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During Fiscal Year 2020, the Bureau had an Acting Director. The Deputy Director started during the middle of the FY 2020. Two of the Bureau’s Offices recruited for Directors during this time period. Office and program staff remained relatively stable otherwise.

Data Updates

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

Women’s/Maternal Health:

Substance Use/Misuse/Disorder: The Maryland Vital Statistics Administration (VSA) reported that in 2020, there were 2,773 unintentional intoxication deaths involving drugs and alcohol, a 16.6% increase from 2019. Ninety percent of these deaths were categorized as opioid-related, higher than at any other point during the opioid crisis. The number of opioid-related unintentional intoxication fatalities increased 18.7%, from 2,106 in 2019, to 2,499 in 2020. This is substantially less than the 70% increase between 2015 and 2016, which was the largest single year increase that has been recorded. Fentanyl-related deaths continue to rise, increasing 20.7% from 1,927 in 2019 to 2,326 in 2020. Maryland Vital Statistics data indicates that drug and alcohol intoxication deaths among women increased from 640 deaths in 2018 to 654 deaths in 2019, a two percent increase.

Mental Health: According to 2019 Pregnancy Risk Assessment Monitoring System (PRAMS) data, 13.1% of women reported depression before pregnancy and 15.6% of mothers reported symptoms of postpartum depression. During the three months before pregnancy, 20.5% of women reported they had anxiety.

Maternal Mortality and Morbidity: Due to delays caused by the COVID-19 Pandemic, numbers for Maternal Mortality are pending. The 2013-2017 maternal mortality rate (MMR) in Maryland decreased 2% from the 2008-2012 rate. The MMR among Black women is 4.0 times the MMR of White women. The leading cause of pregnancy-associated deaths in 2017 was substance use with unintentional overdose, accounting for 38 percent of these deaths.

Preventive Dental Visits in Pregnancy: According to 2019 PRAMS data, 54.1% of women reported having their teeth cleaned during pregnancy, a one percent increase from 53.4% in 2018.

Smoking in Pregnancy: According to 2019 PRAMS data, 11.0% of women reported that they smoked during the three months before pregnancy (down from 16.1% in 2013), 5.0% of women reported that they smoked during the last three months of pregnancy (down from 7.8% in 2013), and 7.8% reported that they smoked postpartum. Non-Hispanic Black women reported the highest rates of smoking during the three months before pregnancy (13.2%) and postpartum (11.9%), while non-Hispanic White women reported the highest rates of smoking during the last three months of pregnancy (6.3%). All smoking rates were highest among women under the age of 25. Prenatal smoking rates in Maryland are slightly higher than the Healthy People 2030 objective for smoking during pregnancy (4.3%).

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 84.8% in 2019, a 2.4% increase from 82.8% in 2018, according to PRAMS data. Among non-Hispanic White women, 93.2% initiated prenatal care during the first trimester, compared to 79.5% among non-Hispanic Black women, and 72.0% among Hispanic women. First trimester prenatal care initiation increased as the woman’s age increased.

Infant Mortality: Maryland VSA reported the infant mortality rate in Maryland in 2019 was 5.9 per 1,000 live births, a 3.3% decrease from 6.1 per 1,000 live births in 2018, and down from 8.5 per 1,000 live births in 2004. The leading causes of death were disorders related to short gestation and low birth weight, congenital abnormalities, SIDS, maternal complications of pregnancy, infectious diseases, cardiovascular disorders, 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: Maryland VSA reported in 2019, 8.7% 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 (12.6%) than Non-Hispanic White mothers (6.6%).

Very Low Birth Weight: Maryland VSA reported in 2019, 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 (2.8% Non-Hispanic Blacks, 0.9% Non-Hispanic Whites, and 1.2% for Hispanics).

Preterm Birth: Maryland VSA reported in 2019, 10.3% of live births occurred before 37 weeks of gestation in Maryland, a 1.0% increase from 10.2% in 2018.Non-Hispanic Black mothers were more likely to have a preterm birth than other races with 13.0%, compared to 8.9% and 9.7% for Non-Hispanic White and Hispanic births, respectively.

Breastfeeding: In 2019, according to PRAMS data, 91.4% of Maryland mothers reported having ever breastfed their babies, an increase from 89.6% in 2018. Rates of breastfeeding in Maryland were high across all races ranging from 89.1% for Non-Hispanic Black mothers to 99.6% among Asian mothers.

Infant Safe Sleep: In 2019, according to PRAMS data, 12.8% of mothers in Maryland reported not placing their infants on their back to sleep and 37.4% of mothers reported that their baby slept with a blanket, 8.1% slept with toys, cushions, or pillows, and 11.2% slept with bumper pads. Over 80 percent of mothers reported that their baby slept in the same room as the mother.

Child Health:

Mortality: According to Maryland VSA data, in 2019, there were 681 deaths to infants and children ages 0 to 18 years old in Maryland. Most of these deaths occurred in infancy. The 2019 child death rate decreased by 3.0% compared to 2018. Congenital abnormalities were the leading cause of death for the 70 children ages 1 to 4 years. Injuries were the leading cause of death for the 77 children ages 5 to 14, followed by congenital abnormalities.

Preventive Health Care: According to 2020 Medicaid data, 67.0% of Medicaid enrolled patients who turned 15 months old during 2020 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), 2018-2019, showed that 40.9% of children ages 9 through 35 months received a developmental screening using a parent-completed screening tool in the past year, a slight increase from 39.3% during the 2017-2018 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 8.5 per 1,000 population in 2019. There were large racial disparities, with a rate of 3.4 per 1,000 population among White non-Hispanic children, 18 per 1,000 population among Black non-Hispanic children, and 5.3 per 1,000 population among Hispanic children.

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 2019. This represented a 10% increase from the 2018 rate of 7.9 per 100,000 population. The actual numbers of suicides in this age range increased from 30 in 2018 to 33 in 2019. The suicide rate remained highest for non-Hispanic White male teens in 2019.

Teen Pregnancy and Reproductive/Sexual Health: Maryland VSA data showed that the adolescent birth rate decreased 55.4% from 31.2 births per 1,000 adolescent females ages 15-19 years in 2009 to 13.9 births per 1,000 adolescent females in 2019. Hispanic females had the highest adolescent birth rate with 36.7 births per 1,000 adolescent females, which was more than double the adolescent birth rate for Black, non-Hispanic females (17.0 per 1,000 adolescent females) and more than five times the adolescent birth rate for White, non-Hispanic females (7.3 per 1,000 adolescent females).

Children and Youth with Special Health Care Needs:

Medical Home: According to the 2018-2019 National Survey of Children’s Health, there are an estimated 260,596 children and youth ages 0 to 17 with special health care needs in the state. The survey estimated that 44.9% of these children have a medical home.

Transition to Adult Care: The 2018-2019 National Survey of Children’s Health estimated that 26.9% 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:

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 the Maternal and Child Health Bureau.

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.
Jed Miller, MD, MPH serves as the Director of the Office of Genetics and People with Special Health Care Needs. Dr. Miller also serves as the State Title V CSHSN Director.
Stacy Taylor 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.
Melissa Beasley served as the Director of the Office of Family and Community Health Services until July 2021.
Maisha DouyonCover, MPH served as the Director of the Office of Quality Initiatives until May 2021.
Kristin Silcox, MS serves as the Epidemiology Program Manager within the Office of Quality Initiatives.
Colleen S. Wilburn, MPA has served as the Title V Manager since 2019.

During Fiscal Year 2021, the Maternal and Child Health Bureau welcomed a new Director. Dr. Shelly Choo began with MCHB on July 15, 2020. Ms. Alena Troxel continued in her role as Deputy Director which she began in December 2019. Melissa Beasley served as the Director of the Office of Family and Community Health Services until the end of July 2020. Maisha Douyoncover served as the Director of the Office of Quality Initiatives until the end of May 2021. Dr. Jed Miller served as the Director for Children and People with Special HealthCare Needs, and Jennifer Wilson served as Director of the Maryland WIC program. Teresa Pfaff started as the Director of the Office of Quality Initiatives in September 2021. In addition, Paula Reynolds started as the Chief Operating Officer in September 2021.

During State Fiscal Year 2022 and 23, the Bureau aligned positions within Title V domains. A maternal health coordinator position was developed to focus on the maternal health workstreams. In addition, an infant and child health coordinator position was developed to focus on infant health workstreams. A child and adolescent health program manager position was developed to focus on child and adolescent health workstreams.

Data Updates

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

Women’s/Maternal Health:

Substance Use/Misuse/Disorder: Due to Maryland Department of Health’s network security event, additional data are not available. However, in Maryland from January to September 2021, preliminary data show that there were 2,129 unintentional intoxication events compared to 2,076 from January to September 2020.

The Maryland Vital Statistics Administration (VSA) reported that in 2020, there were 2,773 unintentional intoxication deaths involving drugs and alcohol, a 16.6% increase from 2019. Ninety percent of these deaths were categorized as opioid-related, higher than at any other point during the opioid crisis. The number of opioid-related unintentional intoxication fatalities increased 18.7%, from 2,106 in 2019, to 2,499 in 2020. This is substantially less than the 70% increase between 2015 and 2016, which was the largest single year increase that has been recorded. Fentanyl-related deaths continue to rise, increasing 20.7% from 1,927 in 2019 to 2,326 in 2020. Maryland Vital Statistics data indicates that drug and alcohol intoxication deaths among women increased from 640 deaths in 2018 to 654 deaths in 2019, a two percent increase.

Mental Health: According to 2020 Pregnancy Risk Assessment Monitoring System (PRAMS) data, 18.1% of women reported depression three months before pregnancy and 14.3% of mothers reported symptoms of postpartum depression. During the three months before pregnancy, 25.2% of women reported they had anxiety.

Maternal Mortality and Morbidity: While the report for cases reviewed in FY2021 are 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 were hemorrhage (29 percent of these deaths) and non-cardiovascular medical conditions (24 percent of these deaths). The leading cause of pregnancy-associated deaths in 2019 was substance use with unintentional overdose, accounting for 50 percent of non-pregnancy-associated deaths.

Preventive Dental Visits in Pregnancy: According to preliminary 2020 PRAMS data, 47.0% of women reported having their teeth cleaned during pregnancy, a decrease from 54.1% in 2019. This number was most likely impacted by COVID.

Smoking in Pregnancy: According to preliminary 2020 PRAMS data, 10.6% of women reported that they smoked during the three months before pregnancy (down from 16.1% in 2013), 4.0% of women reported that they smoked during the last three months of pregnancy (down from 7.8% in 2013), and 5.4% reported that they smoked postpartum. Non-Hispanic White women reported the highest rates of smoking during the three months before pregnancy (14.0%), Black Non-Hispanic women reported the highest rates postpartum (8.4%), and non-Hispanic White women reported the highest rates of smoking during the last three months of pregnancy (5.7%). All smoking rates were highest among women under the age of 25. Prenatal smoking rates in Maryland are slightly higher than the Healthy People 2030 objective for smoking during pregnancy (4.3%).

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 86.0% in 2020, a 1.9% increase from 84.8% in 2019, according to preliminary PRAMS data. Among non-Hispanic White women, 94.4% initiated prenatal care during the first trimester, compared to 85.4% among non-Hispanic Black women, and 68.3% among Hispanic women.

Infant Mortality: Maryland VSA reported the infant mortality rate in Maryland in 2020 was 5.7 per 1,000 live births, a 3.0% decrease from 5.9 per 1,000 live births in 2019, and down from 8.5 per 1,000 live births in 2004. The leading causes of death were disorders related to short gestation and low birth weight, congenital abnormalities, maternal complications of pregnancy, SIDS, circulatory system disorders, infectious diseases, 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: Maryland VSA reported in 2020, 8.5% 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 (12.1%) than Non-Hispanic White mothers (6.4%).

Very Low Birth Weight: Maryland VSA reported in 2020, 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, and 1.3% for Hispanics).

Preterm Birth: Maryland VSA reported in 2020, 10.1% of live births occurred before 37 weeks of gestation in Maryland, a 2.0% decrease from 10.3% in 2019. Non-Hispanic Black mothers were more likely to have a preterm birth than other races at 12.6%, compared to 8.6% and 9.9% for Non-Hispanic White and Hispanic births, respectively.

Breastfeeding: In 2020, according to preliminary PRAMS data, 89.9% of Maryland mothers reported having ever breastfed their babies, a slight decrease from 91.4% in 2019. Rates of breastfeeding in Maryland were high across all races and ethnicities ranging from 84.8% for Non-Hispanic Black mothers to 93.9% among Hispanic mothers.

Infant Safe Sleep: In 2020, according to preliminary PRAMS data, 16.3% of mothers in Maryland reported not placing their infants on their back to sleep and 37.8% of mothers reported that their baby slept with a blanket, 7.6% slept with toys, cushions or pillows, and 13.7% slept with bumper pads. Over 83 percent of mothers reported that their baby slept in the same room as the mother.

Child Health:

Mortality: According to Maryland VSA data, in 2020, there were 669 infants and child deaths ages 0 to 18 years old in Maryland. Most of these deaths occurred in infancy - 58 percent were under the age of one year. The 2019 child death rate decreased by 1.3% compared to 2019. Accidents were the leading cause of death for the 60 children ages 1 to 4 years. Neoplasms were the leading cause of death for the 82 children ages 5 to 14, followed by intentional self-harm.

Preventive Health Care: According to 2021 Medicaid data, 71.7% of Medicaid enrolled patients who turned 15 months old during 2021 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), 2019-2020, showed that 40.3% of children ages 9 through 35 months received a developmental screening using a parent-completed screening tool in the past year, unchanged from 40.9% during the 2018-2019 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 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 7.4 per 100,000 population in 2020. This represented a 15% decrease from the 2019 rate of 8.7 per 100,000 population. The actual numbers of suicides in this age range decreased from 33 cases in 2019 to 28 cases in 2020. The suicide rate remained highest for non-Hispanic White male teens in 2020 at 10 cases, or 36 percent of suicide deaths.

Teen Pregnancy and Reproductive/Sexual Health: Maryland VSA data showed that the adolescent birth rate decreased 52.2% from 27.2 births per 1,000 adolescent females ages 15-19 years in 2010 to 13.0 births per 1,000 adolescent females in 2020. Hispanic females had the highest adolescent birth rate with 35.0 births per 1,000 adolescent females, which was more than double the adolescent birth rate for Black, non-Hispanic females (16.7 per 1,000 adolescent females) and more than five times the adolescent birth rate for White, non-Hispanic females (6.0 per 1,000 adolescent females).

Children and Youth with Special Health Care Needs:

Medical Home: According to the 2019-2020 National Survey of Children’s Health, there are an estimated 273,531 children and youth ages 0 to 17 with special health care needs in the state. The survey estimated that 44.9% of these children have a medical home.

Transition to Adult Care: The 2019-2020 National Survey of Children’s Health estimated that 23.8% 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:

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 the Maternal and Child Health Bureau.

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.
Jed Miller, MD, MPH served as the Director of the Office of Genetics and People with Special Health Care Needs and as the State Title V CSHCN Director until February 2022.
Stacy Taylor, JD serves as the Deputy Director of the Office of Genetics and People with Special Health Care Needs and as Acting Director since Dr. Miller’s departure.
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.
Teresa Pfaff, MPH, MSN, RN, PHNA-BC, CPH serves as the Director of the Office of Quality Initiatives.
Kristin Silcox, MS served as the Epidemiology Program Manager within the Office of Quality Initiatives. Ms. Silcox departed July 2022.
Colleen S. Wilburn, MPA, served as the Title V Manager since 2019. Ms. Wilburn departed June 2022.

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.

Governor Wes Moore and Lieutenant Governor Aruna Miller (Moore-Miller Administration) transitioned into office in January 2023. Dr. Laura Herrera Scott was appointed in early February 2023 as the new Secretary of Health. Dr. Nilesh Kalyanaram started as the Deputy Secretary of Public Health in March 2023. Dr. Elizabeth Kromm was appointed as the Prevention and Health Promotion Administration Director in May 2023.

The Moore-Miller Administration released the 2024 State Plan with Goal 8 is to ensure world class-health systems for all Marylanders. Objective 8.1 of the goal is to Improve eligibility and access to quality care particularly focusing on maternal and infant health, behavioral health, and support for veterans and older adult populations.

The Title V Manager remains vacant even after several postings. In order to further align with the State’s and the Department’s priority to focus on women’s health, a Women’s Health Action Plan was developed. A Women’s Health Lead position was recruited.

Data Updates

The following section provides an overview of population level data updates available during the reporting period. The Maryland PRAMS 2022 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%. Vital Statistics Data on Infant Mortality (including neonatal and postneonatal mortality) was available for 2022, but for all other measures that use Vital Statistics data, 2021 was the most recent year available.

Women’s/Maternal Health:

Substance Use/Misuse/Disorder: Finalized data from the Maryland Vital Statistics Administration (VSA) and the Office of the Chief Medical Examiner (OCME) indicate that there were 2,800 unintentional drug and alcohol related deaths in 2021 in Maryland. 27.4% (n=769) of deaths were among females. Of these, 2,507 (89.5%) deaths were opioid related; fentanyl was involved in 2,344 deaths (83.7%).[1] Preliminary data from the Maryland Overdose Demographics Dashboard indicate there were 2,577 fatal overdoses in 2022 (8.0% decrease from 2021) and 2,509 fatal overdoses in 2023 (10.4% decrease from 2021). 28.8% (n=743) and 27.8% (n=698) of fatal overdoses were among females in 2022 and 2023, respectively. Fentanyl was involved in 2,060 fatal overdoses (79.9%) in 2022 and in 2,031 fatal overdoses (80.9%) in 2023.[2]

Mental Health: According to 2022 Pregnancy Risk Assessment Monitoring System (PRAMS) data,[3] 16.8% of pregnant individuals reported depression three months before pregnancy and 14.6% of pregnant individuals reported symptoms of postpartum depression. During the three months before pregnancy, 29.7% of pregnant individuals reported they had anxiety.

Maternal Mortality and Morbidity: There were 58 pregnancy-associated deaths in 2020, resulting in a pregnancy-associated mortality rate of 84.6 deaths per 100,000 live births in Maryland. The 2016-2020 maternal mortality rate (MMR) in Maryland was 17.5 maternal deaths per 100,000 live births, which is a 26 percent decrease from the 2011-2015 rate. The 2016-2020 MMR among Black Non-Hispanic individuals was 29.2 maternal deaths per 100,00 live births, which is 2.3 times higher than the MMR of White Non-Hispanic individuals. The leading cause of pregnancy-related deaths in 2020 were behavioral health conditions(29 percent of pregnancy-related deaths), cardiovascular conditions (18% of pregnancy related deaths), and infection including COVID-19 (18% of pregnancy related deaths). The leading cause of pregnancy-associated deaths in 2020 was behavioral health conditions (which includes substance use and mental health disorders)

Preventive Dental Visits in Pregnancy: According to 2022 PRAMS data,[4] 49.0% of pregnant individuals reported having their teeth cleaned during pregnancy, comparable to 49.3% in 2021.

Smoking in Pregnancy: According to 2022 NVSS data, 2.7% of Maryland women smoked during pregnancy, compared to 3.7% nationally. The percentage of Maryland women who smoked during pregnancy in 2022 was highest among non-Hispanic Multirace individuals (5.3%), followed by non- Hispanic White individuals (4.4%), and non-Hispanic Black individuals (2.3%). The percentage of Maryland women who smoked during pregnancy in 2022 ranged from 1.7% among individuals aged less than twenty years to 3.3% among those 25-29 years of age.

2022 Maryland PRAMS data [5] is comparable to NVSS data, indicating that 2.3% of pregnant individuals reported smoking during the last three months of pregnancy. 2022 PRAMS data further elaborates that 6.3% of individuals smoked during the three months before pregnancy (down from 8.4% in 2021) and 2.7% smoked postpartum (down from 4.4% in 2021). The Healthy People 2030 target is to increase abstinence from cigarette smoking among pregnant individuals to 95.7%; NVSS data and PRAMS data 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 84.6% in 2022, comparable to 84.9% in 2021, according to PRAMS data.[6] The percentage of non-Hispanic White individuals who initiated prenatal care in the first trimester decreased slightly from 96.3% in 2021 to 95.9% in 2022. The percentage of non-Hispanic Black individuals who initiated prenatal care in the first trimester slightly increased from 85.3% in 2021 to 86.0% in 2022. Similarly, the percentage of Hispanic individuals who initiated prenatal care in the first trimester remained comparable from 2021 (61.3%) to 2022 (62.8%). However, there was a marked 12% decrease in the percentage of non-Hispanic Asian individuals who initiated prenatal care within the first trimester from 2021 (87.7%) to 2022 (76.9%).

Infant Mortality: Maryland VSA reported the infant mortality rate in Maryland in 2022 was 6.2 per 1,000 live births This was about the same as the rate of 6.1 per 1,000 live births in 2021, and down from 8.5 per 1,000 live births in 2004. The five leading causes of infant death in 2022 were low birth weight, congenital malformations, SIDS, maternal complications of pregnancy, and accidents (unintentional injuries). These deaths accounted for 55.9% of all infant deaths. Maternal complications of pregnancy include conditions such as premature rupture of membranes and cervical incompetence.

Low Birth Weight: Currently 2021 for low birth weight is the most recently available data. 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: Currently 2021 for low birth weight is the most recently available data. 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: Currently 2021 for low birth weight is the most recently available data. 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 2022, according to PRAMS data,[7] 91.3% of Maryland mothers reported having ever breastfed their babies, a 1.5% decrease from 92.7% in 2021. Rates of breastfeeding in Maryland by race and ethnicity ranged from 87.0% among Non-Hispanic Black individuals to 99.2% among non-Hispanic Asian individuals.

Infant Safe Sleep: PRAMS data for 2022 births [8] indicated that 83.7% of new mothers placed their babies to sleep only on their backs, an increase of 4.8% from 79.9% in 2021 (NPM 5A). In line with the NPM-5B definition, 40.1% of infants were placed to sleep on a separate approved sleep surface. 64.2% of infants were placed to sleep without soft objects or loose bedding (NPM-5C). In contrast, 30.9% of parents reported that their baby slept with a blanket; 7.2% slept with toys, cushions or pillows; and 7.7% slept with bumper pads. In 2022, 86.9% of mothers reported that their baby slept in the same room as the mother (5.2% increase from 82.6% in 2021).

Child Health:

Preventive Health Care: According to CY 2023 Medicaid data, 69.5% of Medicaid enrolled patients who turned 15 months old during 2023 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) in 2021-2022, showed that 37.6% 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 39.9% during the 2021-2021 survey period.

Adolescent Health:

Children and Youth with Special Health Care Needs:

Medical Home: According to the 2021-2022 National Survey of Children’s Health, there are an estimated 123,306 children and youth ages 0 to 17 with special health care needs in the state. The survey estimated that 49.7% of these children have a medical home.

Transition to Adult Care: The 2021-2022 National Survey of Children’s Health estimated that 16.9% 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.
Iliana Siarmalis, MPH, MCHES, CPH serves as the Deputy Director of the Maternal and Child Health Bureau.
Lauren Whiteman, MPH started as the Director of the Office of Children and Youth with Specific Health Care Needs and as the State Title V CSHCN Director.
Stacy Taylor, JD serves as the Deputy Director of the Office of Children and Youth with Specific 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.
Jessica Hernandez, MSPH serves as the Epidemiology Program Manager within the Office of Quality Initiatives. Ms. Hernandez started April 5, 2023.
The Maternal and Child Health Program Manager or 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.
Dr. Benjamin Wormser serves as the Medical Director for the Maternal and Child Health Bureau.

[1] Source: Unintentional Drug- and Alcohol-Related Intoxication Deaths in Maryland, 2021. Maryland Vital Statistics Administration (VSA). Release date: August 2023.

[2] Source: Opioid Operational Command Center: Maryland Overdose Data Dashboard and Demographic Dashboard. Note: data from 2022 and 2023 are preliminary and subject to change; data are current as of 5/10/2024. Accessed 06/11/2024

[3] CDC defines the minimum overall response rate threshold as 50% for 2021 and 2022 PRAMS data. In 2021 and 2022, Maryland PRAMS had a weighted response rate of 44.1% and 43%, respectively, and thus did not meet the threshold. Maryland PRAMS 2021 and 2022 data should be interpreted with caution.

[4] CDC defines the minimum overall response rate threshold as 50% for 2021 and 2022 PRAMS data. In 2021 and 2022, Maryland PRAMS had a weighted response rate of 44.1% and 43%, respectively, and thus did not meet the threshold. Maryland PRAMS 2021 and 2022 data should be interpreted with caution.

[5] CDC defines the minimum overall response rate threshold as 50% for 2021 and 2022 PRAMS data. In 2021 and 2022, Maryland PRAMS had a weighted response rate of 44.1% and 43%, respectively, and thus did not meet the threshold. Maryland PRAMS 2021 and 2022 data should be interpreted with caution.

[6]Maryland PRAMS 2021 and 2022 data should be interpreted with caution.

[7] Maryland PRAMS 2021 and 2022 data should be interpreted with caution.

[8] Maryland PRAMS 2021 and 2022 data should be interpreted with caution.

The state did not provide any content for this Narrative Section.

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