Maternal and Child Health

Communities and countries and ultimately the world are only as strong as the health of their women.

—Michelle Obama, Former First Lady

Protecting the health of mothers, infants, and children is an essential component to maintaining the overall health of the entire population. Maternal child health is an important indicator of the well-being of the next generation. Health conditions, health behaviors, and health system indicators are all areas of concern that fall under the umbrella of maternal child health. Families, communities, and health care systems can use maternal child health data to help predict future public health challenges and assist with planning to prepare for them.

The data included in this section looks at different indicators used to assess maternal child health in Tulsa County. These factors include birth rates, entry to care, birth outcomes, and social determinants of health. Birth rates are important to help determine where a community’s population is increasing or declining. They can also be beneficial in allocating where resources are needed to better serve the population. Providing quality preconception, prenatal, and interconception care at the correct times is instrumental in reducing the risk of maternal and infant mortality and pregnancy-related complications. Premature birth and low birth weight are two of the more serious risk factors associated with increased infant mortality, and can also indicate long term health issues. Environmental and social factors also influence maternal child health. These factors include tobacco use, education attainments, and marital status. All these components of maternal child health affect the health, wellness, and quality of life of women, children, and families in Tulsa County (1).

Birth rates


Crude Birth Rate

Definition

The crude birth rate is the number of live births divided by the total population and multiplied by 1,000. It is called crude because it does not account for sex or age differences in the populations being compared. The crude birth rate is presented as the number of live births to Tulsa County residents per 1,000 persons, over the years 2014 – 2016.


Why is this indicator important?

The crude birth rate indicates where population growth is occurring naturally through reproduction.


How are we doing?

There were 28,663 live births to Tulsa County residents from 2014 – 2016. Males comprised 51.6 percent of live births while females made up 48.4 percent. Birth rates were highest among Native Hawaiians/ Pacific Islanders (38.9 births per 1,000 population), and lowest among whites and mothers who reported 'multiple races' (14.6 and 15.0, respectively). The Hispanic birth rate (21.9) was higher than the non-Hispanic birth rate (14.5). Compared to Oklahoma, the birth rate by race/ethnicity in Tulsa County was higher in all races and ethnicities except Native Hawaiian/Pacific Islanders and 'other' races.

In 2016, Tulsa County’s crude birth rate of 15.3 live births per 1,000 population was higher than the rate in Oklahoma (13.6) and the United States (12.2). The birth rate in Tulsa County has consistently been higher than both Oklahoma and the US since 2011.

The zip codes with the highest birth rates were concentrated in north and east Tulsa.


Fertility Rate

Definition

The fertility rate is presented as the number of live births to women age 15 – 44 years per 1,000 females in this age group, over the years 2014 – 2016.


Why is this indicator important?

The fertility rate, which is calculated using only females of childbearing age, is a more sensitive indicator than the crude birth rate to show how the population may be growing naturally through reproduction. Sustained high fertility rates lead to a disproportionately young population, while sustained low fertility rates can lead to an aging population. Each of these scenarios requires planning and anticipation of current and future needs which can place burdens on certain social services (2).


How are we doing?

The fertility rate for Tulsa County from 2014 – 2016 was 74.4 live births per 1,000 females ages 15 – 44 years. The fertility rate was highest among Native Hawaiians/Pacific Islanders (150.9). Hispanics had a higher fertility rate than non-Hispanics (97.1 compared to 71.1)

In 2016, Tulsa County had a fertility rate of 74.4 live births per 1,000 females age 15 – 44 years. This rate was higher than both Oklahoma (69.0) and the United States (62.0). The birth rate in Tulsa County has consistently been higher than both Oklahoma and the US since 2011.

The zip codes with the highest fertility rates were concentrated in north and east Tulsa.


Teen Birth Rate

Definition

This indicator is presented as the number of live births to Tulsa County teenagers (ages 15 – 17 and 15 - 19) per 1,000 females in this age group, over the years 2014 – 2016.


Why is this indicator important?

Although teen birth rates are declining, there are still significant disparities among racial and ethnic minorities, as well as socioeconomically disadvantaged youth of any race or ethnicity. Social and economic costs related to teen parents and childbirth include increased health care and foster care costs, increased high school dropout rates, and lower educational attainment for teen mothers and their children. The children of teen mothers are also more likely to be incarcerated at some time during adolescence, have more health problems, give birth as a teenager, and face unemployment as a young adult (3).


How are we doing?

There were 575 births to Tulsa County teenagers age 15 – 17 from 2014 – 2016, for a birth rate of 15.6. There were a total of 2,064 births to Tulsa County teenagers age 15 - 19 during the same time period, for a birth rate of 34.8. The teen birth rates for teens age 15 - 17 and ages 15 - 19 have consistently been declining since 2011.

In 2016, the teen birth rate (ages 15 – 19) in Tulsa County was 33.9 live births per 1,000 females ages 15 – 19. This was the same as Oklahoma, but higher than the United States (20.3). Teen birth rate trends have been decreasing in Tulsa County, Oklahoma, and the US since 2011, but the US teen birth rates are still much lower than Tulsa County and Oklahoma.  

In Tulsa County, blacks had the highest birth rate for teens ages 15 – 17 (26.6). Asians had the lowest birth rate with 8.2 live births per 1,000 females ages 15 – 17. Additionally, the birth rate for Hispanic women in this age group was double that of non-Hispanic women (29.9 compared to 13.2).

Trends were similar for teen birth rates in teens age 15 - 19.

The highest teen birth rates (15- 17) were primarily in zip codes in north Tulsa. The zip codes with the highest teen birth rates (15-19) were in east Tulsa.

Maternal Characteristics


Maternal Education

Definition

This indicator is presented as births to Tulsa County mothers with less than a high school diploma or equivalent (GED). It is presented as a percentage of all births, over the years 2014 – 2016.


Why is this indicator important?

Maternal education is related to the types of jobs an individual can obtain and to income, both of which affect opportunities for healthier living and the ability to access health care. A woman working full time and year-round with at least a high school education makes almost twice as much as a woman who has not earned her high school diploma or equivalent (GED). 

Educational attainment is also correlated with health literacy, which impacts an individual’s ability to communicate with health care providers, understand and follow instructions, and navigate the health care system. Women with less than a high school education also have poorer health outcomes, including higher rates of infant mortality, smoking, and diabetes than women with a high school diploma (4).


How are we doing?

From 2014 – 2016, the percentage of birth mothers in Tulsa County with less than a 12th grade education was 19.6 percent. This percentage was highest among Native Hawaiian/ Pacific Islander mothers (41.1 percent). Additionally, the percentage of Hispanic mothers with less than a 12th grade education was more than three times higher than that of non-Hispanic mothers (47.8 percent compared to 14.0 percent). With the exception of mothers of 'other' races, this indicator was consistently higher in Tulsa County compared to Oklahoma.

In 2016, 19.2 percent of Tulsa County birth mothers had less than a 12th grade education, compared to 16.7 percent in Oklahoma and 13.7 percent in the United States. In general, all of these regions are trending positively in this indicator.

The zip code with the highest rates of low maternal education was 74116.


Births to Unmarried Women

Definition

Unmarried birth mothers include those who have never been married, are widowed, or are divorced. It also includes births to cohabitating parents. This indicator is presented as births to unmarried Tulsa County mothers as a percentage of all births, over the years 2014 – 2016.


Why is this indicator important?

Children born to unmarried mothers have higher rates of infant mortality and an increased likelihood of adverse birth outcomes such as low birth weight. They are also more likely to live in poverty than children of married mothers. As they reach adolescence, children of unmarried mothers are more likely to have low educational attainment, engage in sex at a younger age, and have a birth outside of marriage. In the U.S., a majority of unmarried births now occur to cohabitating parents; however, these children still experience higher levels of socioeconomic disadvantage and have poor behavioral and emotional outcomes compared to those born to married parents (5).


How are we doing?

A total of 43.2 percent of births in Tulsa County were to unmarried mothers from 2014 – 2016. Births to unmarried mothers was highest among black mothers (76.9 percent), followed by Native Hawaiian/ Pacific Islander mothers (66.1 percent). The rate was lowest among mothers who were Asian (15.6 percent). A larger percentage of Hispanic mothers were unmarried compared to non-Hispanic mothers (50.1 percent compared to 41.8 percent).

In 2016, 43.4 percent of Tulsa County births were to unmarried mothers. This was higher than Oklahoma and the United States (42.3 percent and 39.8 percent, respectively).

The zip codes with the highest percentage of births to unmarried women were 74106, 74116, and 74126.  

Maternal Behaviors


Late or No Prenatal Care

Definition

This indicator is defined as births to Tulsa County mothers who had no prenatal care or did not begin prenatal care until after the first trimester (greater than 12 weeks gestation). It is presented as a percentage of all births, over the years 2014 – 2016.


Why is this indicator important?

Prenatal care is medical attention for expecting mothers and their developing babies. It also includes the mother caring for herself by following her healthcare provider’s advice, practicing good nutrition, getting plenty of rest, exercising sensibly, and avoiding things that could harm her or her baby, such as smoking and alcohol. Babies born to mothers who received late or no prenatal care are more likely to be born at a low birth weight and are more likely to die (6).


How are we doing?

From 2014 – 2016, a total of 33.1 percent of Tulsa County mothers did not receive prenatal care or received delayed prenatal care (after the first trimester). Native Hawaiians/ Pacific Islanders had the highest percentage of late or no prenatal care (75.0 percent). This was more than double the rate of late or no prenatal care for white mothers (30.4 percent). Additionally, the percentage of late or no prenatal care for Hispanic mothers compared to non-Hispanic mothers was very similar (34.9 percent compared to 32.4 percent).

In 2016, 33.0 percent of Tulsa County mothers received late or no prenatal care. This was higher than the rate of late or no prenatal care in both Oklahoma (30.1 percent) and the United States (25.1 percent). Tulsa County, Oklahoma, and the U.S. all fell short of the Healthy People 2020 first trimester prenatal care goal of 77.9 percent (or 22.1 percent reporting late or no prenatal care). In general, the rate of late or no prenatal care has been decreasing (improving) since 2011. However, Oklahoma and Tulsa County both saw an increase in the rate from 2015 to 2016. 

The highest rates of late or no prenatal care were in zip codes 74103 and 74106.


Tobacco Use During Pregnancy

Definition

Maternal smoking is defined as tobacco use during pregnancy, regardless of frequency/quantity of use or during what trimester(s). Tobacco use during pregnancy is expressed as a percentage of all Tulsa County births, over the years 2014 – 2016.


Why is this indicator important?

Prenatal tobacco use has been linked to pregnancy complications and poor birth outcomes, including low birth weight and preterm delivery, miscarriage, SIDS, and birth defects. Exposure to secondhand smoke can also cause health complications for mothers and infants (7).


How are we doing?

From 2014 – 2016, a total of 9.6 percent of births were to mothers who reported using tobacco during pregnancy. American Indian/ Alaskan Native mothers had the highest rate of tobacco use during pregnancy (17.9 percent). Asian mothers had the lowest rate, with 0.6 percent of mothers who reported tobacco use during pregnancy. Additionally, smoking during pregnancy was much higher in non-Hispanic mothers compared to Hispanic mothers (11.1 percent compared to 1.8 percent). 

In 2016, the smoking rate among pregnant women in Tulsa County (9.3 percent) was lower than that of Oklahoma (11.7 percent) but higher than the United States (7.2 percent). The Healthy People 2020 national goal is to increase abstinence from cigarettes to 98.6 percent among pregnant women (or to reduce the percentage of pregnant women who smoke to 1.4 percent). None of these regions met this goal.

The zip code with the highest rates of tobacco use during pregnancy was 74103.

Birth Outcomes


Low Birth Weight

Definition

Low birth weight is defined as infants who weigh less than 2,500 grams (5 pounds, 8 ounces) at birth. Very low birth weight is defined as infants who weigh less than 1,500 grams (3 pounds, 4 ounces). This indicator is expressed as a percentage of all births to Tulsa County mothers, over the years 2015 – 2017.


Why is this indicator important?

Low birth weight infants who survive are at increased risk for health problems ranging from neurodevelopmental disabilities to respiratory disorders. Risk factors for low birth weight infants include smoking, alcohol use, lack of weight gain, age, low income, low education level, stress, domestic violence or other abuse, and exposure to air pollution or drinking water contaminated by lead. Prevention includes early and regular prenatal care to help identify conditions and behaviors that can result in low birth weight infants (8).


How are we doing?

Overall, 8.0 percent of Tulsa County infants were born weighing less than 2,500 grams from 2015 – 2017.  Racial disparity was evident: black mothers had twice the percentage of low birth weight infants as white mothers (14.8 percent compared to 6.9 percent). The percentage of low birth weight infants was higher among non-Hispanic mothers (8.3 percent).

In 2016, 7.9 percent of infants in Tulsa County weighed less than 2,500 grams at birth. This was lower (more favorable) than the United States (8.2 percent). Since 2012, Tulsa County has been generally trending downward, in contrast to the US, which has been trending slightly upward (less favorable). Oklahoma met the Healthy People 2020 target of 7.8 percent.

The zip codes with the highest rates of low birth weight infants were 74106 and 74126. 


Preterm Births

Definition

This indicator is defined as births that occur before the 37th week of pregnancy. It is presented as a percentage of all births to Tulsa County mothers, over the years 2015 – 2017.


Why is this indicator important?

Preterm birth is a leading cause of infant mortality and is a predictor for increased risk of illness and disability in all stages of life. Although the causes of preterm delivery are complex, risk factors include maternal age, race, low maternal income or socioeconomic status, infections, previous preterm birth, carrying more than one baby, tobacco and alcohol use, and substance abuse (9).


How are we doing?

Overall, 11 percent of infants born to Tulsa County mothers were preterm from 2015 – 2017. This was highest among black mothers (15.1 percent). The percentage of preterm births was slightly higher among non-Hispanic mothers compared to Hispanic mothers (11.2 percent compared to 10.1 percent).

In 2016, 11.0 percent of live births in Tulsa County were preterm, compared to 10.6 percent in Oklahoma and 9.9 percent in the U.S. The Healthy People 2020 goal is to reduce the preterm birth rate to 11.4 percent. All three of these regions met this goal.

The zip codes with the highest rates of preterm birth were 74106, 74120, 74126, 74130, and 74131.


Infant Mortality Rate

Definition

Infant mortality is defined as the death of a child in the first year of life. The infant mortality rate is presented as the number of infant deaths per 1,000 live births, over the years 2014 – 2016.


Why is this indicator important?

Infant mortality is often used as an indicator to measure the health and well-being of a community because factors affecting the health of an entire population can also influence the mortality rate of infants. There are obvious disparities in infant mortality by age, race, and ethnicity of the mother. Some of the causes of infant mortality are serious birth defects, premature birth, SIDS, maternal complications of pregnancy, and injuries such as suffocation. Many of these factors can be influenced by good preconception and prenatal care for mothers (10).


How are we doing?

Between 2014 and 2016, 212 Tulsa County infants died before the age of one, which was a rate of 7.4 deaths per 1,000 live births. Infant mortality for 'other' races was almost eight times higher than that of whites (37.0 deaths per 1,000 live births compared to 4.7 deaths per 1,000 live births). The infant mortality rate was slightly higher among non-Hispanics than Hispanics (7.7 compared to 5.9).

The infant mortality rate in Tulsa County in 2016 was 7.9 deaths per 1,000 live births. This was higher than Oklahoma (7.4) and the US (5.9; 2015 latest data available). The US overall was the only region to meet the Healthy People 2020 target for infant mortality of 6.0 deaths per 1,000 live births.

The zip codes with the highest rates of infant mortality were 74106 and 74126.

Explore the Data

The charts below allow you to filter the data based on your own needs. There are three sets of charts: zip code, race/ethnicity, and location. Within each set, there are two options: rate per 1,000 and percent of live births. These data are presented as one or three-year rolling totals, from 2011 - present.

The 'rate per 1,000' charts allow you to filter for all indicators that are presented as rates: crude birth rate, fertility rate, teen birth rate (15 - 17 and 15 - 19), and infant mortality rate. The 'percent of live births' charts allow you to filter for all indicators that are presented as percents: low birth weight, preterm births, late or no prenatal care, maternal education, tobacco use during pregnancy, and births to unmarried women.

Clicking on the blue text within the chart will allow you to choose which indicators and/or zip codes/races/ethnicities/locations you would like to see represented in the chart. Please note that if you choose multiple options, the chart will show you a cumulative total of all rates or percentages selected. It will not show you each indicator separately. Additionally, zip codes must be entered as text.

Some data is suppressed due to confidentiality concerns (less than 5 births or deaths in a group). This data is not available, and may result in a message that says "No data is available for this section."

If you would like to download the data, please click here


By Zip Code

These charts contain data for maternal and child health statistics for the 43 zip codes that are fully or partially within Tulsa County. The line graphs allows you to view trends in specific zip codes over time for individual indicators (rate or percent). The maps allow you to see trends for all zip codes in a specific time period for individual indicators (rate or percent). 


By Race/Ethnicity

These charts contain data for maternal and child health statistics for Tulsa County and Oklahoma by race and ethnicity over time.

Click on the blue text below the title to change race/ethnicity and/or indicator (rate or percent).

Clicking on a location in the legend below the chart will remove that location from the chart.


By Location

These charts contain data for annual maternal and child health statistics for Tulsa County, Oklahoma, or the United States. You can choose multiple indicators (all rates or all percents) to view over time for one location. If you choose multiple locations, rates will be shown as cumulative rates for those locations.


Data sources

• Hamilton BE, Martin JA, Osterman MJK, et al. Births: Final data for 2014. National vital statistics reports; vol 64 no 12. Hyattsville, MD: National Center for Health Statistics. 2015.

• Kochanek KD, Murphy SL, Xu JQ. Deaths: Final data for 2011. National vital statistics reports; vol 63 no 3. Hyattsville, MD: National Center for Health Statistics. 2015.

• Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National vital statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016.

• Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2011. National vital statistics reports; vol 62 no 1. Hyattsville, MD: National Center for Health Statistics. 2013.

• Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2010. National vital statistics reports; vol 61 no 1. Hyattsville, MD: National Center for Health Statistics. 2012.

• Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final Data for 2013. National Vital Statistics Reports; vol 64 no 1. Hyattsville, MD: National Center for Health Statistics. 2015.

• Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final data for 2015. National vital statistics report; vol 66, no 1. Hyattsville, MD: National Center for Health Statistics. 2017.

• Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: Final data for 2016. National Vital Statistics Reports; vol 67 no 1. Hyattsville, MD: National Center for Health Statistics. 2018.

• Murphy SL, Kochanek KD, Xu JQ, Heron M. Deaths: Final data for 2012. National vital statistics reports; vol 63 no 9. Hyattsville, MD: National Center for Health Statistics. 2015.

• Murphy SL, Xu JQ, Kochanek KD, Curtin SC, Arias E. Deaths: Final data for 2015. National Vital Statistics Reports; vol 66 no 6. Hyattsville, MD: National Center for Health Statistics. 2017.

• Oklahoma State Department of Health (OSDH), Center for Health Statistics, Health Care Information, Vital Statistics 2014 to 2016, on Oklahoma Statistics on Health Available for Everyone (OK2SHARE). Retrieved from: http://www.health.ok.gov/ok2share.

• United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Division of Vital Statistics, Natality public-use data 2007-2013, on CDC WONDER Online Database, January 2015. Retrieved from http://wonder.cdc.gov/natality-current.html.

• Vital Statistics (2011 – 2016). Center for Health Information. Oklahoma State Department of Health.

• Xu JQ, Murphy SL, Kochanek KD, Bastian BA. Deaths: Final data for 2013. National vital statistics reports; vol 64 no 2. Hyattsville, MD: National Center for Health Statistics. 2016.