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Pregnancy Risk Assessment Monitoring System (PRAMS)

DC PRAMS Background

Since 2017, the Washington, D.C. Department of Health (DC Health) has partnered with the Centers for Disease Control and Prevention (CDC) and Bloustein Center for Survey Research of Rutgers University on the Pregnancy Risk Assessment Monitoring System (PRAMS) surveillance project. PRAMS is an ongoing, population-based survey of residents who delivered a live-born infant. PRAMS collects data on maternal behaviors and experiences from preconception to the postpartum period.

The goal of the PRAMS project is to identify groups of women and infants at high risk for health problems, to monitor changes in health status, and to measure progress towards improving maternal and child health. PRAMS data allow DC Health to analyze population-level trends alongside stakeholders to coordinate efforts and improve health outcomes. Better understanding of maternal attitudes and experiences before, during and shortly after pregnancy allows DC Health to focus efforts on evidence-based approaches to support programs and policies. The continued monitoring and evaluation of maternal and child health indicators also play an important role in ensuring an equitable District.

Prenatal Health in the District of Columbia

The District of Columbia (The District or DC) is home to a rich and diverse population, yet also experiences high and disparate infant mortality rates, preterm births, and low birthweight deliveries. In 2020, 7,836 live births occurred in the District from 7,702 District mothers.(1)

This includes mothers with multiple births. The overall infant mortality rate over the 5-year period, 2014-2018 was 7.6 per 1,000 live births. The rate was highest among non-Hispanic Black infants (11.7 per 1,000 live births) compared to infants of Hispanic mothers (4.6 per 1,000 live births) and non-Hispanic White infants (2.6 per 1,000 live births).(2) During the period of 2014-2018, Wards 5, 7, and 8 had the highest neonatal mortality rates of 8.05, 10.44 and 15.90 per 1,000 live births respectively.(2) The neonatal mortality rate was significantly higher in Ward 8 than in all other wards.(2)

DC Health recognizes the importance of preconception, prenatal and postpartum care. DC Health has several programs and initiatives that assist women at any reproductive stage achieve better health outcomes. Some of the DC Health programs that support mothers and children include: Preterm Birth Prevention Initiative, Baby friendly hospital initiatives, DC Healthy Start project, Safe Sleep program, Home Visiting Program, and Help Me Grow.

DC PRAMS 2020 Data Highlights

DC PRAMS data show high prevalence rates for many positive outcomes; however, disparities exist by age, race/ethnicity, insurance coverage type and ward. For mothers who gave birth in 2020, the percent who ever breastfed was 92.3%.(3) It is estimated that 97.8% of Non-Hispanic White mothers breastfed, while 88.4% of Non-Hispanic Black mothers breastfed(3). According to PRAMS survey data, 51.2% of mothers had their teeth cleaned during pregnancy(3).

  • 43.3% of mothers who were receiving Medicaid or other government funded insurance had their teeth cleaned compared to 56.6% among mothers who had private insurance. Additionally, PRAMS estimates that 64.1% of mothers had intended pregnancies; 35.9% had either an unwanted, mistimed, or unsure pregnancies. Among Non-Hispanic White mothers, 85.2% had intended pregnancies, compared to 47.1% among Non-Hispanic Black mothers, and 63.5% among Hispanic mothers who did(3). Finally, DC PRAMS estimates that 1.9% of mothers smoked cigarettes during the last three months of their pregnancy and 4.8% used marijuana or hash products at any point during pregnancy. While smoking use data do not indicate significant difference between age, race/ethnicity, insurance coverage type or ward, marijuana usage is highest among Non-Hispanic Black mothers at 8.6% compared to 2.4% among Non-Hispanic White mothers.

Download the full report or summary for more information.