The information in this section highlights key population health status findings by domain, drawn from Community Health Needs Assessments (CHNAs) and the five-year Needs Assessment (NA). These insights shaped the Oklahoma MCH program’s Title V priorities and Five-Year Action Plan. The assessment integrated multiple sources: a review of existing CHNAs, diverse data sets, community input via public surveys and listening sessions, and contributions from longstanding partners, including the Southern Plains Tribal Health Board, OFN, and OKDHS. All findings, except those from the CHNA review, were organized by Title V domain to guide priority setting and work plan development.

Community Health Needs Assessment (CHNA)

In December 2022 and April 2023, an online search identified Community Health Needs Assessments (CHNAs) published after 2021, covering various Oklahoma counties. Of the 42 CHNAs reviewed, 8 were published in 2021, 29 in 2022, and 5 in 2023. Most assessments (35) focused on hospital service areas, while 6 originated from community action groups and 1 from a county.

A review of 42 Community Health Needs Assessments (CHNAs) across Oklahoma revealed critical health needs and concerns affecting residents’ health. The chart below highlights the top 10 priorities, with some categories tied for rank. Notably, "Access to Health Care" emerged as a universal issue, cited in 38 CHNAs (90.5%), likely reflecting various subcomponents such as barriers to primary care, which may overlap with other top priorities. Similarly, “Mental and Behavioral Health” encompasses related issues. The top three overall needs identified were “Access to Health Care,” “Mental and Behavioral Health,” and “Substance Abuse.”

Figure 1. Priorities identified from a review Community Health Needs Assessment, Oklahoma 2021-2023

Overall MCH Population
The findings below outline key issues and focus areas that emerged as impacts related to the health of women of reproductive age, before, during, and after pregnancy.

In 2023, an estimated 810,519 women of reproductive age (15-44 years) lived in Oklahoma. The majority were White (70%), while 7% were African American/Black, 10% were American Indian and 15% were Hispanic. The 2024 Health of Women and Children Report ranked Oklahoma 47th in the nation, identifying it as one of the least healthy states for women and children. Contributing to this low ranking are factors such as high premature death rates and a low prevalence of physical activity. Health inequities continue to persist across Oklahoma’s’ MCH population.

Figure 2. Oklahoma Natality At-A-Glance

Social Determinants of Health

Listening sessions with youth, Tribal and Black/African American communities all highlighted the impact of the social determinants of health affecting their physical and emotional wellbeing. Specifically mentioned were access to nutritious food; affordable, quality housing; safe neighborhoods; and reliable transportation. A lack of paid maternity, sick and/or family leave and lack of affordable, quality childcare options also contributed to poor health outcomes.

Public Input Findings

From the listening sessions and public input survey several themes emerged, themes centered around access to care, mental health, and lack of awareness about available resources. The findings are summarized in Table III.C.1.b.ia.

Table III.C.1.b.ia. Top three needs identified from the Listening Sessions and the Public Input Survey

Women/Maternal Health

Access to Care

• SoonerCare for Pregnant Women program expanded Medicaid benefits to 12 months postpartum beginning Jan. 1, 2023. With this expansion, Oklahoma's income threshold for full-scope pregnancy-related benefits increased from 138% to 205% of the federal poverty level (FPL) and provided new mothers with 12 months of continuous postpartum coverage.
• Beginning July 1, 2023, SoonerCare started offering doula services to its members who were pregnant or newly postpartum.
• In 2022, Oklahoma had one of the highest uninsured rates in the U.S., 16% of women of age 19-44 years and 7% of children younger than 19 years were uninsured.
• Nearly 57% of live births were covered by Oklahoma Medicaid in 2023 (Birth-Medicaid linkage project).
• Access to care in the rural and underserved communities continued to be a challenge with nearly 53% of Oklahoma counties considered maternity care deserts by the March of Dimes. 
• Between 2015 and 2024, the number of birthing hospitals has declined in the state from 57 to 43.

Preconception and Perinatal health

• Among women who gave birth in 2023, the prevalence of mothers who were either overweight or obese prior to pregnancy was at 62%, with American Indian mothers having the highest rate of 69%, followed by Hispanics (67.6%) and African American/Black (67.2%).
• Most recent birth data (2023) indicate that 7% of mothers had gestational diabetes and 9% had gestational hypertension.
• Tobacco use among mothers before and during pregnancy dropped to 14.9% and 5.7% respectively (2022).
• Perinatal substance use was a top priority identified from the public input survey and the listening sessions. In 2023, nearly 1 in 5 new mothers reported using marijuana three months before pregnancy (PRAMS 2023). The rate of marijuana use for African American/Black mothers was 35%, Whites 19%, American Indian 28% and Hispanics 11%.
• Unintended pregnancy remains a significant public health concern in Oklahoma, with 29% of mothers indicating an unintended pregnancy and 17% indicating ambivalence. This issue is significantly higher among African American/Black than White mothers (43% vs 25%) (PRAMS 2023).
• Prenatal care in the first trimester improved from 65.4% in 2010 to 70.9% in 2023.
• Approximately 63% of postpartum women underwent depression screening (TOTS 2018-2022).

Maternal Mortality

• Oklahoma’s maternal mortality rate (MMR) was on a decline until the COVID pandemic (Figure 3); about a quarter of Oklahoma maternal deaths from 2020 – 2022 were related to COVID-19. The MMR of 31.0 per 100,000 live births for 2020 – 2022 was partly due to the COVID pandemic.

Perinatal/Infant Health

Prematurity and Infant Mortality

• In 2023, 11.0% of live births in Oklahoma were preterm, the rate was highest for African American/Black infants (15%) and lowest for Hispanic infants (10%).
• Prematurity accounts for approximately 20% of infant deaths each year. This proportion is much higher among African American/Black infants (27%) than White infants (19%).
• In 2023, Oklahoma ranked 45th in the nation in infant mortality rate (IMR of 7.0 per 1,000 live births). Sixty percent of the infant deaths happened in the neonatal period. The IMR declined by 7% from 7.6 per 1,000 live births in 2010 to 7.0 per 1,000 live births in 2023. Disparities in IMR continue to exist. African American/Black infants have three times the infant mortality rate as White infants.
• Prematurity, birth defects, and sudden infant death syndrome continue to be top causes of infant death in the State.

Preparing for a Lifetime

Preparing for a Lifetime, It’s Everyone’s Responsibility (PFLT), is Oklahoma’s statewide public health initiative dedicated to improving the well-being of mothers and infants. This initiative’s primary focus is to reduce infant mortality through several contributing priority areas identified through data:

• Preconception / Interconception health
• Prematurity
• Maternal mental health
• Tobacco
• Breastfeeding
• Infant safe sleep
• Infant injury prevention

Table III.C.1.b.ib shows a breakdown of improvements in key Preparing for Lifetime initiatives from the beginning of the infant mortality reduction initiative to current.

Table III.C.1.b.ib. Preparing for a Lifetime Measures from initiation to current

• Several factors influence a woman’s ability to care for her newborn; two needs identified throughout the public input phase of the needs assessment were parenting skills and a lack of awareness of available resources for new parents.
• Safe infant sleep and breastfeeding are protective factors against infant mortality, data from the current PRAMS survey indicates more mothers initiate (89%) breastfeeding. However, data showed that breastfeeding at 8 weeks declined to 61% and exclusive breastfeeding at 8 weeks to 47%.
• Safe sleep efforts have improved through the back to sleep campaigns and cribs projects, however nearly half the infants share a sleep surface.

Child Health

• Adverse Childhood Experiences (ACEs) are physical, emotional, or social events that cause stress and trauma, and can have negative, long-term effects on a child and their family. Data from the Oklahoma Toddler Survey (2018-2021 TOTS) indicated over 30% of toddlers had experienced one or more ACEs.
• Approximately 71% of children 35 months or younger had completed the combined 7-vaccine series.
• Oklahoma ranked 35th in the nation in unintentional injuries with a rate of 23.4 per 100,0000 children ages 1-19 per America's Health Rankings analysis.
• Top priorities identified for children throughout the needs assessment were attaining healthy weight, physical activity, and safe space for kids. Overall, in Oklahoma, 38% of children aged 6-11 years and 33% of children ages 12-17 years were either overweight or obese.
• The percent of children who were physically active at least 60 minutes per day, ages 6-11 was 22%.

Adolescent Health

• Teen birth rates declined significantly from 50.6 in 2010 to 20.6 in 2023 (per 1000 female population aged 15-19 years).
• The percentage of Oklahoma high school students ever smoking cigarettes declined from 45.7% in 2013 to 24.5% in 2023.
• In 2023, more than one in three high schoolers were overweight or obese. YRBS data found that 49% were physically active for at least 60 minutes per day on 5 or more days.
• Mental health and access to mental health providers were top priorities identified from the youth listening session, specifically lack of accessible and affordable mental health resources.
• About 86% of high school students experienced at least one ACEs before the age of 18, 37% had experienced 4 or more ACEs, See Table III.C.1.ic.
• Bullying is a serious detriment to a child’s health, sense of wellbeing, safety, education, and emotional development, and greatly increases the risk of self-injury and suicide. 28% of high school students reported being bullied at school, electronically, or both.
• Latest data indicate that 45% of Oklahoma’s high school students stated that they felt sad or hopeless almost daily for at least two weeks in a row. Moreover, 12% attempted suicide one or more times during the 12 months prior to taking the survey. In 2023, suicide was the second leading cause of death among adolescents aged 15-19.
• In 2023, 26% of high schoolers were consuming alcohol and 35% reported having ever used marijuana.

Table III.C.1.ic. ACEs and PCEs Composite Score: Oklahoma YRBS 2021 and 2023

Children with Special Health Care Needs

• Between 2022-2023, an estimated 232,699 children with special health care needs (CSHCN) lived in Oklahoma. This translates to 24% of all Oklahoma children (NSCH 2022-2023).
• The majority (80%) of children with special health care needs in Oklahoma were aged 6 years or older.
• The OKDHS Adult and Family Services reported 17,135 children as receiving medical SSI from October 2022 to September 2023.
• Title V funded partners have delivered direct and enabling services to 10,835 children or families of children with special health care needs since 2021 (See Table III.C.1.id). The spectrum of direct and enabling services provided include, but is not limited to, Coordinated Family Advocacy, Behavioral and Mental Health Services, Education Consultation, Respite Services, Physical Services (encompassing Medical and Allied Health disciplines), Healthcare Transition Services, and Sib Shops.

Table III.C.1.id Number of Children with Special Healthcare Needs Served in Oklahoma

Input from the public indicated that efforts are needed to improve access to care specifically to ensure that CSHCN in Oklahoma receive necessary medical care, mental and behavioral health care, and transition support.