Dr. Shelly Choo continued as the MCHB and Title V Director during FY 2022, which she began in July 2020.  Ms. Alena Troxel continued in her role as Deputy Director which she began in December 2019. Samantha Ritter joined MCHB on December 1, 2021 as the Director of the Office of Family and Community Health Services. Teresa Pfaff served as the Director of the Office of Quality Initiatives (OQI) from September 2021 to September 2022. Alena Troxel served as the Acting OQI Director until NaToya Mitchell started in June 2023. Lauren Whiteman started as the Director of the Office of Genetics and People with Special HealthCare Needs on November 16, 2022, and Jennifer Wilson served as Director of the Maryland WIC program. Paula Reynolds continued her role as the Chief Operating Officer for the Bureau.

The Title V Manager position remained vacant from June 2022 to June 2023. In order to further align with the State’s priority of reproductive health, a health policy analyst that focused on clinical women’s health was developed and is currently under recruitment.

Data Updates

The following section provides an overview of population level data updates available during the reporting period. The Maryland PRAMS 2021 data has been included in this report, but should be interpreted with caution. Maryland PRAMS had a weighted response rate of 44.1% and thus did not meet the CDC defined minimum overall response rate threshold of 50%.

Women’s/Maternal Health:

Substance Use/Misuse/Disorder: Due to Maryland Department of Health’s network security event, 2021 and 2022 data shared by the Maryland Vital Statistics Administration (VSA) and the Office of the Chief Medical Examiner (OCME) are still preliminary and subject to change. There were 2,581 fatal overdoses due to drugs and alcohol in 2022, a 9% decrease from the 2,824 fatal overdoses reported in 2021. Of the 2022 fatal overdoses, 2,218 (86%) were categorized as opioid-related and 2,051 (79.5%) involved fentanyl. Fentanyl-related deaths decreased 13% from 2,348 in 2021 to 2,051 in 2022. Overdose deaths decreased 10% among males from 2,051 in 2021 to 1,836 in 2022, and 4% among females from 773 in 2021 to 743 in 2022.[1]

Mental Health: According to 2021 Pregnancy Risk Assessment Monitoring System (PRAMS) data,[2] 16.6% of pregnant individuals reported depression three months before pregnancy and 13.7% of pregnant individuals reported symptoms of postpartum depression. During the three months before pregnancy, 29.0% of pregnant individuals reported they had anxiety.

Maternal Mortality and Morbidity: While the report for cases reviewed in FY 2021 is still being finalized due to delays related to COVID-19 and the Department’s network security incident, preliminary data demonstrate that there were 31 pregnancy-associated deaths in 2019, resulting in a pregnancy-associated mortality rate of 44.2 deaths per 100,000 live births in Maryland. The 2015-2019 maternal mortality rate (MMR) in Maryland is 17.2 maternal deaths per 100,000 live births, which is a 33 percent decrease from the 2010-2014 rate. The 2015-2019 MMR among Black women is 27.8 maternal deaths per 100,00 live births, which is 58 percent higher than the MMR of White women. The leading cause of pregnancy-related deaths in 2019 were hemorrhage (29 percent of deaths) and non-cardiovascular medical conditions (24 percent of deaths) . The leading cause of pregnancy-associated deaths in 2019 was substance use with unintentional overdose, accounting for 50 percent of these deaths.

Preventive Dental Visits in Pregnancy: According to 2021 PRAMS data,[3] 49.3% of pregnant individuals reported having their teeth cleaned during pregnancy, an increase from 47.0% in 2020.

Smoking in Pregnancy: According to 2021 PRAMS data[4], 8.4% of pregnant individuals reported that they smoked during the three months before pregnancy (down from 10.6% in 2020), 2.9% of pregnant individuals reported that they smoked during the last three months of pregnancy (down from 4.0% in 2020), and 4.4% reported that they smoked postpartum (down from 5.4% in 2020). Due to subpopulation response rates not meeting the lower threshold (30 respondents), further stratification by race/ethnicity or age category cannot be reported. The Healthy People 2030 target is to increase abstinence from cigarette smoking among pregnant individuals to 95.7%; PRAMS 2020 and 2021 data, which include self-reported smoking status during the last trimester of a pregnancy, indicate that Maryland has reached this target.

Perinatal Health of Maryland Women and Infants:

Prenatal Care: The annual percentage of Maryland pregnant individuals who initiated prenatal care during the first trimester was 84.9% in 2021, a 1.3% decrease from 86.0% in 2020, according to PRAMS data[5]. The percentage of non-Hispanic White individuals who initiated prenatal care in the first trimester increased by 2.0% from 94.4% in 2020 to 96.3% in 2021.  The percentage of non-Hispanic Black individuals who initiated prenatal care in the first trimester remained comparable from 2020 (85.4%) to 2021 (85.3%). Similarly, the percentage of non-Hispanic Asian individuals who initiated prenatal care in the first trimester remained comparable from 2020 (87.0%) to 2021 (87.7%). However, there was a marked 10% decrease in the percentage of Hispanic individuals who initiated prenatal care within the first trimester from 2020 (68.3%) to 2021 (61.3%).

Infant Mortality: Maryland VSA reported the infant mortality rate in Maryland in 2021 was 6.1 per 1,000 live births, a 7.0% increase from 5.7 per 1,000 live births in 2020, and down from 8.5 per 1,000 live births in 2004. The five leading causes of infant death in 2021 were low birth weight, congenital abnormalities, SIDS, maternal complications of pregnancy,  and complications of the placenta, cord, and membranes. These deaths accounted for 58.8% of all infant deaths. Maternal complications of pregnancy include conditions such as premature rupture of membranes and cervical incompetence.

Low Birth Weight: Maryland VSA reported in 2021,8.9% of live births in Maryland were low birth weight (LBW), weighing less than 2,500 grams at birth. Non-Hispanic Black mothers were nearly twice as likely to have a LBW infant (12.8%) than Non-Hispanic White mothers (6.7%).

Very Low Birth Weight: Maryland VSA reported in 2021, 1.6% of all live births in Maryland were very low birth weight (VLBW), weighing less than 1,500 grams at birth. Non-Hispanic Black mothers were over twice as likely as other races to have VLBW infants (2.7% Non-Hispanic Blacks,1.0% Non-Hispanic Whites, and1.2% for Hispanics).

Preterm Birth: Maryland VSA reported in 2021, 10.7% of live births occurred before 37 weeks of gestation in Maryland, a 6.0% increase from 10.1% in 2020. Non-Hispanic Black mothers were more likely to have a preterm birth than other races at 13.3%, compared to 9.2% and 10.2% for Non-Hispanic White and Hispanic births, respectively.

Breastfeeding: In 2021, according to PRAMS data,[6] 92.7% of Maryland mothers reported having ever breastfed their babies, a 3.1% increase from 89.9% in 2020. Rates of breastfeeding in Maryland were high across all races and ethnicities ranging from 89.4 for Non-Hispanic Black individuals to 98.7% among non-Hispanic Asian individuals.

Infant Safe Sleep: In 2021, according to PRAMS data,[7] 79.9% of infants were placed to sleep only on their backs, a slight increase of 1.8% from 78.5% in 2020 (NPM 5A).  In line with the NPM-5B definition, 33.6% of infants were placed to sleep on a separate approved sleep surface. 58.4% of infants were placed to sleep without soft objects or loose bedding (NPM-5C); in contrast, 34.9% of parents reported that their baby slept with a blanket, 6.3% slept with toys, cushions or pillows, and 11.7% slept with bumper pads. In 2021, 82.6% percent of mothers reported that their baby slept in the same room as the mother.

Child Health:

Mortality: According to Maryland VSA data, in 2021, there were 711 infant and child deaths ages 0 to 18 years old in Maryland. Most of these deaths occurred in infancy - 58.4 percent were under the age of one year. The 2021 child death rate increased by 3.4% compared to 2020. Accidents were the leading cause of death for the 64 children ages 1 to 4 years. Accidents were the leading cause of death for the 100 children ages 5 to 14, followed by neoplasms.

Preventive Health Care: According to CY 2022 Medicaid data, 72.1% of Medicaid enrolled patients who turned 15 months old during 2022 had five or more well-child visits during their first 15 months of life.

Child Development Screenings: Data from the National Survey of Children’s Health (NSCH), 2020-2021, showed that 39.9% of children ages 9 through 35 months received a developmental screening using a parent-completed screening tool in the past year, a slight decrease from 40.3% during the 2019-2020 survey period.

Asthma: Data from the Health Services Cost Review Commission (HSCRC) showed that emergency department visits for asthma among children ages 2 to 17 was 7.1 per 1,000 population in 2022, an increase from 3.5 per 1,000 population in 2020.

Adolescent Health:

Mental Health and Suicide: According to Maryland VSA data, the rate of suicide deaths among youth ages 15-19 years was 8.7 per 100,000 population in 2021. This represented a 17% increase from the 2020 rate of 7.4 per 100,000 population. The actual numbers of suicides in this age range increased from 28 cases in 2020 to 34 cases in 2021. The suicide rate remained highest for non-Hispanic White teens in 2021 at 16 cases, or 47percent of suicide deaths.

Teen Pregnancy and Reproductive/Sexual Health: Maryland VSA data showed that the adolescent birth rate decreased 49.3% from 22.1 births per 1,000 adolescent females ages 15-19 years in 2012 to 11.2 births per 1,000 adolescent females in 2021. Hispanic females had the highest adolescent birth rate with 30.3 births per 1,000 adolescent females, which was more than double the adolescent birth rate for Black, non-Hispanic females (13.3 per 1,000 adolescent females) and more than six times the adolescent birth rate for White, non-Hispanic females (4.9 per 1,000 adolescent females).

Children and Youth with Special Health Care Needs:

Medical Home: According to the 2020-2021 National Survey of Children’s Health, there are an estimated 266,095 children and youth ages 0 to 17 with special health care needs in the state. The survey estimated that 49.5% of these children have a medical home.

Transition to Adult Care: The 2020-2021 National Survey of Children’s Health estimated that 16.8% of adolescents ages 12-17 with special health care needs received services necessary to make transitions to adult health care.

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).

Maryland Department of Health’s Prevention and Health Promotion Administration leadership includes:

• Elizabeth Kromm, PhD, MSc serves as the Director of PHPA. Dr. Kromm started on May 10, 2023. Previously,  Donna Gugel, MHS, served as the Director of PHPA, but retired January 1, 2023
• Courtney McFadden, MPH, continues to serve as Deputy Director of PHPA. Ms. McFadden has been the Deputy Director since 2018 and previously served as the Director of the Maternal and Child Health Bureau. From January 1, 2023 to May 9, 2023, Ms. McFadden served as the Acting Director for PHPA.

Maryland Department of Health’s Maternal and Child Health Bureau leadership includes:

• Shelly Choo, MD, MPH serves as the Director of the Maternal and Child Health Bureau.
• Alena Troxel, MPH serves as the Deputy Director of the Maternal and Child Health Bureau.
• Lauren Whiteman, MPH started as the Director of the Office of Genetics and People with Special Health Care Needs and as the State Title V CSHCN Director in November 2022.
• Stacy Taylor, JD serves as the Deputy Director of the Office of Genetics and People with Special Health Care Needs
• Jennifer Wilson, MEd, RD, LDN, serves as the Director of the Maryland WIC Program.
• Samantha Ritter, MPH serves as the Director of the Office of Family and Community Health Services.
• NaToya Mitchell, MA serves as the Director of the Office of Quality Initiatives. Ms. Mitchell started June 14, 2023. Previously Alena Troxel served as the Acting OQI director from September 2022 until June 2023.
• Jessica Raisanen, MSPH serves as the Epidemiology Program Manager within the Office of Quality Initiatives. Ms. Raisanen started April 5, 2023. 
• The Title V Manager is currently vacant.
• Bailey House, MPH started as the Children and Youth with Special HealthCare Needs Title V Coordinator on June 14, 2023.

[1] Source: Opioid Operational Command Center: Maryland Overdose Data Dashboard and Demographic Dashboard. Note: data from 2021 and 2022 are preliminary and subject to change. Accessed 07/07/2023

[2] CDC defines the minimum overall response rate threshold as 50% for 2021 PRAMS data. In 2021, Maryland PRAMS had a weighted response rate of 44.1% and thus did not meet the threshold. Maryland PRAMS 2021 data should be interpreted with caution.

[3] CDC defines the minimum overall response rate threshold as 50% for 2021 PRAMS data. In 2021, Maryland PRAMS had a weighted response rate of 44.1% and thus did not meet the threshold. Maryland PRAMS 2021 data should be interpreted with caution.

[4] CDC defines the minimum overall response rate threshold as 50% for 2021 PRAMS data. In 2021, Maryland PRAMS had a weighted response rate of 44.1% and thus did not meet the threshold. Maryland PRAMS 2021 data should be interpreted with caution.

[5] CDC defines the minimum overall response rate threshold as 50% for 2021 PRAMS data. In 2021, Maryland PRAMS had a weighted response rate of 44.1% and thus did not meet the threshold. Maryland PRAMS 2021 data should be interpreted with caution.

[6] CDC defines the minimum overall response rate threshold as 50% for 2021 PRAMS data. In 2021, Maryland PRAMS had a weighted response rate of 44.1% and thus did not meet the threshold. Maryland PRAMS 2021 data should be interpreted with caution.

[7] CDC defines the minimum overall response rate threshold as 50% for 2021 PRAMS data. In 2021, Maryland PRAMS had a weighted response rate of 44.1% and thus did not meet the threshold. Maryland PRAMS 2021 data should be interpreted with caution.