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INTRODUCTION                                                             
                                                                                                    
This report summarizes information about the natality, mortality, and                               
morbidity of mothers, children, and youth.  Indicators have been selected for                       
their relevancy to the Maternal and Child Health (MCH) programs administered                        
by the Arkansas Department of Health for the delivery of comprehensive                              
maternal, child, and adolescent health services.  Thus, their selection                             
reflects priorities established for the Arkansas MCH program.  This report                          
also takes into consideration national and international studies that have                          
attempted to delineate health risk factors for mothers and children.  This                          
report contains data for many indicators used in other studies, however, the                        
indicators examined here are by no means exhaustive.  It is designed to make                        
these indicators easily accessible, while at the same time allowing                                 
flexibility to users in their selection.  To accomplish this, the frequencies                       
of particular events or conditions, along with rates or percentages, are                            
presented in concise tables.                                                                        
                                                                                                    
The primary time focus of this report is calendar year 1995.  Data are                              
presented for the state as a whole to satisfy the needs of planners, policy                         
makers, and providers of health services at the regional and local levels.                          
                                                                                                    
Data from birth certificates measuring the demographic, socioeconomic, and                          
health status of the mother as they may affect the health and survival of the                       
infant are tabulated.  These variables include race, age, education, and                            
marital status of the mother; birth order; prenatal care; maternal tobacco use                      
and weight gain during pregnancy; medical risk factors affiliated with the                          
pregnancy; and complications of labor and delivery.  Outcome data on birth                          
weight, Apgar scores, and congenital anomalies, as well as fetal, neonatal,                         
perinatal, postneonatal, and infant mortality are also tabulated by several                         
measures of demographic and socioeconomic status of the mother.  The reader                         
should be aware that outcome data for neonatal, perinatal, postneonatal, and                        
infant mortality are derived from the matched birth-infant death record.                            
Therefore, total number for these items are not representative numbers from                         
the birth totals.                                                                                   
                                                                                                    
All birth certificate data are by place of residence, unless otherwise                              
specified.  This means that events have been assigned to the area where the                         
person lives (usually legal residence) regardless of where the events                               
occurred.  For births and infant deaths, the reference is to the residence of                       
the mother.  For infant deaths, the place of residence at death may differ                          
from the place of residence at birth.  The published tables of infant death                         
data are all based on residence at death.  Fetal deaths in this report are                          
usually by place of residence of the mother.                                                        
                                                                                                    
                                                                                                    
                                                                                                    
Sources of Data                                                                 
                                                                                                    
The main source of the statistics in this report is the vital records system                        
maintained by the Arkansas Division of Vital Records.  Three specific files                         
are used:                                                                                           
                                                                                                    
     The Birth Certificate File containing information reported on live birth                       
certificates.                                                                                       
                                                                                                    
     The Fetal Death Certificate File containing information from fetal death                       
certificates.                                                                                       
                                                                                                    
     The Death Certificate File containing information reported on death                            
certificates.                                                                                       
                                                                                                    
Summary tables using United States data and Arkansas data for years 1965-1980                       
are found in publications produced by the National Center for Health                                
Statistics.                                                                                         
                                                                                                    
                                                                                                    
Limitations and Caveats                                                         
                                                                                                    
Vital records information has a number of limitations, including completeness,                      
accuracy, and timeliness of registration, in addition to quality control and                        
classification problems for variables such as medical complications of labor                        
and/or delivery.  The reporting of live births and infant deaths is considered                      
to be essentially complete for births occurring in Arkansas.  However, fetal                        
deaths are underregistered to an unknown extent.  A cooperative exchange                            
program between the states has been in operation for several decades to                             
allocate birth and death certificates to the state of residence.  This                              
exchange program is not totally complete, however, the incompleteness is not                        
of sufficient magnitude to seriously affect results.  A recently initiated                          
federal project designed to provide national linked birth-infant death                              
certificate files has increased the probability that data on all Arkansas                           
resident infant deaths are reported to the Arkansas Center for Health                               
Statistics.                                                                                         
                                                                                                    
Errors occasionally occur in coding and keypunching large numbers of records.                       
Extensive computer edits and manual reviews of records are performed as this                        
report is prepared.  Identified errors are corrected when found.  Filing of                         
vital statistics documents is an ongoing process.  Although there are filing                        
deadlines, for a variety of reasons some records are delayed or filed late.                         
In the past, this report was completed several months after the publication of                      
Arkansas Vital Statistics, historical totals in this report may, therefore,                  
differ slightly and will usually be larger than those indicated in the                              
aforementioned report.                                                                              
                                                                                                    
The vital records data files provide an opportunity for studying the                                
characteristics and problems of the health of mothers and infants so that                           
health planners and administrators can better direct programs to address                            
problems.  The vital records registration system provides an effective means                        
for measuring health outcomes by place over time.                                                   
                                                                                                    
A certain degree of loss of timeliness is an inevitable structural limitation                       
of the vital records system.  There are delays between the occurrence of a                          
vital event and the completion of the legal document, between completion of                         
the legal document and its filing, and between its filing and the completion                        
of computer processing.  In addition, calendar intervals such as months or                          
years must elapse and all records for that interval must be filed and                               
processed before an analysis of all data for that interval can be conducted.                        
For example, there are two ways of calculating infant mortality rates: (1)                          
period-based, and (2) cohort-based.  This report uses the standard technique                        
of period-based mortality rates.  These rates are calculated by dividing the                        
number of infant deaths in a given calendar year by the number of births in                         
that year and multiplying by 1,000.                                                                 
                                                                                                    
While the period-based rates are much more convenient and timely than cohort-                       
based rates, they are less accurate.  This is because many of the deaths that                       
happen in the early part of a calendar year befall infants born late in the                         
previous year; thus the more recent year is credited with events that                               
transpired in the foregoing year.  This can be a serious problem in areas                           
experiencing extensive immigration or emigration, or rapid changes in infant                        
mortality.                                                                                          
                                                                                                    
The cohort-based rate is calculated by following each infant born in a given                        
year.  The technique uses deaths occuring only to that group, regardless in                         
which calendar year the death takes place.  The disadvantage is that the                            
cohort-based rate requires that a full year elapse after the birth of the last                      
infant on December 31 before the rate can be calculated.                                            
                                                                                                    
Coding and data processing can result in errors that produce delays during                          
correction and updating of the data base.  A considerable amount of time must                       
be devoted to examining the data before it can be considered final and                              
complete.  These delays have been reduced considerably with the automation of                       
the vital records system which began in 1980.                                                       
                                                                                                    
                                                                                                    
The 1989 National Standard Certificates                                                             
                                                                                                    
Beginning with calendar year 1989, Arkansas adopted the new standard                                
certificates of live birth, fetal death, and death.  The new form contains                          
many of the indicators available previously.  However, some questions are now                       
asked in a different way.  For example, in prior years, data on complications                       
of labor and/or delivery were collected with an open-ended question.  The                           
conditions indicated in writing were then coded to ICD-9 codes for analysis.                        
With the 1989 revision of the national standard, live birth and fetal death                         
certificates contain a series of checkboxes, listing specific medical                               
conditions which may affect labor and/or delivery.  Similar checkbox questions                      
are included for medical risk factors for this pregnancy, obstetric                                 
procedures, method of delivery, abnormal conditions of the newborn, and                             
congenital anomalies of the child.  Because the checkbox questions are multi-                       
response, in tables in which these variables are used, the column values may                        
or may not equal the total number of births.                                                        
                                                                                                    
Other questions have been added to the birth and fetal death certificates,                          
including maternal tobacco use and weight gain during pregnancy, clinical                           
estimate of gestation, and whether the mother was transferred prior to                              
delivery or the infant was transferred to intensive care or another hospital.                       
With the progression of these new data items, additional tables and panels of                       
existing tables have been added to this report.  However, some of these items                       
still do not present accurate data and are not included.  For example, this                         
report does not contain tabulations of maternal alcohol use.  Maternal alcohol                      
use is generally considered to be underreported and these data are not                              
considered valid.                                                                                   
                                                                                                    
Note that in certain tables, such as Selected Live Birth Characteristics By                         
Race of Mother or Selected Live Birth Characteristics By Sex of Child,  column                      
values may not equal the total due to records in which the value of the by-                         
variable is unknown.                                                                                
                                                                                                    
Sample copies of the current certificates of live birth, fetal death, and                           
death are included as appendices to this report.                                                    
                                                                                                    
 
 
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