Health Status and Demographics
Connecticut (CT) is a small state of about 5,000 square miles and 169 towns, and in 2018 had an estimated statewide population of 3,572,665[1]. Five towns had a population greater than 100,000 and included: Bridgeport (145,579), New Haven (131,014), Stamford (130,824), Hartford (123,400), and Waterbury (108,629)[2]. 17.92% of the state’s residents lived in these five towns. The remaining 164 towns had a population of just under one-tenth the size of these large towns (median population size =12,096).
The State of CT is characterized by high social and economic contrasts. From 2013-2017, the state median household income (in 2017 dollars) was $73,781. The median household income of the five large towns in CT varied widely from a low of $33,841 in Hartford, to moderate levels in Waterbury ($40,879), New Haven ($39,191), and Bridgeport ($44,841), and to a high of $84,893 in Stamford 2. Among the five largest towns in CT from 2010 to 2017, the population of Stamford grew the fastest, with a 6.7% increase, followed by the town of Bridgeport (1.6%) and the town of New Haven (0.9%). These growth rates were higher than the overall statewide growth rate of 0.4%. The town of Hartford showed a -1.1% change in population, followed by Waterbury (-1.5%), which both showed an overall decrease in population 2.
In May 2019, the seasonally adjusted unemployment rate in CT was 3.8%, down four-tenths of a percentage point from a year ago when it was 4.2%. The number of Connecticut unemployed residents, seasonally adjusted, was down 800 from April at 71,700. Over the year, the number of the state's jobless residents declined by 8,500 (-10.6%). The state's labor force was down an estimated 4,500 over the month at 1,911,100, but is higher over the year by 15,100 (0.8%). The annual growth margin in the state's labor force has been shrinking in recent months. Connecticut now has recovered 80.7% (97,100) of the 120,300 seasonally adjusted jobs lost in the “Great Recession (3/08-2/10). The state’s private sector has recovered 100% (112,000) of the private sector jobs lost during the recession. The national unemployment rate is now 3.6%, which is slightly lower than the most recent CT rate (3.8%)[3].
In CT during 2017, 67.0% of the population was non-Hispanic White. Among racial and ethnic minorities, the percentages were: 16.1% Hispanic/Latino, 11.9% non-Hispanic Black/African American, 4.8% non-Hispanic Asian, and 2.5% of another race or multi-racial background. CT’s largest towns had greater racial and ethnic diversity than CT overall. For example, 37.9% of Hartford’s population was non-Hispanic Black/African American, and 35.3% of Bridgeport’s population was non-Hispanic Black/African American. The Hispanic population accounted for approximately 44.3% of the population in Hartford, and 39.2% in Bridgeport 2.
In 2017, about one in seven residents (16.8%) was 65 years of age or older. About one in five CT residents (20.7%) in 2017 was under 18 years of age. CT’s largest towns had a greater proportion of young persons than the state overall, with more than half of the population younger than 35 years of age in New Haven, Hartford, Waterbury, and Bridgeport, compared to 43.1% statewide. These statistics have policy implications for women of childbearing age and young mothers 2.
Between 2013-2017, 90.2% of CT adults had completed high school or had a GED, and 38.4% had a bachelor’s degree or higher. Relative to the state overall, three of the largest towns, Hartford, Bridgeport, and Waterbury, had a greater proportion of adults with the lowest levels of educational attainment.[4]
Relative to the general population, a different pattern of demographics exists among children living in CT. Between 2013-2017, 13.2% of children under 18 years were living below poverty level in the past 12 months and 20.8% of children under 18 years were living in households with Supplemental Security Income (SSI), cash public assistance income, or Food Stamp/SNAP benefits 4. As expected, given the economics of all ages living in CT, the magnitude and highest percent of childhood poverty exists in four of the five large towns of CT. The percent of childhood poverty between 2013-2017 was 10.2% in Stamford. One in three children in Bridgeport, Waterbury, and New Haven lived in poverty, and 40.7% of all children in Hartford lived in poverty. Other towns, however, also exhibited a high percent of childhood poverty. These towns included: New London (43.9%), Willimantic (38.2%), New Britain (34.6%), Ansonia (27.2%), and Derby (18.0%) these towns are in rural and suburban areas of the state. These data indicate that, although public health interventions for the general high-risk population, including women of reproductive age, should be focused in large urban areas, interventions for families and their children need to be expanded into other areas of the state.
Strengths and Challenges Impacting Health Status
While Connecticut residents report good health status, overall, compared to national statistics, large health disparities exist between non-Hispanic Whites and that of the non-Hispanic Black/African American and Hispanic populations. Disparities among perinatal indicators are significant and persistent. Addressing racial and ethnic disparities in the state is a priority. Reducing disparities in maternal and child health indicators remains one of the major challenges facing the public health community, requiring coordinated and simultaneously executed multi-ecological strategies.
The data described below indicate that, although perinatal programs in Connecticut appear to be having a positive effect on the maternal and child health population, much remains to be done to achieve optimal outcomes for all Connecticut mothers and babies. The lifetime effects of race, racism, social class, poverty, stress, environmental influences, health policy, and other social determinants of health are reflected in the elevated rates of adverse outcomes and persistent disparities. The continuation of evidenced-based programs, coupled with efforts to increase health equity and address social determinants of health, is essential to achieving improved birth outcomes and reducing/eliminating disparities.
Maternal and Child Demographics
During calendar year 2017, there were 36,718 births to CT residents. Of these births, 19,393 were to non-Hispanic White mothers, 4,302 were to non-Hispanic Black/African American mothers, and 9,198 births were to women of Hispanic/Latino ethnicity[5]. In 2016, about 53% of all births to non-Hispanic Black/African American mothers occurred in the five large towns of CT: Bridgeport (14.4%), Hartford (14.5%), New Haven (12.4%), Waterbury (6.9%), and Stamford (4.6%). Similarly, 41.7% of all births to Hispanic, any race mothers occurred in these large towns: Bridgeport (10.5%), Hartford (10.7%), New Haven (7.3%), Stamford (6.9%) and New Britain (6.4%).[6] These data show that women of reproductive age who are of minority race/ethnicity are largely residents of only a handful of large towns and surrounding suburbs. As noted above, these areas are characterized by low income, poor education and housing arrangements, and high rates of unemployment. Public health programs to maximize health and readiness for pregnancy need to be focused in these areas and need to address the socio- economic factors that limit optimal health and wellbeing.
Many maternal health indicators within CT compare favorably with the United States, but are dominated by the majority of non-Hispanic White women, masking the racial and ethnic disparities within the numbers. High-risk groups experience a disproportionate burden of adverse health risk factors and outcomes. Addressing racial and ethnic disparities in the state is a priority. Reducing disparities in maternal and child health indicators remains one of the major challenges facing the public health community, requiring coordinated and simultaneously executed multi- ecological strategies.
Infant Mortality
In CT during 2016, there were 175 deaths among CT babies, representing an infant death rate of 4.9 per 1,000 live births. Of these deaths, three-fourths (131; 74.9%) occurred during the neonatal period, and the remaining 44 were post-neonatal 6.
The Connecticut annual infant mortality rate (IMR, reported as deaths per 1,000 live births) averaged 5.0 (range: 4.6 - 5.6) during the period 2013-2017. With the exception of the 2015 rate of 5.6 deaths per 1,000 live births, all annual overall (i.e. across all race-ethnicities) IMRs for this five-year period were lower than any reported for Connecticut since 2005 and are consistent with a trend of declining annual IMRs for the state since that year. Annual IMRs in both non-Hispanic white and non-Hispanic Black/African American populations declined for the period 2013-2017 at rates of 3.3% and 2.8% per year, respectively, as they had since 2005. By contrast, there was no evidence of decline in mortality rates among Hispanic infants between 2013 and 2017. Most recently, and specifically for the period 2013-2017, annual IMRs in Connecticut’s non-Hispanic white population averaged 3.3 deaths per 1,000 live births and were significantly lower than those observed for the non-Hispanic Black/African American and Hispanic populations. Annual IMRs for non-Hispanic Black/African American populations averaged 10.3 deaths per 1,000 live births, and those for Hispanic populations average 5.9 deaths per 1,000 live births. The averages were 3.1 and 1.7 times higher, respectively, than that for Connecticut’s non-Hispanic white population[7].
Births to Teens
The 2013-2017 annual overall teen birth rates in Connecticut averaged 10.5 (range=8.8 and 12.9, reported as live births per 1,000 women aged 15-19) and continued a recent 10-year decline observed to have begun in 2008. The lower limit for the range of teen birth rates during this five-year period of 8.8 births per 1,000 women aged 15-19 represents the lowest teen birth rate observed this century in Connecticut. Declines across all three major race-ethnicity groups are also evident for the period 2013-2017, with annual rates of declines in teen births rates in the non-Hispanic white, non-Hispanic Black/African American, and Hispanic populations during this period averaging 11.2%, 12.3%, and 10.4% per year, respectively. In the presence of these significant declines across all three major race-ethnicity groups in Connecticut, however, disparities by race and ethnicity nonetheless exist. For the period 2013-2017, the average annual teen birth rate of Hispanic women of 29.9 births per 1,000 women aged 15-19 was 7.8 times higher than the average rate for non-Hispanic White women of 3.8. The average annual teen birth rate among non-Hispanic Black/African American women of 17.3 births per 1,000 women aged 15-19 for 2013-2017 was 4.6 times that of non-Hispanic White women 7.
Despite the decreasing trend in teen births, there were still 1,132 births to women 15-19 years of age in 2016, representing 3.1% of all births. Of these births, 635 were to Hispanic, any race teens (7.4% of all births to Hispanic, any race mothers); and 229 were to non-Hispanic Black/African American teens (4.8% of all births to non-Hispanic Black/African American mothers). In sharp contrast, 244 births were to non-Hispanic White teens, representing only 1.3% of all births to non-Hispanic White women. Hispanic, any race teens accounted for approximately half (56.1%) of all teen births 6.
Support services for young mothers are important, not only within the large towns, but also in surrounding towns of high need. Support for young mothers is a public health imperative, and coupled with teen pregnancy prevention, is likely to have a large impact on the health and well-being of women across the lifespan. Preventive interventions to address teen pregnancy through CT's Title V programs include programs 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. Programs such as the Case Management Program for Pregnant Women and Parenting Teens, Healthy Choices, and federal Family Wellness Healthy Start serve pregnant and parenting teens and include inter-conception services. The Case Management for Pregnant Women program in three large cities with high rates of teen births is similar to the Family Wellness Healthy Start program in the cities of Hartford and New Britain. The program focuses on pregnant females and teens under the age of 20 who are at greatest risk for poor birth outcomes. This is a coordinated, culturally-sensitive approach to providing individualized client services through intensive case management and home visitation. The services focus on building social supports, providing education, promoting birth spacing and family planning, and providing referrals to ongoing medical care. A state priority is to ensure that young people, and in particular young women, receive regular preventive well-visits, and pregnancy prevention interventions during these visits is a means to reducing the teen pregnancy rate in areas of high risk.
Prenatal Care
Rates of late/no prenatal care (PNC) for the entire population of pregnant women in Connecticut ranged from 11.7% to 12.8% for the period of 2013-2015, and were higher for 2016-2017, averaging 15.8%. However, changes in reporting of date of first PNC visit during 2016 due to updating of the Facility Worksheet for Live Birth Certificate by DPH precludes meaningful comparisons of rate of late/no prenatal care during 2016 to earlier years. Prior to 2016 rates of late/no PNC were neither increasing nor decreasing for Connecticut’s entire populations, but for both non-Hispanic Black/African American and Hispanic populations, rates declined by an average of 0.01% annually. Rates of late /no PNC were not different between non-Hispanic black/African American and Hispanic populations for the period 2016, averaging 20.1 and 19.2, respectively% These rates were approximately twice the rate of 9.7% observed for non-Hispanic white women during that same two-year period 5.
The five large towns in CT were home to 36% of all women who received late prenatal care/no prenatal care (Hartford, Stamford, Waterbury, New Haven, and Bridgeport). The towns of New Britain, New London, West Haven, and Danbury also had significantly higher percentages of late prenatal care/no prenatal care, and the percent increased significantly relative to the previous year in Stamford and decreased significantly in Waterbury. Compared to a statewide percent of 23.7% of all births for which women received non-adequate prenatal care in 2015, the percent among non-Hispanic Black/African American and Hispanic, any race mothers was significantly higher (29.5% and 26.6%, respectively).[8]
Early and regular prenatal care is protective against maternal and infant adverse outcomes, including infant mortality, low birth weight, and maternal complications. The Department strives to improve access to prenatal care by supporting primary care sites and providing free pregnancy testing at family planning clinics. At these sites, patients are referred for early prenatal care, in keeping with established protocols. Outreach services in Hartford through the federal Family Wellness Healthy Start program may help encourage pregnant women into early and regular care. Changes in the state's public insurance policies, such as an increased eligibility limit for pregnant women to 263% of the federal poverty level (FPL), and presumptive eligibility for pregnant women, may encourage early entry into prenatal care.
Singleton Low Birth Weight and Very Low Birth Weight
There was no change in the overall rate of singleton low birth weight (LBW) around an average value of 5.8% (range = 5.6-6.1%) for Connecticut, nor for non-Hispanic White and Hispanic populations, for the period 2013-2017. This result is consistent with an observed stable rate of singleton LBW, both overall and in these two race-ethnicities, since the mid-2000s, when rates stopped increasing. Singleton LBW rates for the non-Hispanic Black/African American population, on the other hand, declined during the 2013-2017 period, at a modest rate of .01% per year, as they had since 2000. Disparities among minority race-ethnicity groups have persisted. From 2013 to 2017, the average rate of singleton LBW infants among non-Hispanic Black/African American/African American populations (9.8%) was 2.2 times higher than that among non-Hispanic White women (4.5%). The average rate of singleton LBW among Hispanic women (6.6%) was 1.4 times that of non-Hispanic White women.5
Between 2013 and 2017, there was also no change for Connecticut overall in the rate of singleton very low birth weight (VLBW). There were some minor fluctuations across all three major race-ethnicity groups, but the rates remained largely unchanged and averaged 1.1% for the total population (range=1.0-1.1%). Disparities in rates of VLBW by race-ethnicity in Connecticut were more marked than those for LBW for the period 2013-2017. Average rates of VLBW for the non-Hispanic Black/African American population (2.3%) and Hispanic population (1.3%) were 3.4 and 2.0 times that of the non-Hispanic white population rate of 0.7%, respectively.7
During 2016 in CT, there were 2,964 LBW (less than 2,500 grams or 5.5 pounds) babies born in the state, representing 7.7% of all births. Compared to babies born to non-Hispanic White women (6.4%), the percent of LBW babies born to non- Hispanic Black/African American and Hispanic, any race mothers was significantly higher at 11.4%, and 8.4%, respectively. Masked within the racial/ethnic disparity in LBW is an even greater disparity in VLBW (very low birth weight; less than 1,500 grams or 3.3 pounds). There were 532 VLBW babies born in CT during 2016, representing 1.4% of all births in the state. In sharp contrast to non-Hispanic white mothers (1.0%), the prevalence of VLBW among non-Hispanic Black/African American mothers was 2.8%, and the prevalence among Hispanic, any race mothers was 1.5%. A significantly higher prevalence of LBW was observed in East Hartford (10.8%), Hartford (9.5%), New Britain (10.4%), Bridgeport (8.8%) and Waterbury (10.2%). 6
Current Initiatives
DPH supports/coordinates a number of projects to reduce adverse maternal and child health outcomes and to address racial and ethnic disparities in these outcomes. The majority of the current initiatives are organized by domain, however, it should be noted that many of the initiatives have impact across multiple domains. These activities include the following:
- The CT Maternal and Child Health (MCH) Coalition supports the Maternal and Child Health Block Grant (MCHBG) in monitoring state MCH population needs as well as identifying appropriate state priorities. The CT MCH Coalition is made up of over 120 stakeholders that meet quarterly and are dedicated to improving the health of mothers, infants and children statewide. The Maternal, Infant and Child Health (MICH) focus area of the State Health Improvement Plan is supported by a subset of members from the MCH Coalition. The MICH focus area directly impacts and supports the MCHBG activities in several areas including perinatal/infant health, child health, children with special health care needs, and oral health.
- The Connecticut Department of Public Health (DPH) updated the Organizational Strategic Plan in January 2019. DPH continues to prioritize health equity, quality improvement, and workforce development. It has added data quality and access as well as customer service as priority areas of focus. Efforts to address the priority objective “Recruit, Retain, and Develop a Competent Public Health Workforce” are already well underway. Examples of these activities include an improvement effort to effect efficiency of the recruitment summary that continues to be refined.
Systems of Care Addressing the Needs of Underserved and Vulnerable Populations
The CT Maternal and Child Health Coalition continues to be the Lead Action Team for the Maternal, Infant & Child Health (MICH) section of the State Health Improvement Plan. The CT MCH Coalition also supports the MCHBG in monitoring state MCH population needs and identifying appropriate state priorities. In collaboration with the CT March of Dimes, the CT MCH Coalition has implemented Every Woman Connecticut (EWC) in eight communities. The main goal of Every Woman Connecticut (EWCT) Learning Collaborative is to increase expertise and self-efficacy in implementing routine pregnancy intention screening and appropriate care, education, and services to ultimately improve birth spacing, increase pregnancy intentionality, and the proportion of Connecticut women who deliver a live birth and report discussing pre-/interconception health with a healthcare worker. As a result of the request in May 2018 by DPH to continue Connecticut’s efforts that were started under the ASTHO Increasing Access to Contraception (IAC) project, the EWCT Advisory Committee convened an IAC workgroup. While the national project ended in the summer of 2018, this workgroup has allowed the work to continue. The workgroup has representation from Department of Public Health, Department of Social Services (Medicaid), ACOG, Community Health Centers, Inc., Planned Parenthood of Southern New England, and the March of Dimes. This partnership is well aligned with the efforts to integrate pregnancy intention screening into routine care spearheaded until now by EWCT. EWCT, through this workgroup, will identify and act upon system barriers that limit the uptake of comprehensive contraceptive care for Connecticut people of childbearing ages who wish to avoid or delay a pregnancy.
Reproductive health services are funded with State and Title V funds through a five year contract. The program provides services in those areas of Connecticut with high a concentration of low-income women of "reproductive age," and with high rates of teen pregnancy. The plan for this year is to expand services in the city with the highest repeat teen birth rate to a full time center. The program also plans to work closely with Federally Qualified Health Centers (FQHCs) in implementing the Association of State and Territorial Health Officials (ASTHO’s) Learning Community goal of Increasing Access to Contraception for Medicaid clients. CT has expanded reproductive health services, which affords presumptive Medicaid eligibility for those uninsured and under 250FPL to receive reproductive health and STD services at no cost. Sliding-fee scale services are also offered and provide pregnancy testing, counseling visits, referrals for prenatal care, contraceptive service visits, breast and cervical cancer screenings, STD and HIV screenings and counseling, and other medical services visits as appropriate. The reproductive health care services provided are in accordance with nationally recognized standards of care. Chlamydia and gonorrhea testing will be encouraged as a standard procedure for all patients between the ages of 15-25.
CT’s coordinated system of care for CYSHCN and their families, the CT Medical Home Initiative (CMHI) for CYSHCN, provides community-based, culturally competent care coordination and family support services to more than 8,000 CYSHCN in collaboration with 65 community based Medical Homes (MH) including: community health centers, hospital clinics, pediatric and family practices. CMHI care coordination network contractors included: CT Children’s Medical Center (North Central CT), St. Mary’s Hospital (Northwest), Stamford Health System (Southwest), Family Centered Services (South Central) and United Community and Family Services, (Eastern). CMHI provides technical assistance (TA) to an additional 16 practices implementing a MH model.
DPH will convene the DPH Medical Home Advisory Council (MHAC) quarterly, including the MHAC Family Experience Workgroup. MHAC is comprised of more than 40 representatives including youth representation, state and private agencies, community-based organizations, the state’s Medicaid Administrative Service Organizations (ASOs) and parents/caregivers of CYSHCN, and provides guidance to DPH and its partners in their efforts to improve the system of care for CYSHCN. The MHAC remains DPH’s chief vehicle for collaborating with state/regional/local agencies to organize easily accessible community-based service systems and maximize linkages with professionals and family organizations. Groups collaborate with MHAC and CMHI to develop and organize universally accessible community-based service systems and maximize linkages for their populations.
DPH staff collaborated with the Family to Family (F2F) Health Information Network (administered through Parents Available to Help/Family Voices CT) to disseminate information regarding health finance resources, including public and private insurance. DPH provided training around medical home for F2F Health Information Specialists working for Parents Available to Help/CT Family Voices, who in turn provided health and resource related trainings for families.
DSS expanded ConneCT – an online portal described as “an easy way to get information about your benefits and other DSS programs.” The portal is a consumer friendly tool to check eligibility to receive medical benefits, cash assistance, SNAP, and other services. Applications are available through the portal for all DSS programs (https://connect.ct.gov/access/accessLogout?fwlat=1382490866023).
DPH supported 93 school health service sites in 27 communities statewide. Included are 82 School Based Health Centers (SBHC) and 11 Expanded School Health (ESH) sites. SBHCs serve students, Pre K-12, and are located in elementary, middle and high schools as well as in combination schools where two schools are located in one facility (elementary and middle school or middle and high school). Eligible students are those that attend the schools in which the SBHC is located. All DPH funded SBHCs provide primary care, mental/behavioral health services and health education/promotion activities designed to meet the physical and psycho-social needs of children and youth within the context of family, culture and environment. In some instances, dental care is also offered. ESH sites offer some level of behavioral/mental health services and/or risk reduction education. Care is delivered in accordance with nationally recognized medical/mental health and cultural and linguistically appropriate standards.
The Office of Oral Health (OOH) and its partners developed the State Oral Health Improvement Plan 2019 - 2024 (SOHIP). The framework of the plan includes four focus areas – prevention, access and utilization, medical and dental integration, and data collection and analyses. The plan outlines 16 objectives, suggested strategies, and potential partners. This will guide efforts of state and community programs that are dedicated to ensuring access to oral health services for all residents regardless of race ethnicity, education, or class background. The primary focus is to decrease oral health disparities; promote a culturally competent oral health workforce; increase the engagement of health and human service providers to integrate oral health into their practices; and improve the oral health literacy of CT residents. There are four (4) overarching goals, sixteen (16) objectives and eighteen (18) strategies identified in the improvement plan and will be implemented over a five year period.
Note: Specific state statutes related to the MCH Block Grant authority (and impact to the state’s MCH and CSHCN programs) can be found as an attachment.
[1] United States Census Bureau, 2018 Data
[2] United States Census Bureau, 2017 Data https://www.census.gov/quickfacts
[3] CT Department of Labor, May 2019 Data
[4] U.S. Census Bureau, 2013-2017 American Community Survey 5-Year Estimates (https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml)
[5] CT Department of Public Health: Health Statistics and Surveillance Section, 2017
[6] CT Department of Public Health: Health Statistics and Surveillance Section, Provisional Registration Report, 2016
[7] CT Department of Public Health: Health Statistics and Surveillance Section, 2013-2017
[8] Jiang, Y., Mueller, L.M., Backus, K. (2018). Registration Report for the Year Ended December 31, 2015,
Connecticut Department of Public Health, Hartford, CT (http://www.ct.gov/dph/RegistrationReport)
To Top
Narrative Search