 8 ounces(2.5 kilos) at birth?

� No� Yes

11. Was the baby just before your new one bornmore than 3 weeks before his or her duedate?

� No� Yes

The next questions are about the time whenyou got pregnant with your new baby.

12. Thinking back to just before you gotpregnant with your new baby, how did youfeel about becoming pregnant?

� I wanted to be pregnant sooner� I wanted to be pregnant later� I wanted to be pregnant then� I didn’t want to be pregnant then

or at any time in the future

13. When you got pregnant with your newbaby, were you trying to get pregnant?

� No� Yes Go to Question 16

Check one answer

Go to Question 10Go to Question 14

PRAMS_NM_11_25_Eng_v1.qxd 12/10/08 2:26 PM Page 2

If you did not go for prenatal care, go to Question 23.

18. Did you get prenatal care as early in yourpregnancy as you wanted?

� No� Yes

19. Did any of these things keep you fromgetting prenatal care at all or as early as youwanted? For each item, circle T (True) if itwas a reason that you didn’t get prenatal carewhen you wanted or circle F (False) if it wasnot a reason for you or if something does notapply to you.

True Falsea. I couldn’t get an appointment

when I wanted one . . . . . . . . . . . . . . T Fb. I didn’t have enough money or

insurance to pay for my visits . . . . . T Fc. I had no transportation to get to

the clinic or doctor’s office . . . . . . . T Fd. The doctor or my health plan

would not start care as earlyas I wanted . . . . . . . . . . . . . . . . . . . . T F

e. I had too many other thingsgoing on . . . . . . . . . . . . . . . . . . . . . . T F

f. I couldn’t take time off from workor school. . . . . . . . . . . . . . . . . . . . . . T F

g. I didn’t have my Medicaid or Salud! card . . . . . . . . . . . . . . . . . . . . T F

h. I had no one to take care of mychildren. . . . . . . . . . . . . . . . . . . . . . . T F

i. I didn’t know that I was pregnant . . T Fj. I didn’t want anyone else to know

I was pregnant . . . . . . . . . . . . . . . . . T Fk. I didn’t want prenatal care . . . . . . . . T F

Go to Question 20

20. Where did you go most of the time for yourprenatal care visits? Do not include visitsfor WIC.

� Hospital clinic� Health department clinic� Private doctor’s office or HMO clinic� Indian Health Service clinic or hospital� Community clinic� Other Please tell us:

21. Did any of these health insurance planshelp you pay for your prenatal care?

� Health insurance from your job or the job of your husband, partner, or parents

� Health insurance that you or someone elsepaid for (not from a job)

� Medicaid or Salud!� TRICARE or other military health care � Indian Health Service (IHS), with or

without Medicaid� State Coverage Insurance (SCI) � Premium Assistance for Maternity (PAM)� Other source(s) Please tell us:

� I did not have health insurance to helppay for my prenatal care

Check all that apply

Check one answer

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Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

22. During any of your prenatal care visits, did a doctor, nurse, or other health care workertalk with you about any of the things listedbelow? Please count only discussions, notreading materials or videos. For each item,circle Y (Yes) if someone talked with youabout it or circle N (No) if no one talked withyou about it.

No Yesa. How smoking during pregnancy

could affect my baby. . . . . . . . . . . . . . N Yb. Breastfeeding my baby . . . . . . . . . . . . N Yc. How drinking alcohol during

pregnancy could affect my baby . . . . . N Yd. Using a seat belt during my

pregnancy . . . . . . . . . . . . . . . . . . . . . . N Ye. Medicines that are safe to take

during my pregnancy . . . . . . . . . . . . . N Yf. How using illegal drugs could

affect my baby. . . . . . . . . . . . . . . . . . . N Yg. Doing tests to screen for birth defects

or diseases that run in my family . . . . N Yh. The signs and symptoms of preterm

labor (labor more than 3 weeks before the baby is due) . . . . . . . . . . . . N Y

i. What to do if my labor starts early . . . N Yj. Getting tested for HIV (the virus

that causes AIDS) . . . . . . . . . . . . . . . . N Yk. What to do if I feel depressed during

my pregnancy or after my babyis born . . . . . . . . . . . . . . . . . . . . . . . . . N Y

l. Physical abuse to women by theirhusbands or partners . . . . . . . . . . . . . . N Y

23. At any time during your most recentpregnancy or delivery, did you have a testfor HIV (the virus that causes AIDS)?

� No� Yes� I don’t know

24. During your most recent pregnancy, wereyou on WIC (the Special SupplementalNutrition Program for Women, Infants, and Children)?

� No� Yes

25. During your most recent pregnancy, wereyou told by a doctor, nurse, or other healthcare worker that you had gestationaldiabetes (diabetes that started during thispregnancy)?

� No � Yes

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26. Did you have any of the following problemsduring your most recent pregnancy? Foreach item, circle Y (Yes) if you had theproblem or circle N (No) if you did not.

No Yesa. vagin*l bleeding . . . . . . . . . . . . . . . . . N Yb. Kidney or bladder (urinary tract)

infection . . . . . . . . . . . . . . . . . . . . . . . N Yc. Severe nausea, vomiting, or

dehydration . . . . . . . . . . . . . . . . . . . . . N Yd. Cervix had to be sewn shut

(cerclage for incompetent cervix) . . . . N Ye. High blood pressure, hypertension

(including pregnancy-inducedhypertension [PIH]), preeclampsia,or toxemia . . . . . . . . . . . . . . . . . . . . . . N Y

f. Problems with the placenta (such asabruptio placentae orplacenta previa). . . . . . . . . . . . . . . . . . N Y

g. Labor pains more than 3 weeksbefore my baby was due (pretermor early labor) . . . . . . . . . . . . . . . . . . . N Y

h. Water broke more than 3 weeksbefore my baby was due (prematurerupture of membranes [PROM]). . . . . N Y

i. I had to have a blood transfusion . . . . N Yj. I was hurt in a car accident . . . . . . . . . N Y

The next questions are about smokingcigarettes around the time of pregnancy(before, during, and after).

27. Have you smoked any cigarettes in the past2 years?

� No� Yes

Go to Question 31

28. In the 3 months before you got pregnant,how many cigarettes did you smoke on anaverage day? (A pack has 20 cigarettes.)

� 41 cigarettes or more� 21 to 40 cigarettes� 11 to 20 cigarettes� 6 to 10 cigarettes� 1 to 5 cigarettes� Less than 1 cigarette� I didn’t smoke then

29. In the last 3 months of your pregnancy, how many cigarettes did you smoke on anaverage day? (A pack has 20 cigarettes.)

� 41 cigarettes or more� 21 to 40 cigarettes� 11 to 20 cigarettes� 6 to 10 cigarettes� 1 to 5 cigarettes� Less than 1 cigarette� I didn’t smoke then

30. How many cigarettes do you smoke on anaverage day now? (A pack has 20 cigarettes.)

� 41 cigarettes or more� 21 to 40 cigarettes� 11 to 20 cigarettes� 6 to 10 cigarettes� 1 to 5 cigarettes� Less than 1 cigarette� I don’t smoke now

31. Which of the following statements bestdescribes the rules about smoking insideyour home now?

� No one is allowed to smoke anywhere inside my home

� Smoking is allowed in some rooms or at some times

� Smoking is permitted anywhere inside my home

Check one answerGo to Question 28

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The next questions are about drinkingalcohol around the time of pregnancy(before, during, and after).

32. Have you had any alcoholic drinks in thepast 2 years? A drink is 1 glass of wine, winecooler, can or bottle of beer, shot of liquor, ormixed drink.

� No� Yes

33a. During the 3 months before you gotpregnant, how many alcoholic drinks did you have in an average week?

� 14 drinks or more a week� 7 to 13 drinks a week� 4 to 6 drinks a week� 1 to 3 drinks a week� Less than 1 drink a week� I didn’t drink

then

33b. During the 3 months before you gotpregnant, how many times did you drink 4 alcoholic drinks or more in one sitting?A sitting is a two hour time span.

� 6 or more times � 4 to 5 times � 2 to 3 times � 1 time � I didn’t have 4 drinks or more

in 1 sitting

34a. During the last 3 months of your pregnancy,how many alcoholic drinks did you have inan average week?

� 14 drinks or more a week� 7 to 13 drinks a week� 4 to 6 drinks a week� 1 to 3 drinks a week� Less than 1 drink a week� I didn’t drink

then Go to Question 35

Go to Question 34a

Go to Question 35

34b. During the last 3 months of your pregnancy,how many times did you drink 4 alcoholicdrinks or more in one sitting? A sitting is atwo hour time span.

� 6 or more times � 4 to 5 times � 2 to 3 times � 1 time � I didn’t have 4 drinks or more

in 1 sitting

Pregnancy can be a difficult time for somewomen. The next questions are aboutthings that may have happened before andduring your most recent pregnancy.

35. This question is about things that may havehappened during the 12 months before yournew baby was born. For each item, circle Y (Yes) if it happened to you or circle N (No)if it did not. (It may help to look at thecalendar when you answer these questions.)

No Yesa. A close family member was very sick

and had to go into the hospital . . . . . . N Yb. I got separated or divorced from my

husband or partner . . . . . . . . . . . . . . . N Yc. I moved to a new address . . . . . . . . . . N Yd. I was homeless . . . . . . . . . . . . . . . . . . N Ye. My husband or partner lost his job . . . N Yf. I lost my job even though I wanted

to go on working . . . . . . . . . . . . . . . . . N Yg. I argued with my husband or partner

more than usual. . . . . . . . . . . . . . . . . . N Yh. My husband or partner said he

didn’t want me to be pregnant . . . . . . N Yi. I had a lot of bills I couldn’t pay. . . . . N Yj. I was in a physical fight . . . . . . . . . . . N Yk. My husband or partner or I

went to jail . . . . . . . . . . . . . . . . . . . . . N Yl. Someone very close to me had a

problem with drinking or drugs . . . . . N Ym. Someone very close to me died . . . . . N Y

{

{Go to Question 34b

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Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

41. How was your new baby delivered?

� vagin*lly� Cesarean delivery

(c-section)

42. What was the reason that your new babywas born by cesarean delivery (c-section)?

� I had a previous cesarean delivery (c-section)

� My baby was in the wrong position � I was past my due date � My health care provider worried that my

baby was too big � I had a medical condition that made labor

dangerous for me � My health care provider tried to induce

my labor, but it didn’t work � Labor was taking too long � The fetal monitor showed that my baby

was having problems during labor � I wanted to schedule my delivery � I didn’t want to have my baby vagin*lly� Other reason(s) Please tell us:

43. When were you discharged from thehospital after your baby was born?

Month Day Year

� I didn’t have my baby in a hospital

Check all that apply

Go to Question 43

36. During the 12 months before you gotpregnant with your new baby, did yourhusband or partner push, hit, slap, kick,choke, or physically hurt you in any otherway?

� No� Yes

37. During your most recent pregnancy, didyour husband or partner push, hit, slap,kick, choke, or physically hurt you in anyother way?

� No� Yes

The next questions are about your laborand delivery. (It may help to look at thecalendar when you answer these questions.)

38. When was your baby due?

Month Day Year

39. When did you go into the hospital to haveyour baby?

Month Day Year

� I didn’t have my baby in a hospital

40. When was your baby born?

Month Day Year

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AFTER PREGNANCY

44. Did any of these health insurance planshelp you pay for the delivery of your newbaby?

� Health insurance from your job or the job of your husband, partner, orparents

� Health insurance that you or someone else paid for (not from a job)

� Medicaid or Salud!� TRICARE or other military health care � Indian Health Service (IHS)� State Coverage Insurance (SCI)� Premium Assistance for Maternity (PAM)� Other source(s) Please tell us:

� I did not have health insurance to helppay for my delivery

The next questions are about the time sinceyour new baby was born.

45. After your baby was born, was he or sheput in an intensive care unit?

� No� Yes� I don’t know

Check all that apply

46. After your baby was born, how long did heor she stay in the hospital?

� Less than 24 hours (less than 1 day)� 24 to 48 hours (1 to 2 days)� 3 to 5 days� 6 to 14 days � More than 14 days� My baby was not born in a hospital� My baby is

still in the hospital

47. Is your baby alive now?

� No� Yes

48. Is your baby living with you now?

� No� Yes

49. Did you ever breastfeed or pump breastmilk to feed your new baby after delivery,even for a short period of time?

� No � Yes

50. Are you currently breastfeeding or feedingpumped milk to your new baby?

� No� Yes

51. How many weeks or months did youbreastfeed or pump milk to feed your baby?

Weeks OR Months

� Less than 1 week

Go to Page 10, Question 53a

Go to Page 10, Question 53b

Go to Page 11, Question 57

Go to Question 49

{

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52. What were your reasons for stoppingbreastfeeding?

� My baby had difficulty latching or nursing� Breast milk alone did not satisfy my baby � I thought my baby was not gaining

enough weight � My nipples were sore, cracked, or

bleeding � It was too hard, painful, or too time

consuming� I thought I was not producing enough

milk � I had too many other household duties � I felt it was the right time to stop

breastfeeding� I got sick and was not able to breastfeed � I went back to work or school � My baby was jaundiced (yellowing of the

skin or whites of the eyes) � Other Please tell us:

53a. How old was your new baby the first timehe or she drank liquids other than breastmilk (such as formula, water, juice, tea, orcow’s milk)?

Weeks OR Months

� My baby was less than 1 week old� My baby has not had any liquids other

than breast milk

Check all that apply

53b. How old was your new baby the first timehe or she ate food (such as baby cereal,baby food, or any other food)?

Weeks OR Months

� My baby was less than 1 week old� My baby has not eaten any foods

54. In which one position do you most often layyour baby down to sleep now?

� On his or her side� On his or her back� On his or her stomach

55. Listed below are some things that describehow your new baby usually sleeps. For eachitem, circle T (True) if it usually applies to yourbaby or F (False) if it doesn’t usually apply toyour baby.

True Falsea. My new baby sleeps in a crib

or portable crib . . . . . . . . . . . . . . . . . T Fb. My new baby sleeps on a firm or

hard mattress . . . . . . . . . . . . . . . . . . T Fc. My new baby sleeps with pillows . . T Fd. My new baby sleeps with bumper

pads . . . . . . . . . . . . . . . . . . . . . . . . . T Fe. My new baby sleeps with plush

blankets . . . . . . . . . . . . . . . . . . . . . . T Ff. My new baby sleeps with stuffed

toys . . . . . . . . . . . . . . . . . . . . . . . . . . T Fg. My new baby sleeps with another

person . . . . . . . . . . . . . . . . . . . . . . . . T F

Check one answer

If your baby is still in the hospital, go to Question 57.

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56. Was your new baby seen by a doctor, nurse,or other health care worker for a one weekcheck-up after he or she was born?

� No� Yes

57. Are you or your husband or partner doinganything now to keep from gettingpregnant? (Some things people do to keepfrom getting pregnant include not having sexat certain times [natural family planning orrhythm] or withdrawal, and using birth controlmethods such as the pill, condoms, vagin*lring, IUD, having their tubes tied, or theirpartner having a vasectomy.)

� No� Yes

58. What are your reasons or your husband’sor partner’s reasons for not doing anythingto keep from getting pregnant now?

� I am not having sex� I want to get pregnant� I don’t want to use birth control� My husband or partner doesn’t want to

use anything� I don’t think I can get pregnant (sterile)� I can’t pay for birth control� I am pregnant now� Other Please tell us:

Check all that apply

Go to Question 59OTHER EXPERIENCES

59. Below is a list of feelings and experiencesthat women sometimes have afterchildbirth. Read each item to determinehow well it describes your feelings andexperiences. Then, write on the line thenumber of the choice that best describeshow often you have felt or experiencedthings this way since your new baby wasborn. Use the scale when answering:

1 2 3 4 5Never Rarely Sometimes Often Always

a. I felt down, depressed, or sad. . . ___

b. I felt hopeless . . . . . . . . . . . . . . . ___

c. I felt slowed down . . . . . . . . . . . ___

The next questions are on a variety oftopics.

60. There are many feelings and experienceswomen may have with prenatal care.Please select the statement or statementsthat most closely describe your feelings orexperiences with prenatal care during yourmost recent pregnancy.

� I was happy with the prenatal care I got � I felt disrespected by clinic or hospital

staff during prenatal care� I did not have prenatal insurance coverage

and I did not qualify for Medicaid� I wanted prenatal care earlier, but I was

waiting for my Medicaid eligibility� I received some or all of my prenatal care

outside of the United States� My husband/partner or boyfriend did not

want me to get prenatal care.

Check all that apply

If you did not go for prenatal care, go to Page 12, Question 61.

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61. During your most recent pregnancy, did anyof the following medical problems cause youto go to the hospital or emergency room?For each item, circle Y (Yes) if it caused youto go to the hospital or emergency room orcircle N (No) if it did not. It may help to lookat a calendar when you answer this question.

No Yesa. Preterm or early labor . . . . . . . . . . . . . N Yb. Severe nausea or dehydration . . . . . . . N Yc. Kidney or bladder infection . . . . . . . . N Yd. High blood pressure . . . . . . . . . . . . . . N Ye. vagin*l bleeding . . . . . . . . . . . . . . . . . N Yf. Premature rupture of membranes . . . . N Yg. Other . . . . . . . . . . . . . . . . . . . . . . . . . . N Y

Please tell us:

62. This question is about the care of your teethduring your most recent pregnancy. Foreach item, circle Y (Yes) if it is true or circle N (No) if it is not true.

No Yesa. I had a dental problem while I was

pregnant . . . . . . . . . . . . . . . . . . . . . . . N Yb. I went to a dentist or dental clinic

while I was pregnant . . . . . . . . . . . . . . N Yc. A dental or other healthcare worker

talked with me about how to care for my teeth and gums . . . . . . . . . . . . N Y

d. I could not find a provider or clinic that would take Medicaid patients . . . N Y

e. I could not find a provider or clinic that would take pregnant patients . . . . N Y

f. I could not afford to go to the dentist . . N Yg. I had no way to get to the dentist . . . . N Y

Go to Question 66

63. During your most recent pregnancy, didyou participate in any of these services? Foreach one, circle Y (Yes) if you did participateor circle N (No) if you did not.

No Yesa. Home visiting services by a nurse,

social worker, or other health careworker . . . . . . . . . . . . . . . . . . . . . . . . . N Y

b. Families FIRST. . . . . . . . . . . . . . . . . . N Yc. A class or support group to stop

smoking cigarettes . . . . . . . . . . . . . . . N Yd. Healthy Start . . . . . . . . . . . . . . . . . . . . N Y

64. How did you get your new baby’s infant carseat(s)?

� I bought a car seat new� I received it new for this baby as a gift� I had one from another one of my babies� I bought a car seat used� I borrowed a car seat from a friend or

family member� I borrowed or rented a car seat from a

loaner program� The hospital where my new baby was

born gave me a car seat� A community program gave me a car seat� I did not ever get a car seat for my new

baby� Other Please tell us:

65. Have you worked outside the home in thepast two years?

� No� Yes

Go to Question 67

Check all that apply

If your baby is not alive or is not living withyou, go to Question 70.

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66. New Mexico state law requires that allemployers provide a clean, private locationfor mothers to breastfeed or pump milk fortheir infants. What happens when a motherwants to breastfeed or pump milk for herbaby at your current or most recentworkplace?

� She can breastfeed or pump breast milkany time

� She can breastfeed her baby during breaktimes only

� She can pump breast milk during breaktimes only

� She has flexible break times to breastfeedor pump milk

� She has a clean, private place that is not abathroom, where she can breastfeed orpump milk

� She is not allowed to breastfeed or pumpmilk at work

� I don’t know

67. Since you delivered your new baby, would youhave the kinds of help listed below if youneeded them? For each one, circle Y (Yes) ifyou would have it or circle N (No) if not.

No Yesa. Someone to loan me $50. . . . . . . . . . . N Yb. Someone to help me if I were sick

and needed to be in bed. . . . . . . . . . . . N Yc. Someone to talk with about my

problems . . . . . . . . . . . . . . . . . . . . . . . N Yd. Someone to take care of my baby. . . . N Ye. Someone to help me if I were tired

and feeling frustrated with my new baby . . . . . . . . . . . . . . . . . . . . . . . N Y

Check all that apply

68. Since your new baby was born, have you oryour baby received any home visitingservices by a nurse, social worker, or otherhealth care worker?

� No� Yes

69. Since your new baby was born, have youparticipated in any of these services? For each one, circle Y (Yes) if you haveparticipated or circle N (No) if you have not.

No Yesa. Breastfeeding class or peer

counseling . . . . . . . . . . . . . . . . . . . . . . N Yb. WIC for you or your baby. . . . . . . . . . N Yc. Families FIRST. . . . . . . . . . . . . . . . . . N Yd. A class or support group to stop

smoking cigarettes . . . . . . . . . . . . . . . N Ye. Healthy Start . . . . . . . . . . . . . . . . . . . . N Y

70. Since your new baby was born, have youseen a doctor, nurse, or midwife for yourselffor any of these reasons? For each one, circleY (Yes) if you did or circle N (No) if you didnot.

No Yesa. I got help for depression or

“baby blues” . . . . . . . . . . . . . . . . . . . . N Yb. I received a birth control method . . . . N Yc. I received a referral for a health

problem . . . . . . . . . . . . . . . . . . . . . . . . N Y

71. During the past 12 months, which one of thefollowing statements best describes the foodeaten by you and your family?

� Enough food to eat� Sometimes not enough food to eat� Often not enough food to eat

Check one answer

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Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

74. During the 12 months before your new babywas born, what was your yearly totalhousehold income before taxes? Includeyour income, your husband’s or partner’sincome, and any other income you may havereceived. (All information will be kept privateand will not affect any services you are nowgetting.)

� Less than $10,000� $10,000 to $14,999� $15,000 to $19,999� $20,000 to $24,999� $25,000 to $34,999� $35,000 to $49,999� $50,000 to $64,999� $65,000 to $74,999� $75,000 or more

75. During the 12 months before your new babywas born, how many people, includingyourself, depended on this income?

People

76. What is today’s date?

Month Day Year

The last questions are about the timeduring the 12 months before your new babywas born.

72. During the 12 months before your new babywas born, did you or any member of yourhousehold apply for government paymentssuch as welfare, TANF (TemporaryAssistance for Needy Families), or otherpublic assistance?

� No� Yes

73. Did any of these happen to you when youapplied for government assistance?

� I received assistance� I was told I made too much money to get

assistance� I was told I shouldn’t apply because

I might need my benefits later� I was told I couldn’t get assistance

because I am from another country

Check all that apply

Go to Question 74

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Please use this space for any additional comments you would like to make about the health of mothers and babies in New Mexico.

Thanks for answering our questions!

Your answers will help us work to make New Mexico mothers and babies healthier.

November 25, 2008

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PREGNANCY

RISK

ASSESSMENT

MONITORING

SYSTEM

NEW MEXICO

N e w M e x i c oN a t i v e M o t h e r s f o r

P R A M S

New Mexico PRAMSFamily Health Bureau

NM Department of Health2040 S. Pacheco

Santa Fe, NM 87505

1-800-743-8548Email: [emailprotected]

QUESTIONS?

PARTNERSHIPS

Based on New Mexico Pregnancy Risk Assessment Monitoring System Data

Report on New Mexico Navajo Mothers and Their Infants, 2005-2011

Report on New Mexico Navajo Mothers and Their Infants ......Report on New Mexico Navajo Mothers and Their Infants, 2005-2011. Foreword. T. he epidemiological report, entitled “Report - [PDF Document] (2024)