Program capacity during 2018 was reduced due to a vacancy in the Title V Manager position which was overseen in the interim by the Director of the Maternal and Child Health Bureau.  Maryland Department of Health also had a vacancy in the newly developed Deputy Director position, which was tasked with overseeing Title V, through the end of calendar year 2018.

Data Updates

The following section provides an overview of population level data updates available during the reporting period.

Women’s/Maternal Health:

Cesarean Deliveries: In 2017, one-third of Maryland births were delivered via cesarean section. According to Maryland Vital Statistics Administration data, the rate of cesarean deliveries in Maryland increased from 21.0% in 1997 to 33.8% in 2017. The rate of low risk cesarean deliveries increased nine percent from 25.8% in 2003 to 28.2% in 2017. Older (35+ years) Black, non-Hispanic mothers had the highest rates of low risk cesarean delivery.

Intimate Partner Violence: According to 2017 Maryland PRAMS data, 1.8% of women reported that they were physically abused by a husband or partner during the 12 months before or during pregnancy.

Substance Use/Abuse: The number of drug and alcohol intoxication deaths in Maryland increased in 2017 for the seventh year in a row, reaching an all-time high of 2,282 with 88% categorized as opioid-related. Fentanyl-related deaths continue to rise, increasing 42% from 1,119 in 2016 to 1,594 in 2017. The number of opioid-related deaths increased eight percent between 2016 and 2017, substantially less than the 70% increase between 2015 and 2016 which was the largest single year increase that has been recorded. Deaths increased 7% among men and 14% among women between 2016 and 2017. Intoxication deaths are nearly 2.5 times higher among men than women.

Mental Health: According to 2017 PRAMS data, 11.4% of women reported depression before pregnancy and 12.4% of mothers reported symptoms of postpartum depression. During the three months before pregnancy, 17.5% of women reported they had anxiety.

Maternal Mortality and Morbidity: The 2012-2016 maternal mortality rate (MMR) in Maryland decreased 7.6% from the 2007-2011 rate. The MMR among Black women is 3.7 times the MMR of White women. The leading cause of pregnancy-associated deaths in 2016 was substance use with unintentional overdose, accounting for 33 percent of these deaths.

Perinatal Health of Maryland Women and Infants:

Prenatal Care: The annual percentage of Maryland women who initiated prenatal care during the first trimester has risen to a rate of 84.4% in 2016, a 5% increase from 2015 PRAMS rate of 80.5%

Infant Mortality: Maryland Vital Statistics report the infant mortality rate in Maryland in 2017 was 6.5 per 1,000 live births (unchanged from 2016), down from 8.5 per 1,000 live births in 2004, and a 3.3% decrease from 2015 (6.7 per 1,000 live births). The leading causes of death were disorders related to short gestation and low birth weight, congenital malformations, SIDS, maternal complications of pregnancy, and complications of the placenta, cord, and membranes. Maternal complications of pregnancy include conditions such as premature rupture of membranes and cervical incompetence.

Low Birth Weight: In 2017, 8.9 percent of live births in Maryland were low birth weight (LBW). Non-Hispanic Black mothers were significantly more likely to have a LBW infant than any other race. In 2017, 13.0 percent of Non-Hispanic Black mothers has a LBW infant compared to 6.6 percent among Non-Hispanic White mothers.

Very Low Birth Weight: In 2017, 1.8 percent of all live births in Maryland were VLBW. However, Maryland has had one of the higher VLBW rates among Non-Hispanic Blacks. In Maryland, Non-Hispanic Blacks were over three times more likely than other races to have VLBW infants (3.1% non-Hispanic Blacks, 1.0% non-Hispanic whites, and 1.4% for Hispanics).

Preterm Birth: In 2017, 10.5 percent of live births occurred before 37 weeks of gestation in Maryland, a 4 percent increase from 2016 (10.1 percent). Non-Hispanic Black mothers were more likely to have a preterm birth than other races with a rate of 13.3 percent compared to 9.0 percent and 9.4 percent for Non-Hispanic White and Hispanic births, respectively.

Breastfeeding: In 2017, according to PRAMS data, 89.4 percent of Maryland mothers reported having ever breastfed their babies, an increase from 2015 at 87.3%. Rates of breastfeeding in Maryland were high across all races ranging from 87% for Non-Hispanic Black mothers to 94% among Asian mothers.

Safe Sleep: In 2017, according to PRAMS data, 16.8 percent of mothers in Maryland reported not placing their infants on their back to sleep and forty-one percent of mothers reported that their baby slept with a blanket, 9.0 percent slept with toys, cushions or pillows, and 15.4 percent slept with bumper pads. Over 80 percent of mothers reported that their baby slept in the same room as the mother.

Child Health:

Mortality: In 2017, there were 753 deaths to infants and children ages 0 to 18 years old in Maryland. Most of these deaths occurred in infancy. The 2017 child death rate decreased by 6.5 percent compared to 2015. Injuries were the leading cause of death for the 69 children ages 1 to 4 years. Cancer was the leading cause of death for the 87 children ages 5 to 14, followed by injuries.

Health Insurance Coverage: Maryland Medicaid and U.S. Census population estimate data for 2018 show that approximately 39% (648,000 of 1.65 million children ages 1 to 22 years) of Maryland children are enrolled in the Medicaid program.

Preventive Health Care: According to 2018 Medicaid data, 65.2% of Medicaid enrolled patient who turned 15 months old during 2016 had five ore more well-child visits during their first 15 months of life.

School Readiness: According to Maryland State Department of Education data, in the 2018-2019 school year, 47% of Maryland’s young children entered kindergarten fully ready to learn (i.e. they demonstrated the skills and behaviors needed to fully participate in the kindergarten curriculum). This was a slight increase from 45% in the 2017-2018 school year.

Adolescent Health:

Mental Health and Suicide: According to Maryland Vital Statistics Administration data, the rate of suicide deaths among youth ages 15-19 years was 6.8 per 100,000 population in 2017. The represented an increase from the 2016 rate of 6.5 per 100,000 population. The actual numbers of suicides in this age range increased from 25 in 2016 to 26 in 2017. The suicide rate remained highest for non-Hispanic White male teens in 2017.

Teen Pregnancy and Reproductive/Sexual Health: Maryland Vital Statistics Administration data showed that the adolescent birth rate decreased 54.5% from 31.2 births per 1,000 adolescent females 15-19 years in 2009 to 14.2 births per 1,000 adolescent females in 2017. Hispanic females had the highest adolescent birth rate with 37.8 births per 1,000 adolescent females, which was double the adolescent birth rate for Black, non-Hispanic females (18.0 per 1,000 adolescent females) and more than four times the adolescent birth rate for White, non-Hispanic females (7.3 per 1,000 adolescent females).

Life Course and Cross Cutting:

Smoking in Pregnancy: According to 2017 PRAMS data, 11.5% of women smoked during the three months before pregnancy (down from 16% in 2013), 5.1 percent of women smoked during the last three months of pregnancy (down from 8% in 2013), and 6.9 percent smoked postpartum. Prenatal smoking rates in Maryland are eight times higher than the HP 2020 objective for smoking during pregnancy (1.4%).

Program Capacity:

The Title V program is managed by the Maternal and Child Health Bureau (MCHB) in the Prevention and Health Promotion Administration (PHPA) at the Maryland Department of Health (MDH).

The MDH’s PHPA leadership is as follows:

• Donna Gugel, MHS, serves as the Director of PHPA. Ms. Gugel has been the Director since 2016 and previously served as Deputy Director.
• Courtney McFadden, MPH, serves as Deputy Director of PHPA. Ms. McFadden has been the Deputy Director since 2018 and previously served as the Director of MDH’s MCHB.

The MDH’s MCHB leadership is as follows:

• Maura Dwyer, DrPH, MPH, serves as the Acting Director of the MCHB. In this capacity, Dr. Dwyer also serves as Director of the Office of Quality Initiatives.
• Jed Miller, MD, MPH serves as the Director of the Office of Genetics and People with Special Health Care Needs in the MCHB. Dr. Miller also serves as the State Title V CSHSN Director.
• S. Lee Woods, MD, PhD, serves at the Medical Director of MCH Epidemiology in the MCHB.
• Linda Alexander, MD, MPP, FACOG, serves as the Reproductive Health Medical Director for the MCHB.
• Jennifer Wilson, Med, RD, LDN, serves as the Director of the Maryland WIC Program.
• Colleen S. Wilburn, MPA serves as the Title V Manager

There is currently a vacancy in the position of Director of the Office of Family and Community Health Services.