Health Status Report 6.1.2024 : simplebooklet.com

Health Status Report2021-2023WELCOME TOPUBLIC HEALTHCARECJFHC promotes obstetric, neonatal, andpediatric evidenced based standards of careby providing quality comprehensiveeducation throughout the Consortiumregion. Evidenced based standards of careare identified through professionalassociations such as the American Collegeof Obstetricians and Gynecologists (ACOG),the Associations of Women’s Health,Obstetric and Neonatal Nurses (AWHONN),and the American Academy of Pediatrics(AAP) among others. The identifiedstandards of care are promoted viaeducational programs to all nursing staff aswell as to obstetric and pediatric staff andother health care professionals. It is alsopromoted through transport agreementsbetween agencies which are facilitatedthrough CJFHC. Access to regionalstandards of care and evidenced basedpractice can reduce liability exposure tohospitals, agencies, and the individualpractitioner..I am delighted to present the Health Status Report.As we reflect on the past three years, we have muchto celebrate and to be proud of as we continue ourcommitment to improving the health and well-beingof birthing people, children and families in ourcommunities. This report is a testament to thededication, compassion, and hard work of ourincredible team, partners, volunteers, andsupporters. Together, we have made significantstrides toward achieving our mission to promote anequitable and healthy future for families throughservices, advocacy, education, and collaboration.While we celebrate these accomplishments, werecognize that our work is far from complete. Thereare still challenges ahead, and new opportunities tomake a difference in the lives of the people weserve. We are more determined than ever to pressforward with our mission and continue striving forexcellence in maternal and child health.CEOROBYN D’ORIAii

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02Health Status Report2021-2023Executive SummaryMonitoring the status of maternal and child health in the region isessential to comprehend and limit the occurrence of disease andmortality. This Health Status Report focuses on maternal and childhealth indicators, including birth rates, prenatal care, cesareansection, low birth weight, preterm birth, and fetal mortality. Thestatistics provide a picture of the health status and mortalityexperiences of residents in Central New Jersey.Delivery and Birth Outcomes:Disparities:27.9% of women in the region delivered via cesarean section6.9% of all deliveries were low birth weightWhite non-Hispanic mothers were more likely to initiate prenatal care in the firsttrimester ( 83.2 %) than non-Hispanic Black mothers (66.5%).Black women have a 2 times greater percent of low birth weight births than White womenNearly one third of New Jersey’s population resides in the central region (3million) Poverty rates range from 3.7% in Hunterdon County to 11.3% in MercerCountyCentral New Jersey had 95,960 live births between 2021-2023,averaging 31,987 live births peryearAbout 56.1% of all live births in CJFHC region hospitals were born to White mothers, 25.0%were born to Hispanic mothers, 10.3% were born to Asian mothers and 7.5% were born to Blackmothers.During 2021-2023, 76% of all births were to women who initiated prenatal care during the firsttrimester. On average between 2021 and 2023, 1.3% of mothers received no prenatal careRegional Statistics Maternal Characteristics Health During Pregnancy

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03Health Status Report2021-2023About UsBackgroundOur MissionCapital Health Medical Center-Hopewell, CentraState Medical Center, Community Medical Center, HunterdonMedical Center, Jersey Shore University Medical Center, Monmouth Medical Center, Ocean County MedicalCenter, Penn Medicine Princeton Medical Center, Raritan Bay Medical Center, Riverview Medical Center,Robert Wood Johnson University Hospital, Robert Wood Johnson University Hospital Somerset, SouthernOcean Medical Center, Saint Peter’s University Hospital and Tru Birth Center. All member hospitals providethe data outlined within this report. Initial data provided is of a summary nature followed by more specificdata based on priority areas identified by the New Jersey Department of Health and the CJFHC RegionalNeeds Assessment.Promoting an equitableand healthy future forfamilies through services,advocacy, education, andcollaborationOur VisionHealthier communitieswith equal access toeducation, healthcare,and socail supportsystemsOur GoalsHealth Equity,OrganizationalSustainability,Collaboration, Education, &AdvocacyCentral Jersey Family Health Consortium,Inc. (CJFHC), was originally organizedthrough funding from the Robert WoodJohnson Foundation in 1988. Establishedin 1992, CJFHC is a leading private non–profit 501(C)3 organization licensed bythe New Jersey Department of Health andpart of a regionalized maternal and childhealth (MCH) system. CJFHC serves thecentral New Jersey region which includesHunterdon, Mercer, Middlesex,Monmouth, Ocean and Somersetcounties. Currently, there are 14 memberhospitals and one birthing center,including:

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White Black Hispanic Asian OtherNew Jersey Hunterdon Mercer Middlesex Monmouth Ocean Somerset0%20%40%60%80%100%High School GraduationRateAdults Age 25+ with Bachelor’sdegree or higherMedian HouseholdIncomeUnemploymentRateHunterdon95.8%55.5%$133,5343.0%Mercer89.7%44.2%$92,6973.9%Middlesex89.7%45.1%$105,2064.2%Monmouth94.3%49.9%$118,5273.6%Ocean93.1%32.9%$82,3793.3%Somerset94.0%57.3%$131,9483.4% New Jersey90.6%72.0%$97,1264.1%05Health Status Report2021-2023Population Characteristics of Central NewJersey Statewide, 52.9% of the population is non-Hispanic White, 21.9% is Hispanic, 15.4% is non-HispanicBlack, and 10.5% is non-Hispanic AsianNon-Hispanic Whites account for 83.3% of the population in Ocean County, but only 38.9% of thepopulation in Middlesex County.Mercer County has the largest proportion of the population being Black or African American (20.4%); while only 2.9% of the population in Hunterdon County is Black or African American. Middlesex County has the largest proportion of Asian people (26.1%) and (10.5%) in both Central NewJersey and New Jersey as a whole.Socioeconomic StatusHunterdon County had the highest rate of high school graduation (95.8%), highest median householdincome ($133,534), and lowest unemployment rate (3.0%). Mercer and Middlesex both had the lowest high school graduation rate (89.7%)Middlesex also had the highest unemployment rate (4.2%)Ocean County had both the lowest median household income $76,500 and the lowest percentage ofadults 25+ with a bachelor’s degree or higher while Somerset had the highest percentage (57.3%)1%Socioeconomic Status by County2018-2022Racial/Ethnic Distribution by County11,210%22%15%0.4%5%8%83%1%12%20%22%45%1%25%23%13%39%0.4%5%12%7%75%0.4%2%10%4%1%19%16%11%52%53%3%83%

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Age 10 - 30 YearsLorem ipsum dolorsit amet, like as bebefore consecteturadipiscing elit.Lorem ipsum dolorsit amet, like as bebefore consecteturadipiscing elit.Total Population in Poverty Children in PovertyNew Jersey Hunterdon Mercer Middlesex Monmouth Ocean Somerset0%5%10%15%20%Adult Obesity Limited Access to Healthy FoodFood InsecurityNew JerseyHunterdonMercerMiddlesexMonmouthOceanSomerset0.0%5.0%10.0%15.0%20.0%25.0%30.0%35.0%Uninsured Adults Uninsured ChildrenNew Jersey Hunterdon Mercer Middlesex Monmouth Ocean Somerset0%1%2%3%4%5%6%7%Obesity and Access to Healthy Food06Health Status Report2021-2023 Ocean County has the highest rate of children living in poverty (17%).Mercer County has the highest rate of the general population living in poverty (11%).Hunterdon has the lowest rates of children (3%) and total population living in poverty (4%).Mercer County has the highest rate of uninsured adults (7%) and uninsured children (4%).Ocean County has the highest percentages ofadult obesity (32%), food insecurity (8%), andlimited access to healthy foods (9%)Mercer County has the lowest percentage ofadult obesity (24%)Somerset County has the lowest percentage offood insecurity (5%)Somerset County and Hunterdon County bothhave the lowest percentages of limited accessto healthy foods (3%) Age 30 - 60+ YearsPoverty and Access to Healthcare Persons in Poverty2021-2022Access to Healthcare2021-2023Healthy Lifestyle: Diet2021 9.8%3.8%13.4%2.9%3.7%11.3%14.5%8.4%10.7%6.5%7.6%10.5%16.8%5.2%6.4%7.0%2.0%2.8%6.8%3.8%3.0%3.6%2.0%2.1%4.2%4.9%4.2%6.3%28% 28%32%27%25%28%24%4%3%4%4%5%9%3%9%6%7% 7%6%8%5%223

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Patient Age Ratio :Sexually Transmitted Infections07Health Status Report2021-2023 Hunterdon County had the highest percentage of adults reporting binge/heavy drinking (20%).Middlesex had the lowest percentage of adults binge/heavy drinking (14%).Somerset County had the lowest percentage of adults smoking (10%).Mercer and Ocean had the highest percentages of adults smoking (14%).Mercer County’s chlamydia rates are higher than the New Jersey average.Hunterdon County has the lowest rate of Chlamydia per 100,000 (137.2) and the lowest rate of HIV per100,000 (71.1)Mercer County has the highest rate of HIV in the region with a rate of 265.3 cases per 100,000Age 0 - 10 YearsSubstance Use Alcohol and Tobacco Use2021Sexually Transmitted Infections2021Binge or Heavy Drinking Adult SmokingNew Jersey Hunterdon Mercer Middlesex Monmouth Ocean Somerset0%5%10%15%20%HIV Chlamydia0 100 200 300 400 500New JerseyHunterdonMercerMiddlesexMonmouthOceanSomerset468.9361.1241.5168.6172.2214.1217.7137.2445.4143.2473.1288.3309.7325.317.0%20.0%11.0% 11.0%16.0%11.0%17.0%14.0% 14.0%12.0%16.0% 16.0%10.0%14.0%34,5

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Central NJ NJ US201320142015201620172018201920202021202202004006008001000The leading causes of death in Central NJin 2022 were diseases of the heart (159.6)other underlying causes (139.2) cancer(124.6) The leading causes of death in New Jerseywere diseases of the heart (151.9) otherunderlying causes (144.5) and cancer(123.8) COVID-19 was the 5th highest leadingcause of death in both the state and theregionMortalityIn 2022, the age-adjusted mortality rate forNew Jersey was 683.8 per 100,000 peoplein the population, less than the national rateof 798.8 Central New Jersey has had consistentlylower mortality rates than the state andnation. Since 2020 the age-adjusted mortality ratein the central region has decreased from789.8 to 675.5 in 2022 per 100,000.In 2013, the age-adjusted drug-related mortalityrate for Central New Jersey was 14.7 per 100,000people in the population and the New Jersey ratewas 14.9, more than the national rate (14.6)In 2021, the rate of drug-related deaths for bothCentral New Jersey (32.1) and New Jersey (33.3)fell below the rate for the United States (33.6) In 2022, opioids were the leading substance thatcaused unintentional overdose deaths in NewJersey Age-Adjusted Drug-Related Mortality2013-202308Health Status Report 2021-2023Age-Adjusted MortalityAge-Adjusted Mortality Rate: A death rate that controls for the effects of differences in population agedistributions. When comparing across geographic areas, some method of age-adjusting is typically used tocontrol for the influence that different population age distributions might have on health event rates.Central NJ NJ US2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 20230.010.020.030.040.022.032.119.014.914.614.4731.9676.4655.2675.5798.8683.8Age-Adjusted Mortality rate 2013-20226,78,910

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Child MortalityCountyChild Mortality Rate per100,000 (2019-2021)Hunterdon25.7Mercer45.8Middlesex29.9Monmouth27.0Ocean31.0Somerset27.6New Jersey33.8The leading causes of child (0-17yrs) injury mortality between 2020 and 2021 were suffocation (24.1%)motor vehicle - traffic (20.7%), and poisoning (14.9%)In the central region the rate of unintentional injuries was 5.1 per 100,000, suicide was 1.6 per 100,000 and homicide was 1.7 per 100,000.Central NJ has an overall lower rate of injury mortality compared to the entire stateInjury IntentCentral RegionRate per100,000NJ Rateper100,000Unintentional5.15.4Suicide1.61.6Homicide1.72.2Total8.89.6The leading causes of death for children under age 18 inCentral NJ between 2022 and 2023 were otherunderlying causes of death (62.7%), unintentionalinjuries (16.2%), suicide (4.9%) homicide (3.6%),cancer (3.3%), and diseases of the heart (3.0%).Out of all the regional counties Mercer County (45.8 per 100,000) had the highest child mortality rate,which was also higher than the rate in New Jersey (33.8).Moreover, Mercer County ( 45.8) had a child mortality rate 1.6 times greater than Monmouth County (27.0)which had the lowest child mortality rate in the region.Leading Causes of Child Injury Mortality 2020-202109Health Status Report 2021-2023Child Injury MortalityCentral NJ NJSuocation Motor Vehicle Poisioning0.0%5.0%10.0%15.0%20.0%25.0%24.1%16.9%20.7% 21.0%14.9%11.6%6Child Mortality by County6Child Injury Intent 2020-20216

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On average 31,522 women delivered an average of 31,987 babies every year in Central New Jersey.Like New Jersey overall, the women delivering in the Central Region come from various racial and ethnic backgrounds and socioeconomic statuses.0% 10% 20% 30% 40%Less than 1515 to 1920 to 2425 to 2930 to 3435 to 3940+White Black Hispanic AsianOther0%10%20%30%40%50%60%BirthsThroughout the 2021 to 2023 period, the highest percentage of total births occurred to mothers aged 30 to 34 years (36%), followed by 25 to 29 years (23%), 35 to 39 years (22%), 20 to 24 years (13%), 40 years and over (5%), and 15 to 19 years (2%).During the 2021 to 2023 period, about 56.1% of allbirths in CJFHC region hospitals were born to Whitebirthing people, 8.0% were born to Black birthingpeople, 25.0% were born to Hispanic birthing people,and 10.3% were born to Asian birthing people.Central NJ has representation of one of the mostaffluent counties in the state (Hunterdon), as well asone of the most impoverished counties (Ocean).Both urban and suburban neighborhoods can befound within the six counties of the central region.11Annual Report2021- 20232.0%12.8%23.1%35.6%21.5%5.2%56.1%7.5%25.0%10.3%1.0%7Births by Maternal AgeBirths by Maternal Race/ EthnicityDemographicCharacteristics 4Live BirthsDeliveries95,96094,5660.03%

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Teen Births Note :Lorem ipsum dolor sit amet, consecteturadipiscing elit. Pellentesque sit amet ligulaipsum. Vestibulum massa libero, iaculis idpharetra vitae, gravida ac tellus.Central NJ NJ US2019 2020 2021 2022 20230%1%2%3%4%5%US Born Foreign Born0% 20% 40% 60% 80% 100%HunterdonMercerMiddlesexMonmouthOceanSomersetUS BornForeign BornUnmarried23.5%34.6%1st TrimesterPrenatal Care81.7%64.1%Less than HighSchool3.4%21.2%Teen Mother1.6%2.6%Preterm8.0%8.7%Low BirthWeight6.5%7.7%Patient Satisfaction : Patient To Doctor Help :Over the past five years births to teens across CJFHC region hospitals has decreased minutely going from2.4% in 2019 to 1.9% in 2023. Within this three year period, a total of 1,815 births occurred to teen mothers.Most births to teens occurred to those between the ages of 15 and 19, with births to those under 15 yearsrepresenting only 0.03% of all births from 2021 to 2023.Between 2021 to 2023 more than half (55%) of the births in Middlesex County were to foreign-bornbirthing people.From 2021 to 2023, low birth weight and preterm births were higher among foreign-born mothers thannative-born mothersNative-born mothers tended to have higher levels of educational attainment, were more likely to havebegun prenatal care in the first trimester, and were more likely to be marriedAnnual Report 2021-2023Nativity 2021-2023 Nativity Births to Teen Mothers (<20 years)4.6%4.0%2.7%2.4% 2.2%1.9%22.3% 84.4%45.2%50.0%50.0%78.8% 77.7%21.2%15.6%47.8%52.2%11,1254.8%12

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Education AttainmentNote :White Black Hispanic AsianOther0% 10% 20% 30% 40% 50%MedicaidWICLorem ipsum dolor sit amet, consecteturadipiscing elit. Pellentesque sit amet ligulaipsum. Vestibulum massa libero, iaculis idpharetra vitae, gravida ac tellus.Patient Satisfaction :Note :Patient To Doctor Help :Of the 94,566 deliveries that occurred between 2021 and 2023: 32% had an undergraduate college degree25% had a high school diploma21% had an advanced degree4% had less than high school educationAnnual Report 2021-2023Maternal Education LevelCollege Degree32.4%High School Degree24.5%Advanced Degree21.3%Some College12.7%Some High School5.2%Socioeconomic StatusThe percentage of mothers in Central Jerseythat were Medicaid beneficiaries increased from 26.5% in 2021 to 29.1% in 2023.Nearly half of all Blacks (41%), and Hispanics(45%) were Medicaid beneficiaries The percentage of mothers that participated inthe Supplemental Nutrition Program forWomen, Infants and Children (WIC), decreasedfrom 18.4% in 2021 to 17.0% in 2023 From 2021-2023 33.0%of Hispanic mothers,26.2% of Black mothers, and 15.2% ofmothers of another race participated in theWIC program.Maternal Socioeconomic Status by Race40.9%23.2%27.2%7.8%13.0%26.2%15.2%2.8%33.0%44.5%13

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2021 2022 20230.0%0.5%1.0%1.5%2.0%Lorem ipsum dolor sit amet, consecteturadipiscing elit. Pellentesque sit amet ligulaipsum. Vestibulum massa libero, iaculis idpharetra vitae, gravida ac tellus.White Black HispanicAsian Other0.0%0.5%1.0%1.5%2.0%2.5%3.0%0% 20% 40% 60% 80% 100%HunterdonMercerMiddlesexMonmouthOceanSomersetWhite Black Hispanic AsianOther1.5%Prenatal CareHunterdon County has the highest rate of women starting prenatal care in thefirst trimester (88%), while Mercer County has the lowest rate (64%).The percentage of births to mothers who received no prenatal care was higheramong Black women (2.2%) and women of another race (2.8%), compared toHispanic (1.8%), White (1.0%) and Asian women (0.5%), between 2021 and2023.The percentage of mothers that smoked cigarettes before or during theirpregnancy represented 1.5% of all mothers in 2021 and decreased to 0.81%in 2023.Across the CJFHC Region from 2021-2023, the total percentage of reportedtobacco usebefore or during pregnancy was highest among Black mothers (2.7%).16Annual Report 2021-2023Tobacco use Before or During Pregnancy No Prenatal Care by Race1st Trimester Prenatal Care InitationCigarette Use by RaceCigarette Use Before or During Pregnancy0.8%1.2%2.7%0.8%1.7%0.2%88.0%73.9%64.0%81.2%77.2%76.4%1.0%2.2%1.8%0.5%2.8%15

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Lorem ipsum dolor sit amet, consecteturadipiscing elit. Pellentesque sit amet ligulaipsum. Vestibulum massa libero, iaculis idpharetra vitae, gravida ac tellus.Maternal Risk Factors (%) Risk Factor202120222023Obesity11.9%10.9%12.7%Anemia8.1%9.0%10.0%Diabetes10.5%9.6%9.9%Hypertension8.5%8.2%8.5%Depression2.7%6.4%5.8%Mental Illness5.1%3.8%4.3%Genital Herpes0.4%1.0%1.0%Cardiac Disease0.7%0.8%0.7%Renal Disease0.6%0.6%0.4%Risk Factors202120222023Gestational Diabetes9.6%8.8%9.2%Gestational Hypertension6.2%5.9%6.3%Oligohydramnios1.5%2.0%1.5%Plural Births1.4%1.6%1.5%Maternal Risk Factors Note :Note :Rates of maternal risk factors for birthing people in the Central Jersey regionincreased between 2021 to 2023 for several medical conditions.Obesity increased by 1% (12.0% to 13.0%)Anemia increased by 2% (8% to 10%)Depression increased by 3% (3% to 6%)Genital Herpes increased by 0.6% (0.4% to 1%)Rates of pregnancy risk factors for birthing people in the Central Jersey region did not change muchbetween 2021 and 2023. Gestational diabetes decreased by 0.4% (9.6% to 9.2%) and gestationalhypertension increased by 0.1% (6.2% to 6.3%).Gestational risk factors are those that are first diagnosed during pregnancy.Annual Report 2021-2023Pregnancy Risk FactorsPregnancy Risk Factors (%)16

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Note :Lorem ipsum dolor sit amet, consecteturadipiscing elit. Pellentesque sit amet ligulaipsum. Vestibulum massa libero, iaculis idpharetra vitae, gravida ac tellus.Patient Satisfaction : Patient To Doctor Help :From 2021 to 2023, the percentage of multiple births increased with maternal age, until reaching 38% for women delivering between 30 and 34 Multiple births occurred in 24% of women delivering between the ages of 35 and 39, and 22% of women delivering between the ages of 25 and 29Plurality Total Live Births by CJFHC Region Hospitals, 2021-2023Other Facility/Out of Hospital Births430Capital Health Medical Center-Hopewell11046CentraState Medical Center2154Community Medical Center5750Hunterdon Medical Center2962Jersey Shore University Hospital9919Monmouth Medical Center19424Penn Medicine Princeton Medical Center6286Ocean Medical Center3045Raritan Bay Medical Center2894Riverview Medical Center4184Robert Wood Johnson University Hospital7495Robert Wood Johnson Somerset2597Saint Peters University Hospital16267Southern Ocean Medical Center1108Tru Birth399Total9553015-19 20-24 25-29 30-3435-39 40+0%10%20%30%40% Birthing HospitalsCentral New Jersey hospitals account for one-third of all births in New Jersey.91.5% of births in Central NJ were to residents of the Central Region.Monmouth Medical Center is the largest birthing hospital in the region with approximately 19,424 births between2021-2023.Annual Report 2021- 20232021-2023 Multiple Births by Maternal Age 9.2%0.6%21.7%37.7%24.2%6.6%18

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C-Section C-Section VBAC NTSV2021 2022 20230%5%10%15%20%25%30%C-Section NTSVHunterdonMercerMiddlesexMonmouthOceanSomerset0%5%10%15%20%25%30%35%38% 83%Note :Patient Satisfaction :Note :Middlesex County had the highest percentage of C-Sections in Central NJ (34.4%) while Ocean Countyhad the lowest percentage of C-Sections (17.7%) (range of 16.7% ) C-Section rates increased by 0.2% Vaginal births after C-Section (VBAC) rates decreased by 0.7%Low risk C-section (Nulliparous, Term, Singleton, Vertex) increased by 4.5%38.1% of women delivering were exclusively breastfeedingat the time of discharge82.5% of women delivering were breastfeeding exclusivelyor in combination with formula feeding at the time ofdischarge.Annual Report 2021-2023 Feeding Method2021-2023 Feeding Method Rates Delivery Method by Year2021-2023 C-Section Rates by County3.4%2.7%27.7%28.8%24.3%27.9%32.0%31.4%31.2%25.7%34.4%28.2%31.4%27.5%17.7%20.1%33.4%30.9%Exclusive BreastfeedingExclusive or Combination Feeding19

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Maternal Morbidity Lorem ipsum dolor sit amet, consecteturadipiscing elit. Pellentesque sit amet ligulaipsum. Vestibulum massa libero, iaculis idpharetra vitae, gravida ac tellus.LBW Very LBWAll Births Singleton0.0%1.0%2.0%3.0%4.0%5.0%6.0%Patient Satisfaction : Patient To Doctor Help :Infection is the most common complication and has increased between 2021 and 2023Excessive blood loss increased by 3%From 2021 to 2023, the rate of low birth weight (weighing less than 2,500 grams) infants increased from5.7% to 6.0%.Very low birth weight (weighing less than 1,500 grams) and extremely low birth weight (weighing less than1,000 grams) infants have averaged about 1.0% of all births.An average of 5.0% were low birth weight singleton births0.4% were very low birth weight singleton births.Annual Report 2021-2023Low Birth Weight Low Birth Weight2021-2023Births to Teen Mothers (<19 years)Maternal Morbidity (%)Diagnosis/Procedure202120222023Infection with Streptococcus17.1%19.4%20.0%Excessive Blood Loss8.6%8.1%11.6%Third or Fourth Degree Perineal Laceration0.5%0.5%0.5%Maternal Transfusion0.6%0.4%0.5%LBW Very LBW Extremely LBW2021 2022 20230.0%1.0%2.0%3.0%4.0%5.0%6.0%Low Birth Weight by Year5.7%6.0%6.0%0.5%0.5%0.6%0.5%0.5%0.4%6.0%4.7%5.9%0.4%0.6%22

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Lorem ipsum dolor sit amet, consecteturadipiscing elit. Pellentesque sit amet ligulaipsum. Vestibulum massa libero, iaculis idpharetra vitae, gravida ac tellus.Patient Satisfaction :Small/Large for Gestational Age Preterm Very Preterm0.0% 2.0% 4.0% 6.0% 8.0%All BirthsSingletonFetal Mortality Rate2011-2021NJ US2011-2013 2012-2014 2013-2015 2014-2016 2015-2017 2016-2018 2017-2019 2018-2020 2019-20210.01.02.03.04.05.06.07.06.56.06.612% 14%Preterm Note :Preterm births have increased slightly during the 3-yearperiod (8.0% to 8.3%)Preterm births averaged 7.2% of all birthsVery preterm births have averaged about 1.1%Preterm singleton births averaged about 6.0%Very preterm singleton births averaged about 0.9%Small for gestational age infants averaged 12.0% of all birthsLarge for gestational age infants averaged 14.1% of all birthsAnnual Report 2021-2023SGA and LGA Birth Rates 2021-2023Preterm Births2021-2023Fetal Mortality RateIn New Jersey, fetal deaths have decreased slightly from 6.6 per 1,000 births to 6.5 since 2019The average fetal mortality rate from 2019-2021 was higher in New Jersey (6.5) compared to 5.7in the US7.2%0.9%6.0%1.1%Small for Gestational Age*Fetal mortality data retrieved from CDC WonderLarge for Gestational Age5.723

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Health DisparitiesStructural RacismSocial Risk Factors EnvironmentalRisk FactorsQuality of HealthcareResidentialSegregationEducationIncomeJustice Health CareCrowded unsafe housing Environmental pollutants Infectious diseaseLimitedaccess tofresh foods Green areas Gaps in provider-patientcommunicationInattention to warning signs Lack of timely diagnosis andtreatmentInadequate coordination andcontinuity of careHealth disparities research focuses on understanding the complex associations between race, health, and health careThe Covid-19 Pandemic had shed light on the magnititute of health disparities in the US, Hill et. al., (2022)emphasized that Maternal and infant health disparities are symptoms of broader underlying social andeconomic inequities that are rooted in racism and discriminationThe remainder of this chapter explores the disparities in various maternal and infant health measures byhealth. These are purely descriptive depictions and do not reflect the underlying social determinants thatimpact these outcomes.Annual Report 2021-2023Disparities in maternal health outcomeFactors Driving Disparities In Maternal and Infant Health Integrating a maternal-infant dyad lens can enhance understanding on the connections betweenpreventable, quality-based disparities in maternal and newborn care Health Outcomes: Morbidity, Mortality, Lower Life Expectancy, Health Status, DisabilitySocial, environmental and healthcare factors that contribute to Health Outcomes 1415,161625

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Note :Lorem ipsum dolor sit amet, consecteturadipiscing elit. Pellentesque sit amet ligulaipsum. Vestibulum massa libero, iaculis idpharetra vitae, gravida ac tellus.Lorem ipsum dolor sit amet, consecteturadipiscing elit. Pellentesque sit amet ligulaipsum. Vestibulum massa libero, iaculis idpharetra vitae, gravida ac tellus.Patient Satisfaction :Note :Patient To Doctor Help :Breastfeeding rates are significantly lower among Black and Hispanic women (33.3% and 30.9%,respectively).Black non-Hispanic and Asian women had the highest percentage of Cesarean deliveries of allrace/ethnicities (37.0% and 35.5%, respectively).Annual Report 2021-2023Cesarean Section by RaceExclusive Breastfeeding Through Entire Stay by RaceWhite Black Hispanic Asian OtherWhite Other AsianBlackHispanic42.7%33.3%30.9%33.6%38.3%23.9%37.0%35.5%31.0%31.6%BreastfeedingCesarean Section27

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Annual Report2021- 2023RecommendationsThe AAP recommends that birth hospitals or centers implement maternity care practices shown to improvebreastfeeding initiation, duration, and exclusivityIncrease enrollment and participation of families with newborns in the Family Connects NJ program, and toreceive support during the transition to parenthood Increase awareness on Car Seat Safety Check Events provided by the Safe Kids NJ programIncrease the proportion of pregnant women from minority cultural groups who receive early and adequateprenatal careIncrease awareness on diabetes, and provide nutrition during pregnancy information recommended byACOGPreconception Care, Prenatal Care, andPostpartum CareProfessional EducationDevelop an education plan for health providers to engage in positive discussions on breastfeeding. Theplan can be implemented in a lunch and learn event in clinics and areas with low breastfeeding rates Increase health professional and patient communication toward breastfeeding initiation issues, becauseinfant formula alone is not a solutionThe development of a Fetal Monitoring Certificate Course can enhance the clinical skills of clinical staff onc-sectionReduce cesarean births among low-risk women with no prior births Increase health professional clinical competency on methods to change fetal positions to reduce c-sections and surgical site infections Educate health professionals on the Nurture NJ Maternal and Infant Health Strategic Plan, with a focus onreducing the number of cesarean births among low-risk birthing persons Patient EducationBased on the results from this report and the input from both the Continuous Quality Improvement Committeeand the Interdisciplinary Case Review Team, the following recommendations are made:Increase abstinence from cigarette smoking among pregnant women, by asking all pregnant women abouttobacco use during prenatal care visits, provide cultural and pregnancy-tailored information Increase education on the NJ FamilyCare Supplemental Prenatal and Contraceptive Program, to provideprenatal and family planning services to birthing persons who do not qualify for NJ FamilyCare because oftheir immigration statusIncrease education/programming to educate fathers, grandmothers, partners, teens, and children aboutbreastfeeding to help support family members who may be breastfeeding in order to increase socialsupports.Increase patient information on the need for prenatal care and the importance of prenatal care in order todetermine possible needs for a fetus position change to reduce c-section deliveries 31

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Annual Report2021- 2023RecommendationsEstablish equitable systems to improve the quality of lactation support in the areas of early initiation ofbreastfeeding, limited use of breastfeeding supplements, and rooming-in that incorporate the voices andexperiences of members of marginalized and oppressed groups. Reduce the number of babies born prematurely and eliminate racial disparities in New Jersey throughcommunity and professional education programs, such as the Prematurity Prevention Initiative Support the increase in a diverse workforce that is aware of bias and can provide appropriate care acrossthe maternal and infant care and education continuumRacial/Ethnic EquityScreening and ReferralsImplementing the Screening and Treatment guidelines for Maternal Mental Health by the ACOG: 1. Provide educational materials to all new prenatal patients and again to patients at their postpartum visit.Women and their families, or other members of their support system should be proactively provided witheducation so that they are aware of signs and symptoms of perinatal mood and anxiety disorders 2. Screening patients at least once during the perinatal period for depression and anxiety, and, if screeningin pregnancy, it should be done again postpartumInfant Health Education The AAP recommends that birth hospitals or centers implement maternity care practices that have beenshown to improve breastfeeding initiation, duration, and exclusivityThe AAP emphasizes the training of neonatal clinicians on NICU lactation support for mothers of very lowbirth weight infantsProviding education on the revised 2022 Infant Safe Sleep guidelines by the AAP Sleep surface: Use a firm, flat, non-inclined sleep surface. Sleep surfaces with inclines of >10 degreesare unsafe for infant sleep. 1.Breastfeeding: Feeding of human milk is recommended because it is associated with a reduced risk ofSIDS. Unless it is contraindicated or the parent is unable to do so, it is recommended that infants be fedwith human milk (ie, not offered any formula or other non-human milk based supplements) exclusively for6 months, with continuation of human milk feeding for 1 year or longer as mutually desired by parent andinfant,2.Sleep location: For clinical and non-clinical health providers to know factors that increase themagnitude of baseline risk of parent–infant bed sharing, and risks when bed-sharing or surface sharing 3.Prenatal and postnatal exposure to tobacco, alcohol, and other substances: Avoid smoke, nicotine,alcohol, marijuana, opioids, and illicit drug use exposure during pregnancy and after birth.4.Use of home cardiorespiratory monitors: Not to use commercial devices that are designed to monitorinfant vital signs to reduce the risk of SIDS and prevent sleep-related deaths5.32

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RecommendationsAnnual Report2021- 2023Consumer Education Implementing the Screening and Treatment guidelines for Maternal Mental Health by ACOG Increase access to guidance and resources to address issues or concerns related to pregnancy and childhealth Importance of vaccination during pregnancy to reduce the incidence of infections and their associatedadverse outcomes in both birthing persons and infants. Increase awareness on access to the Summer EBT program through the USAID Child Nutrition Program,to reduce the rates of food insecurity among families living in Central New Jersey counties System Issues Issues were identified by the Interdisciplinary Case Review Team during the review of deaths occurring in2022:Prenatal records on labor and delivery records are incomplete 1. Lack of access to results of maternal and fetal evaluation testing, especially if testing was completed outof state 2. Lack of access to the death certificate for tracking cause of death3. Lack of perinatal pathologists in New Jersey, leading to fetal autopsies being sent out of state which canbe cost prohibitive for many4. Follow-up appointments for birthing persons who experience a loss need to occur 1-3 weeks after loss5. Lack of access to early and regular prenatal care appointments6.Increase the number of families that have autopsies or related services7.Prevention Increase awareness of risk for perinatal loss (maternal obesity, substance use and chronic disease) andsymptoms that warrant engaging the healthcare providerNeed for perinatal bereavement education for hospital Social WorkersNeed for healthcare providers to assess pregnancy intendedness and provide anticipatory guidancerelating to prescribed medicationsNeed to increase the number of maternal interviews Education related to available hospital services for emergency workers/EMT’s about hospitals with OBservices and neonatal levels of careConsumer education is needed surrounding Marijuana use in pregnancyCommunity education is needed to decrease the estimated number of new HIV infections Need to increase awareness and understanding of the PRA at private provider offices and increaseawareness of available resources Need for preeclampsia/eclampsia education among Emergency Department staff33

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Annual Report2021- 2023American Community Survey. (2022). Population Estimates. United States Census Bureau. U.S. CensusBureau QuickFacts: United States1.U.S. Census Bureau. (2022). Selected Economic Characteristics. American Community Survey, ACS 5-Year Estimates Data Profiles, Table DP03. Retrieved May 16, 2024, fromhttps://data.census.gov/table/ACSDP5Y2022.DP032.Compare Counties | County Health Rankings & Roadmaps. (n.d.). County Health Rankings & Roadmaps.Retrieved May 16, 2024, from https://www.countyhealthrankings.org/health-data/compare-counties?compareCounties=34019%2C34021%2C34023%2C&year=20243.Health, D. (n.d.). NJSHAD - Query Builder - New Jersey Sexually Transmitted Disease Data - Crude Rates(Cases Per 100,000 Population). Retrieved May 16, 2024, from https://www-doh.state.nj.us/doh-shad/query/builder/std/STD/CrudeRate.html4.Health, D. (n.d.-a). NJSHAD - Query Builder - New Jersey HIV/AIDS Data as of 2021 - Prevalence Rate.Retrieved May 16, 2024, from https://www-doh.state.nj.us/doh-shad/query/builder/hiv/Prevalence/Rate.html5.Health, D. (n.d.-b). NJSHAD - Query Builder - New Jersey Mortality Data: 2000-2021 - Age-adjusted Rates(Deaths Per 100,000 Standard Population) for Counties. Retrieved May 16, 2024, from https://www-doh.state.nj.us/doh-shad/query/builder/mort/MortCntyICD10/AgeRate.html6.Health, D. (n.d.-d). NJSHAD - Query Builder - NJ Provisional Death Data Query - 2022 Age-adjusted Rates(Deaths Per 100,000 Standard Population) for Counties. Retrieved May 16, 2024, from https://www-doh.state.nj.us/doh-shad/query/builder/provdth/MortCoRates/AgeRate.html7.Multiple Cause of Death, 1999-2020 Request. (n.d.). CDC WONDER. Retrieved May 16, 2024, fromhttp://wonder.cdc.gov/mcd-icd10.html8.Provisional Mortality Statistics, 2018 through Last Week Request. (n.d.). CDC WONDER. Retrieved May 16,2024, from http://wonder.cdc.gov/mcd-icd10-provisional.html9.D.Powell. (n.d.). Department of Health | Population Health | New Jersey SUDORS Overdose Mortality DataExplorer. The Official Web Site for The State of New Jersey. Retrieved May 22, 2024, fromhttps://www.nj.gov/health/populationhealth/opioid/sudors.shtml10.Natality, 2016-2022 expanded Request. (n.d.). CDC WONDER. Retrieved May 16, 2024, fromhttp://wonder.cdc.gov/natality-expanded-current.html11.Provisional Natality, 2023 through Last Month Request. (n.d.). CDC WONDER. Retrieved May 16, 2024,from http://wonder.cdc.gov/natality-expanded-provisional.html12.Health, D. (n.d.-c). NJSHAD - Query Builder - New Jersey PRAMS Data - Infant Sleep Position. RetrievedMay 16, 2024, from https://www-doh.state.nj.us/doh-shad/query/builder/prams/PRAMS/InfSleepPosition.html13.Health, D. (n.d.-c). NJSHAD - Query Builder - New Jersey PRAMS Data - Baby Sleeps in Crib. RetrievedMay 16, 2024, from https://www-doh.state.nj.us/doh-shad/query/builder/prams/PRAMS/InfCrib.html14.Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them | KFF. (n.d.).KFF. Retrieved May 19, 2024, from https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/15.Glazer, K. B., Zeitlin, J., & Howell, E. A. (2021). Intertwined disparities: Applying the maternal-infant dyadlens to advance perinatal health equity. Seminars in Perinatology, 4, 151410.https://doi.org/10.1016/j.semperi.2021.15141016.Robert Wood Johnson Foundation. (2023). Birth and Reproductive Justice—Improve Maternal and InfantHealth Outcomes by Enhancing Care, Supports, and Prevention. Robert Wood Johnson Foundation.Retrieved from https://www.rwjf.org/en/insights/our-research/2023/05/a-policy-agenda-for-a-healthier-more-equitable-new-jersey/birth-and-reproductive-justice-improve-maternal-and-infant-health-outcomes.html17.Maughan, E., Paola, K., Ryan, CW., McFarland, C., Garcia, GM., D’Oria, R. (2022). New JerseyBreastfeeding Strategic Plan. New Jersey Department of Health. Accessed fromhttps://www.nj.gov/health/fhs/wic/documents/FINAL%20New%20Jersey%20Breastfeeding%20Strategic%20Plan%202022.pdf?_18.References 35

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