B. Reproductive Health

Data collected about women’s health have traditionally focused on issues related to women as mothers and caregivers. Therefore, there are good statistical data about many aspects of reproductive and sexual health. Pregnancy rates, birth rates, and infant mortality rates are available for about 100 years in Indiana. Responsible sexual behaviors and the incidence of sexually transmitted disease have only been tracked more recently.

Pregnancy rates in Indiana are lower than the national average: 74.0 per 1,000 females in Indiana (1999 data) compared to 104.7 per 1,000 females nationally (1996 data). Nationally, over 80% of all women have had a child by age 45, and the average woman has 2.2 children. In 1900 the average was 4.0 births per woman. The rate fluctuated during the twentieth century (2.2 births per woman during the Great Depression, 3.7 births per woman in the postwar period, and as low as 1.8 births per woman in the mid-1980s), but has remained at about 2.0 births per woman in the last two decades. The crude birth rate was 14.8 per 1,000 population in the United States in 2000. There were 3,959,417 births nationally in 1999, compared to 85,489 in Indiana in the same year. Nationally, the birth rate increased 3% in 2000, to 4,064,948 births. Comparable data are not yet available for Indiana.

The proportion of male and female births in Indiana between 1989 and 1999 has been holding steady among whites and blacks. Female births accounted for 48.8% (n = 41,694) of all births in Indiana in 1999.

The proportion of births to unmarried women in the United States changed very little between 1994 (32.6%) and 1999 (33.1%). The national birth rate for unmarried women was 45.2 births per 1,000 unmarried women aged 15-44 years in 1999. In Indiana, births to single mothers accounted for 34.6% of all births in 1999. There is a big discrepancy between the percent of births to single white mothers (29.6%) and births to single black mothers (77.0%) in Indiana for the same period.

Nationally, birth rates for teenagers have declined in all racial and ethnic groups since 1991. The national birth rate for teenagers declined to 48.7 births per 1,000 females age 15-19 years in 1999, a historic low. In Indiana, there were 58,975 births to teen mothers in Indiana in 1995-1999. Only Marion County shows a rate of births to teen mothers age 10-14 above the state average (0.9 births per 1,000 females age 10-14). For most counties in Indiana, the number of births to girls age 10-14 is below 20; therefore, rates are unstable. Twelve counties have a rate of births to teen mothers age 10-19 above the state average (28.2 per 1,000 females age 10-19), and 25 counties have a rate of births to teen mothers age 10-19 below the state average.

Low birth weight in the United States, which had been rising since the mid-1980s, leveled off in 1998, 1999, and 2000 at 7.6%. Percent of births at low birth weight in Indiana was 7.9% in 1998 and 7.8% in 1999.

Infant mortality rates in Indiana exceed national rates. The death rate of infants under one year old is at 7.1 per 1,000 live births nationally, but 7.8 per 1,000 live births in Indiana. The neonatal death rate (babies less than 28 days old) is 4.7 per 1,000 live births in the United States, but 5.2 per 1,000 live births in Indiana. Deaths of babies between 28 and 364 days old (postneonatal period) occur at a rate of 2.3 per 1,000 live births in the United States, but at 2.7 per 1,000 live births in Indiana. There were 3,396 infant deaths in Indiana during 1995-1999, for an overall rate of 8.1 per 1,000 live births for this period.

Smoking is a major preventable health risk during pregnancy. In Indiana 20.9% of pregnant women smoked during pregnancy. Nearly one-third of teenagers age 18-19 (32.0%) smoked during pregnancy in 1999 in Indiana. Approximately one-fourth of babies at low birth weight (less than 2,500 grams) were born to mothers who smoked during pregnancy in Indiana in 1999.

The Indiana maternal mortality rate for 1999 is 0.03 per 100,000 age-adjusted, based on two deaths. Stated another way, this is a rate of 2.33 deaths per 100,000 live births. This compares favorably with the national rate of 11.5 pregnancy-related deaths per 100,000 live births between 1991 and 1997 (“Pregnancy-Related Deaths among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native Women—United States, 1991-1997,” Morbidity and Mortality Weekly Report, vol. 50, no. 18 [May 11, 2001]: 361-364).

Motherhood represents an important part of many women’s lives, and it can impact women’s physical and mental health. As Amy B. Bernstein points out, “pregnancy and childbirth occur during defined episodes,” but “motherhood spans a woman’s lifetime” (Bernstein 2001, p. 173). In general, motherhood is perceived as “positively associated with some measures of women’s health and well-being” (Bernstein 2001, p. 182). The different impact of motherhood (as a social rather than a medical issue) on women’s health and well-being is just beginning to be explored.

The impact of changing perceptions about women’s reproductive health and motherhood is evident in changes in availability of maternity leave and child care. Limits on the amount of maternity leave provided by the U.S. Family and Medical Leave Act constrain many women’s ability to take prenatal leave, thus possibly affecting the quality of prenatal care. The increasing number of women with infants in the labor force (nationally, 59% in 1998) has affected the availability of child care in some corporations. As women integrate their roles as mothers and wage-earners, further changes are likely to become evident.