Maternal and Child Health

The seeds of success in every nation on Earth are best planted in women and children.

—Joyce Banda

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, for the single year 2018 and over the years 2016–2018.

Why is this indicator important?

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

How are we doing?

In 2018, Tulsa County’s crude birth rate of 13.8 live births per 1,000 population was higher than the rate in Oklahoma (12.7) and the United States (11.6). The birth rate in Tulsa County has consistently been higher than both Oklahoma and the US since 2011, although it has shown a slight downward trend in Tulsa County since 2016.

There were 27,629 live births to Tulsa County residents from 2016 – 2018. Males comprised 51.4 percent of live births while females made up 48.6 percent. Birth rates were highest among Native Hawaiians/ Pacific Islanders (45.4 births per 1,000 population), and lowest among mothers who reported 'other race' (5.9). The Hispanic birth rate (21.8) was higher than the non-Hispanic birth rate (13.5). Compared to Oklahoma, the birth rate by race/ethnicity in Tulsa County was higher in all races and ethnicities except American Indian/Alaskan Native and 'other' races.

From 2016-2018, the crude birth rate was highest in the North Tulsa region at 19.1 births per 1,000 population.  This is much higher than the overall rates for 2018 for Tulsa County, Oklahoma and the US.  The second highest crude birth rate in the Tulsa County metro area was in the East Tulsa region at 17.2 births per 1,000 population.  The crude birth rate was lowest in the Downtown region, at 6.6 births per 1,000 population.  

The zip codes with the highest birth rates were concentrated in the North Tulsa (highest 74116) and East Tulsa regions.  The zip code with the lowest rate was 74103 in the Downtown region.


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, for the single year 2018 and over the years 2016 to 2018.

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?

In 2018, Tulsa County had a fertility rate of 67.4 live births per 1,000 females age 15 – 44 years. This rate was higher than both Oklahoma (64.7) and the United States (59.1). The birth rate in Tulsa County has consistently been higher than both Oklahoma and the US since 2011. All three locations have shown slight downward trends from 2016 to 2018.

The fertility rate for Tulsa County from 2016–2018 was 70.5 live births per 1,000 females ages 15 – 44 years. The fertility rate was highest among Native Hawaiians/Pacific Islanders (202.8). This was true for Oklahoma as well.  Hispanics had a higher fertility rate than non-Hispanics (97.3 compared to 74.8).  The fertility rates for all races were higher from 2016-2018 in Tulsa County than in Oklahoma, except for American Indian/Alaskan Natives and those who reported "other" race.

From 2016-2018 in Tulsa County, fertility rates were the highest in the North Tulsa region at 94.5 births per 1,000 females aged 15-44, followed by the East Tulsa region at 81.7 births per 1,000 females aged 15-44.  The Downtown region of Tulsa County had the lowest fertility rate from 2016-2018 at 26.8 births per 1,000 females aged 15-44.  

The zip codes with the highest fertility rates were concentrated in the North and East Tulsa regions.


Teen Birth Rate

Definition

This indicator is presented as the number of live births to Tulsa County teenagers (ages 15 to 17 and 15 to 19) per 1,000 females in this age group, for the single year 2018 and over the years 2016–2018.

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?

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 slightly less than Oklahoma (27.4), but higher than the United States (17.4). 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.  

There were 450 births to Tulsa County teenagers age 15 – 17 from 2016–2018, for a birth rate of 11.9. There were a total of 1,722 births to Tulsa County teenagers age 15-19 during the same time period, for a birth rate of 28.6. The teen birth rates for teens age 15-17 and ages 15-19 have consistently been declining in Tulsa County since 2011.

In Tulsa County, blacks had the highest birth rate for teens ages 15–17 (20.5), although this rate was much lower than from 2011-2013 at 29.0.  Asians had the lowest birth rate with 4.9 live births per 1,000 females ages 15–17. Additionally, the birth rate for Hispanic women in this age group was almost triple that of non-Hispanic women (24.4 compared to 9.5).  There were too few births to be reported in this age group in the Native Hawaiian/Pacific Islander population during the time period.

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

The North Tulsa region had the highest teen birth rates in both of the age groups for the time period, followed by the East Tulsa region.  The Owasso/Sperry region had the lowest birth rate for teens 15-17 at 3.4 live births per 1,000 females, and the Sand Jenks/Bixby region had the lowest birth rate for teens 15-19 at 12.1 live births per 1,000 females.  

In terms of zip codes, the highest teen birth rates (15- 17) was in the East Tulsa region at 32.6 in 74108.  The zip code with the highest teen birth rates (15-19) was the North Tulsa region at 81.3 in 74116.

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 for the single year 2018 and over the years 2016 to 2018.

Why is this indicator important?

Maternal education is related to the types of jobs an individual can obtain and 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?

In 2018, 18.2 percent of Tulsa County birth mothers had less than a 12th grade education, compared to 15.2 percent in Oklahoma and 12.7 percent in the United States. In general, all of these regions have shown slightly declining trends in percentages since 2011.  

From 2016 – 2018, the percentage of birth mothers in Tulsa County with less than a 12th grade education was 18.8 percent. This percentage was highest among Native Hawaiian/ Pacific Islander mothers (45.8 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 (43.1 percent compared to 13.4 percent). With the exception of mothers of 'other' races, this indicator was consistently higher in Tulsa County compared to Oklahoma.

The North Tulsa and East Tulsa regions had the highest percentages of mothers with less than a high school education at 37.1 percent and 27.6 percent respectively.  The Owasso/Sperry and the Jenks/Bixby regions had the lowest percentages of mothers with less than a high school education at 6.7 percent and 7.4 percent respectively.  

However, the zip code with the highest percentage of low maternal education in the period 2016-2018 was 74050, which is in the Sand Springs/West Tulsa region.  The zip codes with the next 5 highest percentages were in the North Tulsa and East Tulsa regions (74110, 74115, 74116, 74130 and 74146), 



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, for the single year 2018 and over the years 2016 to 2018.

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?

In 2018, 43.0 percent of Tulsa County births were to unmarried mothers. This was higher than Oklahoma and the United States (42.2 percent and 40.1 percent, respectively).

A total of 42.9 percent of births in Tulsa County were to unmarried mothers from 2016–2018. This was almost identical to the percent of unmarried mothers in Oklahoma overall (42.2 percent).  Births to unmarried mothers was highest among black mothers in both Tulsa County and Oklahoma (76.8 and 72.8 percent respectively), followed by Native Hawaiian/ Pacific Islander mothers (73.6 percent for Tulsa County and 64.4 percent for Oklahoma). The rate was lowest among mothers who were Asian (12.3 percent, Tulsa County; 12.2 percent, Oklahoma). A larger percentage of Hispanic mothers were unmarried compared to non-Hispanic mothers (49.9 percent compared to 41.3 percent); this was also true for the state of Oklahoma overall.

The regions with the highest percentages of births to unmarried women in Tulsa County from 2016-2018 were the North Tulsa region (69.1 percent) and the East Tulsa region (52.3 percent).  

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



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, for single year 2018 and over the years 2016 to 2018.

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?

In 2018, 31.6 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 (28.2 percent) and the United States (22.5 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), although the US met the goal in 2018 for all practical purposes. 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. 

From 2016–2018, 31.9 percent of Tulsa County mothers did not receive prenatal care or received delayed prenatal care (after the first trimester). This percentage was higher than that for Oklahoma overall for the same time period (28.7 percent).  Native Hawaiians/ Pacific Islanders had the highest percentage of late or no prenatal care in both Tulsa County and Oklahoma overall (68.1 percent and 62.4 percent, respectively). This was more than double the rate of late or no prenatal care for white mothers (29.5 percent, Tulsa County, 26.1 percent Oklahoma). Additionally, the percentage of late or no prenatal care for Hispanic mothers compared to non-Hispanic mothers was very similar (34.0 percent compared to 31.4 percent, Tulsa County, 29.8 percent compared to 28.2 percent, Oklahoma overall).

The North Tulsa region had the highest percentage of mothers who received late or no prenatal care for 2016-2018 at 39.9 percent, followed by the East Tulsa region (34.4 percent) and the Sand Springs/West Tulsa region (33.4 percent).  The Owasso/Sperry region had the lowest percentage of mothers who received late or no prenatal care during the 2016-2018 time period, at 23.1 percent.  

The highest rates of late or no prenatal care were in zip codes 74103 (Downtown region) and 74106 (North Tulsa region).


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, for the single year 2018 and over the years 2016 to 2018.

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?

In 2018, the smoking rate among pregnant women in Tulsa County (8.1 percent) was lower than that of Oklahoma (10.6 percent) but higher than the United States (6.5 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.

From 2016–2018, a total of 10.1 percent of births were to mothers who reported using tobacco during pregnancy in Tulsa County, and 13.0 percent in Oklahoma. American Indian/ Alaskan Native mothers had the highest rate of tobacco use during pregnancy for both locations (19.1 percent Tulsa County; 17.5 percent Oklahoma overall).  Asian mothers had the lowest rate, with 0.5 percent of mothers who reported tobacco use during pregnancy in Tulsa County and 0.9 percent in Oklahoma.  Additionally, smoking during pregnancy was much higher in non-Hispanic mothers compared to Hispanic mothers (11.9 percent compared to 2.3 percent in Tulsa County and 14.5 percent compared to 4 percent in Oklahoma). 

The percentages of mothers who use used tobacco during pregnancy in Tulsa County were highest in the North Tulsa region (17.5 percent) and the Sand Springs/West Tulsa region (16.2 percent) in the time period 2016-2018.  The lowest percentages of mothers who used tobacco during pregnancy for the 2016-2018 time period were the Jenks/Bixby region (5.1 percent) and the South Tulsa region (5.9 percent).

The zip codes with the highest rates of tobacco use during pregnancy was 74050 and  (Sand Springs/West Tulsa region) and 74103 (Downtown region).

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, for the single year 2018 and over the years 2016 to 2018.

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?

In 2018, 8.8 percent of infants in Tulsa County weighed less than 2,500 grams at birth. This higher than Oklahoma and the US, which were identical for 2018 at 8.3 percent.  From 2012 to 2015, Tulsa County had been generally trending downward on this indicator; however, since 2015 the percentage of babies born with low birth rate has been increasing again.  The percentages for Tulsa County for low birth weight babies born has been highly variable from 2011 to 2018, while for Oklahoma and the US, the percentages have remained more stable.  None of the three locations met the Healthy People 2020 target of 7.8 percent.

From 2016-2018, 8.3 percent of Tulsa County infants were born weighing less than 2,500 grams.  Racial disparity was evident: black mothers had about twice the percentage of low birth weight infants as white mothers for both Tulsa County and for Oklahoma overall (Tulsa County, 15.9 percent compared to 7.1 percent; Oklahoma 14.5 percent compared to 7.5 percent). The percentage of low birth weight infants was higher among non-Hispanic mothers for both locations as well (Tulsa County, 8.7 percent; Oklahoma, 8.3 percent).

The region with the highest percentage of low birth weight infants was the Downtown region, at 10.8 percent, followed closely by the North Tulsa region, at 10.0 percent.  The Jenks/Bixby (5.1 percent) and the South Tulsa (6.1 percent) regions had the lowest percentages of infants born with low birth weight.

The zip codes with the highest rates of low birth weight infants were 74106 (North Tulsa region) at 13.9 percent and 74119 (Downtown region) at 13.8 percent. 


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, for the single year 2018 and over the years 2016 to 2018.

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?

In 2018, 12.3 percent of live births in Tulsa County were preterm, compared to 11.4 percent in Oklahoma and 10.0 percent in the U.S. The Healthy People 2020 goal is to reduce the percentage of preterm births to 11.4 percent. The US met this goal, and Oklahoma tied the goal, while Tulsa County in 2018 did not.  

From 2016-2018, 11.5 percent of infants born to Tulsa County mothers were preterm. This percentage was slightly higher than the 11.0 percent preterm births for Oklahoma overall for the same time period.  The percentages of preterm births for both Tulsa County and Oklahoma were highest among black mothers (Tulsa County, 16.4 percent; Oklahoma, 15.0 percent). The percentage of preterm births was slightly higher among non-Hispanic mothers compared to Hispanic mothers for both Tulsa County and for Oklahoma overall (Tulsa County, 11.5 percent compared to 11.4 percent; Oklahoma, 11.2 percent compared to 10.4 percent).

Within the Tulsa County regions for the time period 2016-2018, the Downtown region had the highest percentage of preterm births at 15.7 percent, followed by the North Tulsa region at 14.1 percent. The South Tulsa region had the lowest percentage of preterm births at 10.1 percent for the same time period.

The zip codes with the highest rates of preterm birth were 74119 (Downtown region), 74106, 74126 and 74130 (all in North Tulsa region).


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, for the single year 2018 and over the years 2016 to 2018.

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?

The infant mortality rate in Tulsa County in 2018 was 6.9 deaths per 1,000 live births. This was slightly lower than Oklahoma (7.1) and higher than the US (5.8). 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.

Between 2016 and 2018, 224 Tulsa County infants died before the age of one, which was a rate of 8.1 deaths per 1,000 live births. Infant mortality for 'other' races was about fifteen times higher than that of whites (65.3 deaths per 1,000 live births compared to 4.1 deaths per 1,000 live births). The infant mortality rate was slightly higher among non-Hispanics than Hispanics (8.3 compared to 7.1).

The North Tulsa region had the highest infant mortality rate of all of the Tulsa County regions for 2016-2018 at 12.9 deaths per 1,000.  The Owasso/Sperry region had the lowest infant mortality rate for 2016-2018 at 3.1 deaths per 1,000.

The zip codes with the highest rates of infant mortality were 74106 (North Tulsa region), 74132 (Sand Springs/West Tulsa region) and 74126 (North Tulsa region).

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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 2016 to 2018, 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 2007-2018, on CDC WONDER Online Database, January 2015. Retrieved from http://wonder.cdc.gov/natality-current.html.

• Vital Statistics (2011 – 2018). 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.

• American Community Survey, 5-Year Estimates 2011-2018.  www.censusdata.gov