United States of America Country Profile for Demographic and Health Surveys, the Years Refer to When the Surveys Were Conducted

WHO Director-General Roundtable with Women Leaders on Millennium Development Goal 5

United States of America Country profile For Demographic and Health Surveys, the years refer to when the Surveys were conducted. Estimates from the Surveys refer to three or five years before the Surveys.

United States of America and the world

1. Maternal mortality ratio: global, regional and 2. Lifetime risk of maternal death (1 in N), 2005 country data, 2005

Maternal death is defined as the death of a woman while pregnant or The lifetime risk of maternal death is the estimated risk of an individual within 42 days of termination of pregnancy, from any cause related to woman dying from pregnancy or childbirth during her adult lifetime, the pregnancy or its management but not from accidental or incidental based on maternal mortality and the fertility rate in the country. The causes. The maternal mortality ratio is the number of maternal deaths lifetime risk of dying from pregnancy-related causes in the United States per 100 000 live births per year. The ratio in the United States of America of America is very low (1 in 4800), similar to the overall figure for is 11 per 100 000 live births versus the average of 9 per 100 000 live developed regions of the world (1/7300). This is lower than the rest of the births in developed regions of the world, and much lower than the world: the global average lifetime risk is 1 in 92 and 1 in 22 in sub-Saharan global average of 400 per 100 000 live births. Africa.

1/92 3/250 500 1/100 400 400 1/125 300 3/500 200 live births 1/250 100 11 9 Deaths per 100 000 0 1/500 United States of Developed World 1/4800 1/7300 Lifetime risk of death (1 in N) America regions 0 United States of Developed World America regions

Source: Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 Source: Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www.who.int/reproductive-health/publications/maternal_mortality_2005/index.html). (http://www.who.int/reproductive-health/publications/maternal_mortality_2005/index.html).

Demographic and health data

3. Total population (in thousands)1 302 841 (2006) Lifetime risk of maternal death (1 in N)2 4 800 (2005) Total maternal deaths2 440 (2005)

Sources: 1World Health Organization 2008, World Health Statistics 2008 Geneva, Switzerland http://www.who.int/whosis/whostat/E¡N_WHS08_Full.pdf 2Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www.who.int/reproductive-health/publications/maternal_mortality_2005/index.html).

4. Maternal deaths by race, 2005 5. Causes of maternal deaths, 2005 A maternal death is defined as the death of a woman while pregnant or A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to within 42 days of termination of pregnancy from any cause related to the pregnancy or its management but not from accidental or incidental the pregnancy or its management but not from accidental or incidental causes. Data from the United States of America for 2005 indicate that causes. The most frequent causes of maternal deaths in the United States maternal mortality is distributed unevenly among race and national of America were other direct causes such as placental anomalies or origin groups: it is substantially higher among black or African American complications of anaesthesia; indirect causes; post-partum complications women than among white women or Hispanic or Latina women. and embolism. Specifically, in 2005, the overall maternal mortality ratio was 15.1 per 100 000 live births. It was 36.5 per 100 000 live births among black or African American women, 6.7% 6.3% 40 8.0% more than three times 36.5 35 Haemorrhage that of white women 28.9 Hypertensive disorders 30 (including Hispanic or 25.5% 10.6% Post-partum complications 25 Latina women) of 11.1 per Abortion 20 100 000 live births. The 15.1 Embolism 15 2.4% maternal mortality ratio 11.1 Ectopic pregnancy 10 Other direct causes among women other than 9.0% 5 Indirect causes white or black or African Deaths per 100 000 live births 0 Unclassified American was 28.9 per All races White Other than black or Black or 2.9% African American African American America The United States of or white 100 000 live births. 28.6%

Source: Kung H-C et al. Deaths: final data for 2005. National Vital Statistics Reports, 2008, 56(10):1–120. Source: Kung H-C et al. Deaths: final data for 2005. National Vital Statistics Reports, 2008, 56(10):1–120.

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6. Total fertility 7. Proportion of live births by race and Hispanic or Latina origin of the mother, 2005 The total fertility is the average number of children that would be born In 2007, Hispanics and Latinas had the highest birth rate in the to a woman over her lifetime. The total fertility rate can be separated into United States of America, on average about 23 live births per 1000 the births that were planned (wanted total fertility rate) and those that women. Whites (a category that includes some Hispanics and were unintended (unwanted total fertility rate). According to a survey Latinas) had the lowest birth rate of any ethnic group, with about conducted in 2006, the total fertility rate was 2.1 per woman in the 13 births per 1000 women. United States of America.

5 Births

4 Hispanic or Latina 23.1

3 Asian or Pacific Islander 16.5 2.1 2.1 2.1 2 American Indian or Alaska Native 14.2 Black or African American 16.2 1 White 13.4 Total fertility rate per woman 0 Live births per 1000 population 2000 2005 2006 0 5 10 15 20 25

Year Race

Source: World health statistics 2008. Geneva, World Health Organization, 2008 (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf). Source: National Center for Health Statistics. Health, United States, 2007 with chartbook on trends in the health of Americans. Washington, DC, United States Government Printing Office, 2007.

8. Perinatal mortality rate 9. Adolescent birth rate (15–19 years old) by race Perinatal mortality refers to deaths of fetuses in the womb and of and Hispanic or Latina origin, 2005 newborn babies early after delivery. It includes (1) the death of a fetus Adolescent pregnancy is pregnancy in an adolescent girl (girls 10–19 in the womb after 22 weeks of gestation and during childbirth and (2) years old). The adolescent pregnancy rate indicates the proportion of the death of a live-born child within the first seven days of life. adolescent girls who become pregnant among all girls in the same The perinatal mortality rate reflects the availability and quality of both age group in a given year. According to data from 2005, the rate varied maternal and newborn health care. According to data from 2004, the between different ethnic groups in the United States of America. The perinatal mortality rate in the United States of America was 6.7 highest adolescent birth rate was among Hispanic or Latina women, per 1000 pregnancies. about 183 live births per 1000 women.

Black or African-American 137.9 8 (not Hispanic or Latina) 6.7 6.7 White (not Hispanic or Latina) 59.5 6 Hispanic or Latina 183.1 4 Asian or Pacific Islander 38.3 American Indian or Alaska Native 118.1 2 Black or African-American 140.4 per 1000 live births 0 Whites 83.6 2003 2004 Year All 91.3 Per 1000 women (15–19 years old) 0 50 100 150 200

Race and Hispanic or Latina origin Source: MacDorman MF, Munson ML, Kirmeyer S. Fetal and perinatal mortality, United States, 2004. National Vital Statistics Reports, 2007, 56(3):1–20 Source: National Center for Health Statistics. Health, United States, 2007 with chartbook on trends in the health of Americans. Washington, DC, (http://www.cdc.gov/nchs/about/major/fetaldth/abfetal.htm). United States Government Printing Office, 2007.

10. Legal abortion rates by age (younger than 25 years) and race and Hispanic or Latina origin, 2005

Legal abortion rates reflect the number of women that have abortions per 100 live births. In the United States of America, in 2004, the number of reported legal abortions among girls younger than 15 years was 76 per 100 live births. The highest rate reported in any racial or ethnic group was among Blacks or African Americans (47 per 100 live births).

Legal abortions in the United States, 2004

100 76.2 80 47.2 60 36.2 29.1 40 16.1 21.1 23.6 20 Legal abortions per 100 live births 0 White Black or Hispanic Not Hispanic <15 15–19 20–24 African or or Latina American Latina

Age in years Race and Hispanic or Latina origin

Source: National Center for Health Statistics. Health, United States, 2007 with chartbook on trends in the health of Americans. Washington, DC, United States Government Printing Office, 2007.

United States of America 3

Intervention coverage for mothers and newborns

11. Unmet need for family planning Unknown 13. Antenatal care The unmet need for family planning is the proportion of all women who Antenatal care visits (ANC) include all visits made by pregnant women are at risk of pregnancy and who want to space or limit their childbearing for reasons relating to pregnancy. In 2006, 96% of women in the United but are not using contraceptives.es. States of America received ANC during pregnancy from a skilled health Source: World contraceptive use 2007. New York, United Nations Department of Economic and Social Affairs, Population Division, 2007 (http://www.un.org/esa/population/publications/contraceptive2007/contraceptive2007.htm). care worker, a decline from 99% in 2004. 12. Family planning: modern contraceptive use by method, 2000–2005 Modern contraceptive methods include oral and injectable hormones, intrauterine devices, diaphragms, hormonal implants, female and 100 99 male sterilization, spermicides and condoms. The graph shows the 99 percentage of women of reproductive age (15–49 years) who are in 98 union and using (or whose partner is using) any of these contraceptive 97 methods. Data from 2002 indicate that, in the United States of 96 America, sterilization was the most common form of contraception 96 used by women of reproductive age (30% of those using 95 contraception), followed by Prevalence of modern contraceptive use among women % of women who gave birth 94 (and their partners) who are married or in union, 2002 use of oral contraceptives 2004 2006 Condoms 18% (“the pill”) (26% of those Pill IUD using contraception). A Pill 26% Male sterilization smaller percentage (6%) Injectables or implant 6% Female sterilization Injectable or implant used the intrauterine IUD 6% Condom s contraceptive device (IUD) Female sterilization 30% and injectables or implants. Male sterilization 14%

Source: World contraceptive use 2007. New York, United Nations Department of Economic and Social Affairs, Population Division, 2007 (http://www. un.org/esa/population/publications/contraceptive2007/contraceptive2007.htm). Source: World health statistics 2008. Geneva, World Health Organization, 2008 (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf).

14. Utilization of skilled birth attendants 15. Low birth weight by race and Hispanic or A skilled birth attendant is an accredited health professional – such as Latina origin, 2004 a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) Babies weighing less than 2500 g at birth are considered to have pregnancies, childbirth and the immediate postnatal period and in the low birth weight. According to a survey conducted in 2003, of those identification, management and referral of complications among women babies who were weighed at birth, about 6% were reported to and newborns. All women should have access to skilled care during weigh less than 2500 g (2.5 kg). Low-birth-weight babies often face pregnancy and at delivery to ensure that complications are detected and severe short- and long-term health consequences and tend to have managed. In the United States of America, data for 2000–2006 showed higher mortality and morbidity. In the United States of America, of 100% coverage with a skilled birth attendant during delivery. the babies who were weighed at birth in 2004, 13% of those born to blacks or African Americans had low birth weight, the highest rate of any racial or ethnic group.

100.5 100.0 100.0 13.0 15 99.5 8.0 8.0 10 99.0.0 7.0 7.0 7.0 5 98.5

or Latina origin 0

98.0 Race and Hispanic 98.0.0 Black or American Asian or White Hispanic all races African Indian Pacific or Latina 97.5 American or Alaska Islander birth attendant 1990–1999 Native % of births assisted by skilled % of births assisted 97.0.0 1990–1999 2000–2006

Source: National Center for Health Statistics. Health, United States, 2007 with chartbook on trends in the health of Americans. Washington, DC, United Source: World health statistics 2008. Geneva, World Health Organization, 2008 (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf). States Government Printing Office, 2007.

16. Smoking among pregnant women, 2004 Smokers 10% According to data from 2004, 10% of pregnant women smoked in the United States of America. The effects of smoking on the baby include stunting growth and brain development and impairing breathing after birth, increasing the likelihood of prematurity and the risk of problem pregnancies Smokers Nonsmokers skilled birth attendant % of births assisted by Nonsmokers 90%

Sources: National Center for Health Statistics. Health, United States, 2007 with chartbook on trends in the health of Americans. Washington, DC, United States Government Printing Office, 2007.

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17. Smoking among pregnant women by age, 2004 18. Caesarean section rates by urban versus rural location, 2001 Caesarean section is a surgical procedure in which incisions are made According to 2004 data, smoking during pregnancy was highest through a woman’s abdomen and womb to deliver her baby. It is among pregnant women 20–24 years old, closely followed by women performed whenever abnormal conditions complicate vaginal delivery, 15–19 years old. threatening the life and health of the mother and/or the baby. Data from 2001 showed that the overall rate of caesarean section in the United States of America was 25.0 per 100 live births, with virtually the same rate in rural areas (25.3) and in urban areas (24.9).

20 25.4 14.2 15.5 25.3 15 25.3 9.2 25.2 10 6.1 6.3 7.2 25.1 4.1 25.0 5 25.0 24.9 24.9

% of women who smoked 0

<15 15–19 20–24 25–29 30–34 35–39 40–54 per 100 live births 24.8 Caesarean section rate Age (in years) 24.7 To t al Rural Urban

Source: National Center for Health Statistics. Health, United States, 2007 with chartbook on trends in the health of Americans. Washington, DC, Source: National Center for Health Statistics. Health, United States, 2007 with chartbook on trends in the health of Americans. Washington, DC, United States Government Printing Office, 2007.. United States Government Printing Office, 2007..

19. Breast cancer screening, 2005 20. Cervical cancer screening, 2005

Cervical cancer is the second most common type of cancer among Breast cancer is the most common type of cancer among women women worldwide. Cervical cancer screening is done using a Pap worldwide. Breast cancer screening is the regular examination of smear, a sample taken directly from the cervix. The Pap smear a woman’s breasts to detect breast cancer early. It may include has been credited with dramatically reducing the incidence and mammography (breast X-ray) and/or a physical examination of the mortality of cervical cancer in high-income countries. In the breasts by a health care professional. Regular breast screening can United States of America, in 2005, 78% of women aged 18 and detect cancer when it is small, which means there is a better chance older had had a Pap smear within the preceding three years. This of treating the cancer successfully, it may be less likely to spread and includes 74% of Hispanics or Latinas, 80% of blacks or African there may be more treatment options. In 2005, 67% of women aged Americans and 79% of whites. These rates had declined for all 40 years and older had a mammogram within the preceding two years, women (from 79% in 2003), for Hispanics or Latinas (from 75% in a statistically significant drop from 70% in 2003. Among racial and 2003), for blacks or African Americans (from 83% in 2003) and for ethnic groups, 59% of Hispanics or Latinas (down from 65% in 2003), whites (80% in 2003). 65% of blacks or African Americans (down from 70% in 2003) and 68% of whites (down from 71% in 2003) had a mammogram within the preceding two years.

Cervical screening by pap smear

Proportion of women who had mammogram during preceding 2 years 83.0 85

79.0 80.0 80.0 79.0 80 78.0 70.0 70.0 71.0 75.0 74.0 2003 80 75 67.0 65.0 68.0 65.0 2005 60 50.9 2003 70 40 2005 20 65 All Black or White Hispanic 0 % of women screened by

cervical cancer screening African or Latina % of women aged 40 years and older All Black or White Hispanic African or Latina American American Race and ethnic origin Race and ethnic origin

Sources: Breast cancer screening. In: Cancer trends progress report 2007. Bethesda, MD, National Cancer Institute, National Institutes of Health, 2007 (http:// Source: Cervical cancer screening. In: Cancer trends progress report 2007. Bethesda, MD, National Cancer Institute, National Institutes of Health, 2007 progressreport.cancer.gov/doc_detail.asp?pid=1&did=2007&chid=72&coid=716&mid=#trends). (http://progressreport.cancer.gov/doc_detail.asp?pid=1&did=2007&chid=72&coid=717&mid=#trends).

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Resources 22. Human resources

The work of at least 23 health workers (doctors, nurses or midwives) per 21. Financial flow 10 000 population is estimated to be necessary to support the delivery of (per capita total expenditure on health at average the basic interventions required to achieve the Millennium Development exchange rate in US dollars) 2005 6 347 Goals related to health. Globally, 57 countries have been identified with critical shortages below this minimum. These countries have a severe Source: World health statistics 2008. Geneva, World Health Organization, 2008 (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf). crisis in human resources for health. Of these 57 countries, 36 are in sub-Saharan Africa. The United States of America, with about 119 health workers (as defined above) per 10 000 population, is well above this threshold value and is spared from facing this crisis daily, with mothers and children lacking access to proper maternal and child care, HIV/TB and malaria care, and sexual and reproductive health information and services, including skilled birth attendants.

Increasing the human resources around the world and establishing a balance between the services needed and the personnel available, and their distribution, are key elements of a well-functioning health system and critical requirements for achieving Millennium Development Goals.

Source: WHO Global Atlas of the Health Workforce [online database]. Geneva, World Health Organization, 2008 (www.who.int/globalatlas/autologin/ hrh_login.asp).

23. Ratification of treaties and support of international consensus

Convention on the Elimination of All Forms of Discrimination against Women Signature only, not ratified

Convention on the Rights of the Child Signature only, not ratified

International Covenant on Economic, Social and Cultural Rights Signature only, not ratified

International Conference on Population and Development Yes

Fourth World Conference on Women Yes

Sources: Ratifications and reservations [web site]. Geneva, Office of the United Nations High Commissioner for Human Rights, 2008 (http://www2.ohchr.org/english/bodies/ratification/index.htm).

Report of the Fourth World Conference on Women, Beijing, 4–15 September 1995. New York, United Nations, 1996 (http://www.un.org/womenwatch/confer/beijing/reports).

Report of the International Conference on Population and Development, Cairo, 5–13 September 1994. New York, United Nations, 1994 (http://www.un.org/popin/icpd/conference/offeng/poa.html).

24. Other determinants of health: water, sanitation, communication and road networks

Fixed-line and mobile phone subscribers (per 100 population) 137 (2006)

Internet users (per 100 population) 70 (2006)

Roads paved (% of total roads) 65 (2005)

Improved water source (% of population with access) 99 (2006)

Improved sanitation facilities (% of urban population with access) 100 (2006)

Source: World Bank indicators [online database]. Washington, DC, World Bank, 2008 (http://ddp-ext.worldbank.org/ext/ddpreports/ViewSharedReport?&CF=&REPORT_ID=9147&REQUEST_ TYPE=VIEWADVANCED&HF=N/CPP&WSP=N).

For further information, contact:

Child and Adolescent Health and Development Gender, Women and Health Immunization, Vaccines and Biologicals Tel: +41 22 791 3281 Tel: +41 22 791 2394 Tel: +41 22 791 4612 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] Web site: www.who.int/child_adolescent_health/en Web site: www.who.int/gender Web site: www.who.int/immunization/en

Making Pregnancy Safer Reproductive Health and Research Tel: +41 22 791 3966 Tel: +41 22 791 3372 E-mail: [email protected] E-mail: [email protected] Web site: www.who.int/making_pregnancy_safer/en Web site: www.who.int/reproductive-health

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