Assessment of midwifery care providers intrapartum care competencies, in four sub-Saharan countries: a mixed-method study protocol.

BACKGROUND: We aim to assess competencies (knowledge, skills and attitudes) of midwifery care providers as well as their experiences and perceptions of in-service training in the four study countries; Benin, Malawi, Tanzania and Uganda as part of the Action Leveraging Evidence to Reduce perinatal mortality and morbidity in sub-Saharan Africa project (ALERT). While today more women in low- and middle-income countries give birth in health care facilities, reductions in maternal and neonatal mortality have been less than expected. This paradox may be explained by the standard and quality of intrapartum care provision which depends on several factors such as health workforce capacity and the readiness of the health system as well as access to care. METHODS: Using an explanatory sequential mixed method design we will employ three methods (i) a survey will be conducted using self-administered questionnaires assessing knowledge, (ii) skills drills assessing basic intrapartum skills and attitudes, using an observation checklist and (iii) Focus Group Discussions (FGDs) to explore midwifery care providers' experiences and perceptions of in-service training. All midwifery care providers in the study facilities are eligible to participate in the study. For the skills drills a stratified sample of midwifery care providers will be selected in each hospital according to the number of providers and, professional titles and purposive sampling will be used for the FGDs. Descriptive summary statistics from the survey and skills drills will be presented by country. Conventional content analysis will be employed for data analysis of the FGDs. DISCUSSION: We envision comparative insight across hospitals and countries. The findings will be used to inform a targeted quality in-service training and quality improvement intervention related to provision of basic intrapartum care as part of the ALERT project. TRIAL REGISTRATION: PACTR202006793783148-June 17th, 2020.

Association between birth attendant and early newborn care in Senegal.

OBJECTIVE: To examine the association between type of birth attendant and early newborn care in Senegal. DESIGN: This was a secondary analysis of cross-sectional data from the 2017 Continuous Demographic and Health Survey. PARTICIPANTS: The study included data on 6328 women with live births in the three years preceding the survey. MEASUREMENTS: The main exposure was the type of birth attendant (doctor, nurse/midwife, auxiliary midwife/matrone, traditional birth attendant, or "others (friend, relative, or no one)). We assessed three outcomes: 1) early initiation of breastfeeding, 2) breastfeeding support, and 3) cord examination. We used multivariable logistic regression to estimate the odds ratios and 95% confidence intervals of early newborn care after adjusting for potential confounders. FINDINGS: The coverage of all three newborn care indicators of interest was low. In the adjusted regression models, women whose births were assisted by a nurse/midwife were nearly twice as likely to initiate breastfeeding early compared to those assisted by doctors (odds ratio: 1.87, 95% confidence interval: 1.00-3.45). Women assisted at birth by doctors were significantly more likely to report breastfeeding support and newborn cord examination than those assisted by other types of birth attendants. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Although most recent births were facility-based and assisted by skilled birth attendants, the prevalence of early newborn care was suboptimal. This presents a missed opportunity to improve neonatal outcomes. Training and supporting skilled birth attendants may bridge the gap between opportunity and practice, and lead to improved coverage and quality of newborn care in Senegal.

Maternal Report of Outcomes of Chiropractic Care for Infants.

OBJECTIVE: The purpose of this study was to investigate the report by mothers of their infants' condition before and after a trial of care provided by registered chiropractic clinicians in addition to ratings of satisfaction, cost of care, and reports of any adverse events or side effects. A second purpose was to report the demographic profile of infants who presented for care to 16 chiropractic clinics in the United Kingdom. METHODS: This observational study prospectively collected reports by mothers of their infants' demographic profiles and outcomes across several domains of infant behavior and their own mental state using the United Kingdom Infant Questionnaire. Participating registered chiropractors were recruited through the Royal College of Chiropractors annual meeting in January 2016, and 15 clinics and the Anglo-European College of Chiropractic University College teaching clinic volunteered to participate. RESULTS: In all, 2001 mothers completed intake questionnaires and 1092 completed follow-up forms. Statistically significant (P < .05) improvements were reported across all aspects of infant behavior studied, including feeding problems, sleep issues, excessive crying, problems with supine sleep position, infant pain, restricted cervical range of motion, and time performing prone positioning. Maternal ratings of depression, anxiety, and satisfaction with motherhood also demonstrated statistically significant improvement (P < .05). In total, 82% (n = 797) reported definite improvement of their infants on a global impression of change scale. As well, 95% (n = 475) reported feeling that the care was cost-effective, and 90.9% (n = 712) rated their satisfaction 8 or higher on an 11-point scale. Minor self-limiting side effects were reported (5.8%, n = 42/727) but no adverse events. CONCLUSION: In this study, mothers reported that chiropractic care for their infants was effective, safe, and cost-effective. Although the observational design makes it impossible to determine efficacy, the study's findings indicate that, on average, the changes observed by mothers were positive and may be clinically relevant.

Assessment of health facility capacity to provide newborn care in Bangladesh, Haiti, Malawi, Senegal, and Tanzania.

BACKGROUND: Despite the importance of health facility capacity to provide comprehensive care, the most widely used indicators for global monitoring of maternal and child health remain contact measures which assess women's use of services only and not the capacity of health facilities to provide those services; there is a gap in monitoring health facilities' capacity to provide newborn care services in low and middle income countries. METHODS: In this study we demonstrate a measurable framework for assessing health facility capacity to provide newborn care using open access, nationally-representative Service Provision Assessment (SPA) data from the Demographic Health Surveys Program. In particular, we examine whether key newborn-related services are available at the facility (ie, service availability, measured by the availability of basic emergency obstetric care (BEmOC) signal functions, newborn signal functions, and routine perinatal services), and whether the facility has the equipment, medications, training and knowledge necessary to provide those services (ie, service readiness, measured by general facility requirements, equipment, medicines and commodities, and guidelines and staffing) in five countries with high levels of neonatal mortality and recent SPA data: Bangladesh, Haiti, Malawi, Senegal, and Tanzania. FINDINGS: In each country, we find that key services and commodities needed for comprehensive delivery and newborn care are missing from a large percentage of facilities with delivery services. Of three domains of service availability examined, scores for routine care availability are highest, while scores for newborn signal function availability are lowest. Of four domains of service readiness examined, scores for general requirements and equipment are highest, while scores for guidelines and staffing are lowest. CONCLUSIONS: Both service availability and readiness tend to be highest in hospitals and facilities in urban areas, pointing to substantial equity gaps in the availability of essential newborn care services for rural areas and for people accessing lower-level facilities. Together, the low levels of both service availability and readiness across the five countries reinforce the vital importance of monitoring health facility capacity to provide care. In order to save newborn lives and improve equity in child survival, not only does women's use of services need to increase, but facility capacity to provide those services must also be enhanced.

Dietary transition difficulties in preterm infants: critical literature review / Dificuldades de transição alimentar em crianças prematuras: revisão crítica de literatura

ABSTRACT OBJECTIVE: To analyze the scientific literature on dietary changes in preterm children during the first years of life. DATA SOURCE: The PubMed database was used for article selection. The texts were analyzed according to their objectives, research design, and research group characteristics. The following were selected to comprise the criteria: (1) publications in the period from 1996 to 2014; (2) participation of infants and children from birth to 10 years of age; (3) development of oral motor skills necessary for feeding; (4) development of the feeding process; and (5) feeding difficulties during childhood. SUMMARY OF THE FINDINGS: There were 282 studies identified, of which 17 were used in the review, and five more articles were identified through the reference list of selected articles, totaling 22 references. CONCLUSION: Very low birth weight preterm newborns are more likely to have feeding problems in early postnatal stages and during childhood when compared with full-term infants. Monitoring the feeding of these infants after hospital discharge is strictly recommended in an early intervention program aiming at better development of feeding skills.

RESUMO OBJETIVO: Analisar a literatura científica sobre alterações alimentares em crianças prematuras durante os primeiros anos de vida. FONTE DOS DADOS: A base de dados do Pubmed foi a precursora para a seleção dos artigos. Os textos foram analisados quanto aos seus objetivos, desenhos da pesquisa e características do grupo pesquisa e foram selecionados os seguintes temas para compor os critérios: (1) publicações de 1996 a 2014; (2) participação de bebês e crianças, do nascimento até os 10 anos; (3) desenvolvimento das habilidades motoras orais necessárias para a alimentação; (4) desenvolvimento do processo de alimentação e (5) dificuldades alimentares durante a infância. SÍNTESE DOS DADOS: Foram identificados 282 estudos, 17 foram usados e cinco artigos foram identificados por meio da lista de referência bibliográfica dos artigos selecionados, totalizando 22 referências bibliográficas. CONCLUSÃO: A revisão permitiu concluir que recém-nascidos pré-termo muito baixo peso (RNPTMBP) são mais propensos a apresentar problemas de alimentação nos estágios iniciais pós-natal e durante a infância quando comparados com crianças a termo. O monitoramento da alimentação após a alta hospitalar é estritamente recomendado em um programa de intervenção precoce com vistas ao melhor desenvolvimento das habilidades alimentares.

Dietary transition difficulties in preterm infants: critical literature review.

OBJECTIVE: To analyze the scientific literature on dietary changes in preterm children during the first years of life. DATA SOURCE: The PubMed database was used for article selection. The texts were analyzed according to their objectives, research design, and research group characteristics. The following were selected to comprise the criteria: (1) publications in the period from 1996 to 2014; (2) participation of infants and children from birth to 10 years of age; (3) development of oral motor skills necessary for feeding; (4) development of the feeding process; and (5) feeding difficulties during childhood. SUMMARY OF THE FINDINGS: There were 282 studies identified, of which 17 were used in the review, and five more articles were identified through the reference list of selected articles, totaling 22 references. CONCLUSION: Very low birth weight preterm newborns are more likely to have feeding problems in early postnatal stages and during childhood when compared with full-term infants. Monitoring the feeding of these infants after hospital discharge is strictly recommended in an early intervention program aiming at better development of feeding skills.

Factors Associated with Colostrum Avoidance Among Mothers of Children Aged less than 24 Months in Raya Kobo district, North-eastern Ethiopia: Community-based Cross-sectional Study.

BACKGROUND: UNICEF and WHO recommend colostrum as newborns' perfect food that should be initiated within the first hour after birth. OBJECTIVE: To assess colostrum avoidance practices and associated factors among mothers of children aged <24 months in Raya Kobo district, North-eastern Ethiopia. METHODS: A quantitative community-based cross-sectional study supplemented by qualitative method was used. Descriptive statistics, binary and multivariable logistic regression analyses were used in the statistical analysis. RESULTS: Colostrum avoidance was practiced by 13.5% (95% confidence interval: 10.99-16.33) of mothers having children aged <24 months. In multivariable logistic regression analysis, giving birth at home, mother-heading households, lack of awareness on the advantages of colostrum and late initiation of breastfeeding remained statistically significant factors associated with colostrum avoidance practices. CONCLUSION: Promoting institutional delivery, timely initiation of breastfeeding and creating awareness on the advantages of colostrum feeding are recommended interventions to reduce colostrum avoidance.

Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care in low-income and lower-middle-income countries: a systematic review.

BACKGROUND: Each year almost 3 million newborns die within the first 28 days of life, 2.6 million babies are stillborn, and 287,000 women die from complications of pregnancy and childbirth worldwide. Effective and cost-effective interventions and behaviours for mothers and newborns exist, but their coverage remains inadequate in low- and middle-income countries, where the vast majority of deaths occur. Cost-effective strategies are needed to increase the coverage of life-saving maternal and newborn interventions and behaviours in resource-constrained settings. METHODS: A systematic review was undertaken on the cost-effectiveness of strategies to improve the demand and supply of maternal and newborn health care in low-income and lower-middle-income countries. Peer-reviewed and grey literature published since 1990 was searched using bibliographic databases, websites of selected organizations, and reference lists of relevant studies and reviews. Publications were eligible for inclusion if they report on a behavioural or health systems strategy that sought to improve the utilization or provision of care during pregnancy, childbirth or the neonatal period; report on its cost-effectiveness; and were set in one or more low-income or lower-middle-income countries. The quality of the publications was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. Incremental cost per life-year saved and per disability-adjusted life-year averted were compared to gross domestic product per capita. RESULTS: Forty-eight publications were identified, which reported on 43 separate studies. Sixteen were judged to be of high quality. Common themes were identified and the strategies were presented in relation to the continuum of care and the level of the health system. There was reasonably strong evidence for the cost-effectiveness of the use of women's groups, home-based newborn care using community health workers and traditional birth attendants, adding services to routine antenatal care, a facility-based quality improvement initiative to enhance compliance with care standards, and the promotion of breastfeeding in maternity hospitals. Other strategies reported cost-effectiveness measures that had limited comparability. CONCLUSION: Demand and supply-side strategies to improve maternal and newborn health care can be cost-effective, though the evidence is limited by the paucity of high quality studies and the use of disparate cost-effectiveness measures. TRIAL REGISTRATION: PROSPERO_ CRD42012003255.

Neonatal care practices in a tribal community of Odisha, India: a cultural perspective.

Neonatal care practices have been shown to vary across tribal communities. This cross-sectional study was conducted in tribal block in Nabarangpur district of Odisha, India, to measure perinatal and antenatal practices by qualitative inquiries of 55 mothers who had babies aged <60 days and from 11 traditional birth attendants. Reasons for home deliveries were cited as easy availability of traditional birth attendants and family preferences. Application of indigenously made substances on umbilical stump and skin of the baby, bathing baby immediately after birth, late initiation of breast-feeding and 'Budu practices' were common. Cultural issues, decision of family members and traditional beliefs still play a crucial role in shaping neonatal care practice in tribal communities. Awareness on child care, ethnographic understanding of health-seeking behavior of tribal community and mobilization of community by health workers can be useful in improving health status of mothers and newborn babies in tribal population.

Influence of neonatal practice variation on outcomes of late preterm birth.

OBJECTIVE: Examine variation in short-term outcomes of late preterm births (34(0/7)-36(6/7) weeks) between a university teaching hospital, teaching community hospital, and nonteaching community hospital. STUDY DESIGN: Review of maternal and newborn data from a random sample of late preterm births at three hospitals in North Carolina from 2008 to 2009. Outcomes included length of stay, neonatal intensive care unit (NICU) admission, respiratory support, antibiotic exposure, phototherapy exposure, and hypoglycemia. RESULTS: We analyzed data from 331 singleton late preterm newborns: 93 (28.1%) from a university teaching hospital, 110 (33.2%) from a teaching community hospital, and 128 (38.7%) from a nonteaching community hospital. Mean gestational age did not vary between hospitals. NICU admission, exposure to antibiotics, and phototherapy were more common at the university teaching hospital after controlling for risk factors, yet length of stay was shortest at the university teaching hospital and longest at the teaching community hospital after adjustment. CONCLUSION: Practice variation contributes to differences in length of stay, NICU admission, and exposure to antibiotics and phototherapy among late preterm newborns. Differences in practice during the birth hospitalization may affect outcomes and health care utilization (e.g., readmission) after discharge.

Newborn care practices at home and in health facilities in 4 regions of Ethiopia.

BACKGROUND: Ethiopia is one of the ten countries with the highest number of neonatal deaths globally, and only 1 in 10 women deliver with a skilled attendant. Promotion of essential newborn care practices is one strategy for improving newborn health outcomes that can be delivered in communities as well as facilities. This article describes newborn care practices reported by recently-delivered women (RDWs) in four regions of Ethiopia. METHODS: We conducted a household survey with two-stage cluster sampling to assess newborn care practices among women who delivered a live baby in the period 1 to 7 months prior to data collection. RESULTS: The majority of women made one antenatal care (ANC) visit to a health facility, although less than half made four or more visits and women were most likely to deliver their babies at home. About one-fifth of RDWs in this survey had contact with Health Extension Workers (HEWS) during ANC, but nurse/midwives were the most common providers, and few women had postnatal contact with any health provider. Common beneficial newborn care practices included exclusive breastfeeding (87.6%), wrapping the baby before delivery of the placenta (82.3%), and dry cord care (65.2%). Practices contrary to WHO recommendations that were reported in this population of recent mothers include bathing during the first 24 hours of life (74.7%), application of butter and other substances to the cord (19.9%), and discarding of colostrum milk (44.5%). The results suggest that there are not large differences for most essential newborn care indicators between facility and home deliveries, with the exception of delayed bathing and skin-to-skin care. CONCLUSIONS: Improving newborn care and newborn health outcomes in Ethiopia will likely require a multifaceted approach. Given low facility delivery rates, community-based promotion of preventive newborn care practices, which has been effective in other settings, is an important strategy. For this strategy to be successful, the coverage of counseling delivered by HEWs and other community volunteers should be increased.

A cross sectional study of newborn care practices in Gilgit, Pakistan.

OBJECTIVE: The purpose of this article is to explore the traditional newborn-care beliefs and practices and to identify factors that affect newborn health, aiming to design an appropriate, culturally-sensitive and acceptable intervention to reduce neonatal morbidity and mortality. METHODS: A cross sectional study was conducted in the district of Gilgit in Pakistan. A structured questionnaire was administered to 708 mothers who gave birth to a live child in the past one year. Descriptive and inferential analysis was performed to identify socio-economic and health care factors associated with newborn care practices. RESULTS: Illiterate mothers were more likely to use harmful newborn care practices, while those seeking health care from private sector were less likely to use harmful newborn care practices. Ninety-four percent of the newborns were given a bath soon after birth, likelihood to be 2 times more amongst illiterate mothers. Cord application was a very common practice, mostly with matti (crashed apricot seed), and a majority of the mothers reported newborn massage generally with mustard oil. The administration of colostrum as the first feed was relatively common in the study area. Twenty-seven percent of mothers reported giving pre-lacteals; from which prominent feeds included salt water (44%) and cow's milk (26%). Initiation of breastfeeding within 1 hour after birth was (71%), while (29%) reported to breastfeed their newborn within 24 hours. Thirty-seven percent newborns were exclusively breastfed for six months. CONCLUSION: This study underscores the existence and predominance of risky practices in newborn care; that stresses the need for health education programs to ensure safety of the newborn.

Cleft lip and palate in Scotland: a survey.

The aim of the survey was to assess midwives' experiences and knowledge of cleft lip and/or palate (CL+/-P), confidence in supporting the families and giving feeding advice, and to identify areas for input from the cleft team. In order to do so, questionnaires were sent to maternity units across Scotland. The results were as follows: 206 questionnaires were returned (42 per cent response rate). Forty one per cent of the midwives had helped a baby with CL+/-P to be born; 23 per cent knew the incidence of CL+/-P; 33 per cent were aware of the stages in treating CL+/- P; 99 per cent were aware that feeding difficulties are a potential complication. When asked about offering support to the families, 70 per cent were not confident and 60 per cent were not confident at giving feeding advice. Regarding cleft team input, 65 per cent would like a training day, 45 per cent requested small group teaching, 50 per cent would like a website and 57 per cent would like printed literature. Our recommendations are to implement training, for midwives, along with supporting websites and literature.

Community neonatal practices and its association with skilled birth attendance in rural Haryana, India.

AIM: The study aimed to document home-based neonatal care practices and their association with type of birth attendance. METHODS: This study was conducted in rural Haryana on mothers who had delivered a live baby one to 2 months prior to interview. The study instrument, administered through home visits, had questions related to cord care, breastfeeding, thermal care, baby handling and healthcare seeking. Logistic regression was performed to test for association [OR; 95% CI] of key newborn care practices with skilled birth attendance. RESULTS: Of the 415 mothers interviewed, 26.7% applied nothing on umbilicus; 15% were kept in skin-to-skin contact with mother; 20.2% were exclusively breastfed in first month. Seeking care in private sector and cost incurred in the treatment for a neonatal illness was significantly higher for male babies. Delivery by skilled birth attendant (68.5%) was associated with applying nothing on the cord [1.8; 1.01-3.25], in skin-to-skin contact with mother for ≥ 6 h a day [2.21; 1.18-4.13], bathing the baby after third day [14.63; 6.85-31.21] and exclusive breastfeeding [8.84; 3.42-22.8]. CONCLUSION: The results of this study call for not only upscaling skilled birth attendance but also improving the quality of care currently provided.

Noninstitutional births and newborn care practices among adolescent mothers in Bangladesh.

OBJECTIVE: To describe home-based newborn care practices among adolescent mothers in Bangladesh and to identify sociodemographic, antenatal care (ANC), and delivery care factors associated with these practices. DESIGN: The 2007 Bangladesh Demographic Health Survey, conducted from March 24 to August 11, 2007. SETTING: Selected urban and rural areas of Bangladesh. PARTICIPANTS: A total of 580 adolescent women (aged 15-19 years) who had ever been married with noninstitutional births and having at least one child younger than 3 years of age. METHODS: Outcomes included complete cord care, complete thermal protection, initiation of early breastfeeding, and postnatal care within 24 hours of birth. Descriptive statistics and multivariate logistic regression methods were employed in analyzing the data. RESULTS: Only 42.8% and 5.1% newborns received complete cord care and complete thermal protection. Only 44.6% of newborns were breastfed within 1 hour of birth. The proportion of the newborns that received postnatal care within 24 hours of birth was 9%, and of them 11% received care from medically trained providers (MTP). Higher level of maternal education and richest bands of wealth were associated with complete thermal care and postnatal care within 24 hours of birth but not with complete cord care and early breastfeeding. Use of sufficient ANC and assisted births by MTP were significantly associated with several of the newborn care practices. CONCLUSIONS: The association between newborn care practices of the adolescent mothers and sufficient ANC and skilled birth attendance suggest that expanding skilled birth attendance and providing ANC may be an effective strategy to promote essential and preventive newborn care.

Knowledge, attitudes and practices of Iraqi mothers and family child-caring women regarding breastfeeding.

We assessed breastfeeding knowledge, attitudes and practices of 3413 Iraqi mothers and adult female relatives in the same household and their association with sociodemographic characteristics. The majority of the women (73.1%) initiated breastfeeding early after delivery, 92.9% believed colostrum was good for their baby and 64.6% breastfed on demand. However, knowledge was lacking about full exclusive breastfeeding until 6 months postpartum, signs of good positioning and latch-on and the correct to introduce supplements. Nearly 35% believed that breast milk was not enough for their infants. Rural and less educated women knew less about breastfeeding concepts than more educated urban women but more continued breastfeeding longer and introduced supplements later.

Newborn care practices in low socioeconomic settlements of Karachi, Pakistan.

To explore traditional neonatal beliefs and care practices and to assess the predictors for giving prelacteal feeds, a qualitative and quantitative study was conducted in low socioeconomic settlements of Karachi, Pakistan. Five focus group discussions and 15 in-depth semi-structured interviews were conducted in July and August 2000; structured questionnaires were administered to 525 recently delivered women through November. Antenatal care coverage was common; a little over half of the women delivered at home with traditional birth attendants. Among the 387 women who reported at least one antenatal visit, most (78.6%) reported receiving counseling on breastfeeding by their healthcare provider. A significant proportion of women (44.8%) reported giving lacteals; colostrum (41.7%) or animal/formula milk (3.1%), as the first feed. Newborns were bathed immediately (82.1%) after delivery as the vernix was considered 'dirty looking' (78.5%), and it was felt it should be removed. To foster muscle relaxation (80.2%) and strengthen the bones (43.0%), daily massage was universally practiced, mustard oil (75.9%) being the most frequently used lubricant. Risky feeding practices such as giving prelacteals (55.0%) or supplementary feeds (71.3%), or delaying first feed (30.9%) were common. During the neonatal period, breast milk was the preferred feed (98.6%); however, honey (28.7%), ghutti (27.8%) and water (11.8%) were also given in order to 'reduce colic' or 'act as a laxative', which were perceived health benefits mentioned by mothers and traditional birth attendants. Ethnicity and birth attendant at delivery were strong predictors for women who gave prelacteals (after adjusting for education, socioeconomic status and facility delivery). Although administration of colostrum as the first feed was relatively common in this setting, the predominance of other risky traditional newborn care practices stresses the need for promoting health education programs on improving newborn care practices.

Surveillance for selected maternal behaviors and experiences before, during, and after pregnancy. Pregnancy Risk Assessment Monitoring System (PRAMS), 2000.

PROBLEM/CONDITION: Various maternal behaviors and experiences are associated with adverse health outcomes for both the mother and the infant. These behaviors and experiences can occur before pregnancy (e.g., insufficient intake of folic acid), during pregnancy (e.g., complications requiring hospitalization, such as high blood pressure), and after pregnancy (e.g., inadequate follow-up of infants who were discharged early). Information regarding maternal behaviors and experiences is needed to monitor trends, to enhance the understanding of the relations between behaviors and health outcomes, to plan and evaluate programs, to direct policy decisions, and to monitor progress toward Healthy People 2010 objectives (US Department of Health and Human Services. Healthy People 2010. 2nd. ed. With understanding and improving health and objectives for improving health [2 vols.]. Washington DC: US Department of Health and Human Services, 2000). REPORTING PERIOD COVERED: This report covers data for 2000. DESCRIPTION OF SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected self-reported maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver a live-born infant in 31 states and New York City. PRAMS employs a mixed-mode data collection methodology; as many as three self-administered surveys are mailed to a sample of mothers, and nonresponders are followed up with a telephone interview. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets. PRAMS data can be used to produce statewide estimates of various perinatal health behaviors and experiences among women delivering a live infant. Four indicators for the year 2000 (multivitamin use, pregnancy-related complications, infant checkup, and postpartum contraceptive use) from 19 states are examined in this report. RESULTS: In 2000, the prevalence of multivitamin use > or =4 times per week in the month before pregnancy ranged from 25.0% to 40.7% across the 19 states. Prevalence of pregnancy-related complications requiring hospitalization ranged from 8.8% to 16.3%. Prevalence of infant checkups within 1 week of early (< or =48 hours) hospital discharge ranged from 51.5% to 88.6%. Prevalence of postpartum contraceptive use ranged from 77.9% to 89.9%. INTERPRETATION: PRAMS data indicate that 19 states are well below the Healthy People 2010 objective for folic acid consumption, as measured by multivitamin use. Data for infant checkups indicate that guidelines for care are not being followed for as many as half of those discharged early. However, data for additional years are needed to assess trends in these four indicators. PUBLIC HEALTH ACTION: State maternal and child health programs can use these population-based data to monitor progress toward Healthy People 2010 objectives, evaluate adherence to guidelines for care, and assess changes in prevalence of other health behaviors. The data can be shared with policy makers to direct policy decisions that might affect the health of mothers and infants. By providing data on maternal behaviors and experiences that are associated with adverse outcomes, PRAMS supports the activities of two CDC initiatives-to promote safe motherhood and to reduce infant mortality and low birthweight.