Findings

MCH Population Health Status

Domain 1: Women’s and Maternal Health

Just over half (52%) of women who gave birth in Connecticut (CT) in 2022 (provisional) were non-Hispanic White, 27% were Hispanic, 12% were non-Hispanic Black, and 5% were non-Hispanic Asian.

The 2018-2022 annual overall teen birth rates in CT averaged 7.4 (range = 6.4 – 8.3, reported as live births per 1,000 women aged 15-19) and has declined since at least 2016 at an annual rate of 5.8%. The lower limit for the range of teen birth rates during this five-year period of 6.4 births per 1,000 women aged 15-19 represents the lowest teen birth rate observed this century in CT. Declines across all three major race-ethnicity groups are also evident for the period 2018-2022, with annual rates of declines in teen birth rates in the non-Hispanic White, non-Hispanic Black, and Hispanic populations during this period averaging 10.8%, 8.5%, and 5.8% per year, respectively. In the presence of these significant declines across all three major race-ethnicity groups in CT, however, disparities by race and ethnicity nonetheless exist. For the period 2018-2022, the average annual teen birth rate of Hispanic women of 21.0 births per 1,000 women aged 15-19 was 10.0 times higher than the average rate for non-Hispanic White women of 2.1. The average annual teen birth rate among non-Hispanic Black women of 10.8 births per 1,000 women aged 15- 19 for 2018-2022 was 5.1 times that of non-Hispanic White women.

During pregnancy, 18.2% of women in CT had high blood pressure in 2021, which was highest among non-Hispanic Black women (21.4%) and lowest among non-Hispanic Other/multi-race women (14.6%). Overall, 11.9% of women in CT developed gestational diabetes, which was highest among non-Hispanic Other/multi-race women (15.5%) and lowest among non-Hispanic White women (6.1%). The prevalence of gestational diabetes is increasingly common with age, 18.3% in women 35 and older. Overall, 8.0% of women had thyroid problems, with the highest prevalence’s among non-Hispanic Other/multi-race women and women 35 and older.

CT, within a given year, identifies approximately 15-20 deaths that may be related to pregnancy and childbirth. CT does have racial disparities with maternal deaths, with Black/African American women and women who have Medicaid for insurance experiencing a higher percent of the maternal deaths. Through the work of the MMRC, CT identifies and characterizes these maternal deaths as Pregnancy-Related or Pregnancy-Associated maternal deaths, which are approximately 8-10 Pregnancy-Related per year.

Among all CT hospital deliveries in 2020, 1% had a severe maternal morbidity event (SMM). There are racial and ethnic disparities in SMM. SMM is more likely to occur among non-Hispanic Black (142 per 10,000), non-Hispanic Asian (89) and Hispanic (86) mothers compared to non-Hispanic White mothers (68). Additionally, 3 of 10 deliveries with an SMM event had more than one type of SMM, the most common being acute renal failure.

Following delivery of a live birth in 2021, 11.9% of women in CT reported postpartum depressive symptoms. However, the racial/ethnic patterns shift, with lowest prevalence among non-Hispanic White women (9.1%) and highest among non-Hispanic other/multi-race women (19.4%), however, less than half sought help for their symptoms.

Domain 2: Perinatal and Infant Health

Singleton preterm birth and low birthweight (LBW) rates show persistent racial disparities in CT. In 2022 (provisional), 6.4% of non-Hispanic White women delivering singletons gave birth preterm, compared to 11.2% of non-Hispanic Black women. From 2018 to 2022, the average rate of singleton LBW infants among non-Hispanic Black populations (10.6%) was 2.4 times higher than that among non-Hispanic White women (4.5%). The average rate of singleton LBW among Hispanic women (6.9%) was 1.5 times that of non-Hispanic White women.

The CT annual infant mortality rate (IMR, reported as deaths per 1,000 live births) averaged 4.4 (range: 4.3 - 4.7) during the period 2018-2022. Annual IMRs in CT’s non-Hispanic White population averaged 2.9 deaths per 1,000 live births 2018-2022 and were significantly lower than those observed for the non-Hispanic Black and Hispanic populations. Annual IMRs for non-Hispanic Black populations averaged 9.1 deaths per 1,000 live births, and those for Hispanic populations averaged 5.7 deaths per 1,000 live births. The averages were 3.1 and 2.0 times higher, respectively, than that for CT’s non-Hispanic White population.

Racial disparities in infant health continue postnatally. Most women in CT reported that their health care provider had recommended they place their infants to sleep on their backs during 2021. However, fewer women reported putting their infants to sleep on their backs only. Only 58.4% of Black women reported solely back sleeping compared to 88.9% of White women. Breastfeeding practices also vary by race/ethnicity. While 93.6% of women of all race/ethnicities report initiating breastfeeding postpartum, by 8 weeks, only about two-thirds of non-Hispanic Black and Hispanic women are still breastfeeding, compared to 79% of non-Hispanic White and Other/Multi-race women.

An increasing concern in CT is infants born with Neonatal Abstinence Syndrome (NAS) – a condition where a neonate goes through withdrawal from certain drugs that they were exposed to in the womb. Most commonly, NAS is due to chronic maternal opioid exposure. The rate of CT babies with NAS per 1,000 CT hospital births increased from 7.4 in 2010 to 11.2 per 1,000 in 2016 (source: CT DPH Hospital Discharge Data). After 2016, the rate of NAS in CT remained around 9-10 per 1,000 each year and ultimately declined to 7.9 in 2021. The highest rate of NAS is among those who are non-Hispanic White and had their delivery paid by Medicaid (42.2 per 1,000). Collaborative partnerships have formed in CT between non-governmental professional organizations, multiple state agencies, and public/private professional organizations to address NAS in the state.

Domain 3: Child Health

Overall, 91.1% of children aged 0-17 years old were reported to have excellent or very good health in CT in 2021-2022. However, disparities exist in some manageable and preventable childhood conditions, indicating room for improvement.

Just over 8% of children in CT currently had asthma in 2022, with non-Hispanic Black and Hispanic children having higher prevalence rates of 18.2% and 8.7%, respectively. Asthma is one of the leading causes of school absenteeism, putting children at risk for poor academic performance. Disparities in utilization of health care for asthma have been reported, with Hispanic and non-Hispanic Black children visiting hospitals’ emergency departments 3.1 and 4.8 times more than non-Hispanic White children (2022 Hospital Discharge Dataset). Additionally, Hispanic, and non-Hispanic Black children are hospitalized for asthma at 2.3 and 4.1 times the rate of non-Hispanic White children, respectively, suggesting a disproportionate burden in asthma severity. Children in general, but especially non-Hispanic Black and Hispanic children bear the highest burden of asthma in CT.

The medical home model for children and adults is a proven approach to provide comprehensive and high-quality primary care. According to the National Survey of Children’s Health, in 2021-2022, CT (49.3%) was slightly above the U.S. average (46.1%) in the proportion of children without special health care needs who have a medical home. CT exhibits disparities across race and ethnicity for children receiving care within a medical home, with 60.3% of non-Hispanic White children and 66.8% of non-Hispanic children of other race receiving care within a medical home, while only 28.8% of non-Hispanic Black children, and 35.1% of Hispanic children did. The coronavirus pandemic also affected medical and preventative visits. In 2021-2022, 23.6% of children missed, had a delay or skipped a preventive check-up because of the coronavirus pandemic.

In 2021-2022, 89.6% of children aged 12-17 years old received needed mental health treatment or counseling. In 2021-2022, 46.3% of children, ages 9 through 35 months, received a developmental screening using a parent-completed screening tool in the past year. However, this is just under half of the population, indicating that improvement is still needed.

Adverse Childhood Experiences (ACEs) are stressful or traumatic events, including abuse, neglect and household dysfunction that occur during childhood. ACEs and trauma are risk factors for depression, anxiety, and post-traumatic stress disorder. In their most extreme form, ACEs can result in death. In 2021-2022, 83.1% of CT’s youngest residents between 0-17 years of age experienced zero or one adverse childhood experience and 16.9% had experienced two or more, with 27.5% of Hispanic children experiencing two or more adverse childhood experiences compared to 10.2% of non-Hispanic White children. To address the immediate threat of violence, as well as long terms health consequences, the State of CT is engaged in several public health and policy initiatives.

Domain 4: Children with Special Healthcare Needs

Children and youth with special health care needs (CYSHCN) have or are at increased risk for chronic, physical, developmental, behavioral, or emotional conditions. In addition, they often require more health-related services beyond what is required by children generally. There is a well-documented benefit for children in having health insurance. According to the National Survey of Children’s Health, in 2001, nearly three-quarters of CYSHCN had private insurance (73%). In 2021-2022, 95.3% of CYSCHN were covered by health insurance or a health coverage plan. Of those, 33.5% reported that the insurance was not adequate for the child’s health needs. The proportion of CYSHCN who had either private or public insurance was 58.6% and 32.5%, respectively; 4.3% had a combination of both.

Among CYSHCN, CT (37.4%) was slightly lower than the U.S. average (40.7%) in the proportion of children ages 0-17 years of age who have a medical home in 2021-2022. In CT, on average, 58.9% of children with special health care needs, ages 0 through 17, received needed care coordination compared to 55.6% of CYSHCN in the U.S. in the same time period. In 2021-2022, CT rose to 20.1%, (14.4% in 2020-2021) which is still lower than the national average of 22.1% in the proportion of 12-17-year-old CYSHCN who received the services needed to transition to adult health care. Families of CYSHCN reporting receiving care in a well-functioning system varied greatly by age. In 2021-2022, the proportion was 19.4% for 0-5-year-olds, 27.2% for 6-11-year-olds and 3.5% for 12–17-year-olds. Overall, 5.4% of parents of CYSHCN reported they were usually or always frustrated getting services for their child, compared to only 1.6% of parents of children without special health care needs.

The prevalence of mental/behavioral health conditions has been increasing among children and has been found to vary by geographic and sociodemographic factors. Further, the receipt of treatment is also generally dependent on sociodemographic and health-related factors. Adequate insurance and access to a patient-centered medical home may improve mental health treatment. In CT, among children aged 3-17, 24.8% have a mental, emotional, developmental or behavioral (MEDB) problem. In 2021-2022, 3.0% of children (aged 3-17) in CT has a current diagnosis of autism spectrum disorder (ASD), which is equivalent to the national percentage (3.3%).

Domain 5: Adolescent Health

The adolescent health data relies on the results from the CT School Health Survey (CSHS). Use and misuse of illicit drugs (e.g., heroin, fentanyl, cocaine), prescription opioid medications and alcohol are major issues nationally and in CT. In recent years, illicit drug use among CT high school students has declined. Nonetheless, in 2023, 12.2% of high school students reported ever taking prescription pain medication for non-medical reasons. Prevalence was highest among Hispanic and non-Hispanic Black students (14.6% and 14.8%, respectively) and lowest among non-Hispanic White students (9.9%). Only 0.7% of CT high school students currently smoke cigarettes. In contrast, 28.0% report ever using an electronic vaping product, and 11.5% report current use.

Bullying is considered a traumatic event, and fighting may be considered either a traumatizing experience or a consequence/outcome of having repeated exposure to trauma. Bullying also indicates disruption in the school setting that impacts school connectedness, which is an important protective factor for substance use, sexual behavior, mental health, and academic success. In recent years, CT females were more likely than CT males to be bullied on school property. In 2023, 20.9% of females and 14.9% of males reported being bullied on school property in the past 12 months. Bullying was more common among non-Hispanic White students (20.0%), compared to non-Hispanic Asian students (8.5%). The percentage of females being cyberbullied is also consistently higher than the percentage of males in recent years, with 20.4% of females and 13.2% of males reporting the experience in the past 12 months. Youth who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are more likely to be bullied, both on school property and electronically, when compared to students who identify as heterosexual. The percentage of LGBTQ youth who reported cyberbullying was double the percentage of heterosexual youth who reported cyberbullying, 28.9% versus 14.0%.

In the 2023, the prevalence of sexual dating violence varied dramatically among high school students, with 11.4% of heterosexual students reporting it, compared to 28.5% of those identified as being gay/lesbian/bisexual, and 19.7% of those who responded, 'I describe my sexual identity some other way' or 'I am not sure about my sexual identity (questioning)’. Among CT high school students, 6.7% report being forced to have sexual intercourse (when they did not want to) and this also varied by sexual identity, with 4.0% of heterosexual students, compared to 17.7% of gay/lesbian/bisexual students experiencing this.

According to the 2021 Adolescent Behaviors and Experiences Survey, more than one in three high school students (37.1%) experienced poor mental health during the COVID-19 pandemic. Nationally, suicide contemplation by high school students in the last 12 months was 17.2%. By comparison, in 2023, CT is below the national average at 15.7. However, 19.4% of females and 11.7% of males reported seriously considering suicide in the past 12 months. In 2023, 9.3% of females and 5.9% of males attempted suicide. More multi-race female students (13.5%) and Hispanic female students (13.1%) attempted suicide compared to non-Hispanic Black (7.9%) and non-Hispanic White (7.6%) students. In 2021, the rate of CT youths who died by suicide was 2.3 per 100,000 CT population. According to the National Survey of Children’s Health, in 2021-2022, 17.9% of adolescents, ages 12 through 17, had depression or anxiety.

Title V Agency

The mission of the DPH is to protect and improve the health and safety of the people of CT by: assuring the conditions in which people can be healthy; promoting physical and mental health, and preventing disease, injury, and disability.

Dr. Manisha Juthani serves as Commissioner of DPH. Dr. Juthani is an infectious diseases physician at Yale School of Medicine in New Haven, where she specializes in the diagnosis, management, and prevention of infections in older adults. Dr. Juthani assumed the role as Commissioner on September 20, 2021.

Leadership:

Julie Vigil, MS, MPH, CHC, CHRC, FACHE is the Chief of the Community, Family Health, and Prevention Branch (CFHPB) and Mark Keenan, RN, MBA is the Chief of the Maternal Child Health and Access to Care Section (MCHACS). Mr. Keenan previously served as the Title V Maternal and Child Health Director. Marc Camardo, MPH, is the Title V Director and SSDI Director and reports to Mark Keenan. Ann Gionet is the Children with Special Health Care Needs Director and reports to Mark Keenan. Amy T. Soto, MS, MSW, is the MCHBG Family Advocate and reports to Ann Gionet.

The Title V Program resides within the CFHPB. The CFHPB works to improve the health of the overall population across the lifespan, especially mothers, infants, children, adolescents, and other vulnerable groups, by establishing opportunities that support healthy living habits through education, early detection, access to care and chronic disease prevention. The CFHPB is comprised of the following units: 1) Reproductive and Perinatal Health Unit; 2) Adolescent and Child Health; 3) Maternal and Child Health Epidemiology; 4) Chronic Diseases; 5) Women, Infants and Children (WIC); 6) Epidemiology; and 7) Nutrition, Physical Activity and Obesity. The CFHPB also includes the: 1) Genomics Office; 2) Health Access, Early Hearing, Repayment, Oral Health and Primary Care Office; and 3) Office of Injury and Violence Prevention. Staff work collaboratively across units and offices to coordinate resources and maximize program capacity.

The Title V Program is responsible for the direct or indirect administration of programs carried out with funds from the MCHBG. The majority of CT's activities serving mothers, infants, children, adolescents, and children and youth with special health care needs reside within the CFHPB, including: Autism Spectrum Disorder; Children and Youth with Special Health Care Needs including Respite and Extended Services; Family Advocacy; School Based Health Centers; Sickle Cell Disease; Maternal Mortality Review; Case Management for Pregnant Women; Family Planning; Healthy Choices for Women and Children; Supplemental Nutrition Assistance Program; Birth Defects Registry; Early Hearing Detection and Intervention; State Systems Development Initiative; Pregnancy Risk Assessment Monitoring System; Primary Care Office: Family Wellness Healthy Start; Provide Supplemental Nutritious Foods; Breastfeeding promotion and support; and Nutrition education. These programs either receive Title V funds or work in collaboration with the Title V Program.

The CFHPB employs 110 permanent staff with expertise and skills in various areas of public health having graduate degrees or have experience in nursing, social work, allied health, health education, research, evaluation, epidemiology, law, planning, administration, and management. Most CT's Title V program activities reside organizationally within the CFHPB. The proposed FFY 2024 plan will maintain overall staff support at 22.0 FTE positions.

The MCHBG supports a full time equivalent in the Health Information Systems and Reporting Section to maintain vital record databases containing information on births, deaths, hospitalizations, and risk factors related to maternal and child health. Epidemiologists use vital record information to help direct and evaluate Title V program activity. Funding from the MCHBG also provides support for staff in the Newborn Screening Program, the Fiscal Office, Public Health Systems Improvement, and Grants and Contracts.

Staff from other programs across the DPH collaborate and/or provide support to the Title V staff. These programs include Obesity, Asthma, WIC, Environmental Health, STD, HIV, Vital Records, State Laboratory (Newborn Screening) and Tracking Units, Oral Health, Tobacco, Nutrition, Facility Licensing, and Injury and Violence Prevention.

Number, location, and full-time equivalents of staff who work on behalf of the Title V Program

The State of CT is highly invested in supporting efforts to implement the core public health functions (assessment, policy development, and assurance) and to achieve increased accountability through ongoing performance measurement and supporting an adequately sized and skilled workforce.

Current Initiatives

Within DPH, several initiatives are underway to reduce adverse birth outcomes and risk factors associated with poor birth outcomes, and to address disparities in these health indicators. The initiatives listed below may not be directly funded by the MCHBG but are in alignment with the mission of improving the health of the MCH population through a health equity lens. These initiatives will continue and include the following:

DPH has submitted its reaccreditation application to the Public Health Accreditation Board (PHAB) in September 2023. The preparation for the application began in 2022, as soon as DPH obtained an extension approval from the Public Health Accreditation Board (PHAB) to apply for reaccreditation under their revised standards and measures version 2022. In August 2024, a site visit with PHAB is scheduled and the final determination of accreditation will be provided.  

State Health Improvement Plan: CT’s State Health Improvement Plan (SHIP) provides a roadmap for statewide health improvement efforts. The SHIP framework includes an Advisory Council, Four priority area Action Teams, a statewide SHIP Coalition, and a Data Committee. Several sub-committees also exist within this framework on an as-needed basis. DPH provides leadership and coordination to this statewide initiative to improve collective impact across the state. The Advisory Council, an 18-member body, provides leadership and overall strategic guidance to the statewide effort. Members include a consumer, state agencies, healthcare professionals, a former legislator, and representatives from educational institutions, charitable foundations, and non-profit community-based organizations. The Action Teams are organized by priority focus areas – Access to Healthcare, Economic Stability, Healthy Food and Housing, and Community Strength and Resilience.

The CT Maternal and Child Health (MCH) Coalition advocates for health equity and the elimination of racial and ethnic health disparities. Through the establishment of Initiatives, operating under the auspices of the MCH Coalition, CT is supporting efforts to improve pre and interconception health care/pregnancy intentionally through the establishment of Every Woman CT and the MCH Coalition convened the Reproductive Justice Alliance designed to improve the state’s maternal mortality and morbidity statistics, especially for Black and Brown birthing people. These Initiatives welcome MCH Coalition members as well as those who are limiting their involvement to a working group and their scope of focus and work. 

The Maternal Mortality Review Committee (MMRC) in CT works to identify factors that may have contributed to the death and to make recommendations to reduce pregnancy-related morbidity, mortality, and disparities. The MMRC is committed to a multipronged approach to avoid all preventable maternal deaths and improve maternal health and health equity. Through equitable partnerships with communities, the MMRC work to understand the severity and complexity of maternal health disparities, advocate for policy solutions, and support innovative approaches and interventions to eliminate inequities that threaten the health and well-being of all birthing persons.

Preventive interventions to address teen pregnancy through CT's Title V programs include those to delay the onset of sexual activity, promote abstinence as the social norm, reduce the number of adolescents who have sex at young ages, and increase the number of sexually active adolescents who use contraceptives effectively.  Healthy Choices for Women and Children, a case management program serving Waterbury, and the Family Wellness Healthy Start (FWHS) program serve pregnant and parenting teens and include interconception services. The FWHS program works to eliminate disparities in infant mortality and adverse perinatal outcomes especially among the target population of African American and Hispanic women in Hartford and New Britain.

The Personal Responsibility Education Program targets teens ages 13-19 in Bridgeport, Hartford, Meriden, Waterbury, and New Britain to provide evidence-based HIV, STD, and pregnancy prevention activities that have been found through rigorous research and evaluation to be effective in reducing sexual activity, increase contraceptive use in already sexually active youth, and delay unplanned pregnancy through both abstinence and contraception.

The Reproductive Health Program is administered by Planned Parenthood of Southern New England, Inc. (PPSNE) and is funded with state and Title V funds through a five-year contract. The program provides services in those areas of CT with a high concentration of low-income women of reproductive age, and with high rates of teen pregnancy.

The Children and Youth with Special Health Care Needs Program’s CT Medical Home Initiative provides community-based medical home care coordination networks and collaboratives to support children with special health care needs. Services include: a statewide point of intake, information and referral; provider and family outreach; and parent-to-parent support. Care coordination services include linkage to specialists and to community resources, coordination with school-based services, and assistance with transition to adult health care and other services.

United Way of CT’s 2-1-1 Infoline is an integral part of the CT Medical Home Initiative, providing a statewide point of entry as well as information and referral. DPH has dedicated MCHBG as well as other federal funding towards improving the United Way resource database and website, thus enhancing access to information for providers and consumers. The improvements include the ability to access information in numerous languages. United Way has also provided outreach and training to family and community-based organizations regarding how to effectively use the 2-1-1 website.

In addressing the needs of adolescents, the CT Title V program strategies emphasize supporting adolescent wellness (including comprehensive well child visits) and process improvement for the transition to adult life. School Based Health Centers were utilized in promoting comprehensive adolescent well visits, inclusive of developmental assessment, risk assessment and behavioral health screening, anticipatory guidance, and body mass index (BMI) screening and intervention.

The DPH Immunization Program oversees the provision of all recommended childhood vaccines to over 680 providers statewide including private physician offices, community health centers, School Based Health Centers, and local health departments. All nationally recommended childhood vaccines are provided to School Based Health Centers for children up through 18 years of age free of charge.

Partnership and Collaborations by Domain