1. THE NEW BIRTH CERTIFICATE Making vital statistics more vital Centers for Disease Control and Prevention National Center for Health Statistics Division of Vital Statistics Reproductive Statistics Branch

2. Development of the Revised Birth Certificate The U.S. Standard Certificate of Live Birth is revised about every 10 years. The last revision was in 1989. – Process began with consensus of the States that revision was needed – In 1998, NCHS/CDC assembled an expert panel to evaluate the current certificate and recommend changes

3. The Revision Process The Panel to Evaluate the U.S. Certificates and Reports: – State vital registration and statistics executives - Patricia W. Potrzebowski (Chair), PA; Donald Berry, DE; Carol V. Getts, MI; Karen Grady, NH; Dorothy S. Harshbarger, AL; Michael R. Lavoie, GA; A.Torrey McLean, NC; Barry Nangle, UT; Alvin T. Onaka, HI; Lorne A. Phillips, KS; Steven Schwartz, NYC – Researchers and representatives of data providers and user organizations - (e.g., AAP, ACNM, ACOG, AHA, AHIMA, AMA) In a series of meetings over 16 months, the Panel reviewed survey responses, literature and testimony from other experts and private citizens

4. The Panel’s Recommendations Improve data quality Improve data quality - Standardized worksheets (Tested prior to implementation) - Standardized electronic systems Add/delete/modify individual items Add/delete/modify individual items

5. Standardized Worksheets To encourage collection from the best sources, two worksheets have been developed and tested – Mother’s Worksheet – Facility Worksheet

6. Mother’s Worksheet Data directly from the mother (e.g., race, education, cigarette smoking, WIC) – Tested on women with a recent live birth – Slight modifications made – Overall, mother’s worksheet worked well – Companion brochure

7. Facility Worksheet Data directly from the medical records (e.g., pregnancy risk factors, method of delivery) – Tested in hospitals – Hospital staff completed the worksheet using medical records – Outside expert reviewed responses for accuracy – Several items modified or deleted – Testing generally showed that the facility worksheet could be completed efficiently and accurately

8. Guide to Completing Facility Worksheet To assist hospital staff in completing the facility worksheet a comprehensive instruction manual has been developed. It includes: – Definitions – Preferred sources within the records – Key words/common abbreviations

9. Detailed Specification for Electronic Systems Detailed specifications for each data item on the birth certificate have been developed – Automatic edits/cross edits – Ability to edit and query at data entry – Suggested screens – On-line help – Drop-down menus – Test decks for vendors/States

10. New Birth Certificate: New Items – Fertility therapy – WIC – Infections during pregnancy – Maternal morbidity – Breast feeding – Principal source of payment for the delivery

11. New Birth Certificate: Modified Items – Cigarette smoking before and during pregnancy – Method of delivery – Pre-pregnancy weight, weight at delivery and height – Congenital anomalies

12. The New U.S. Standard Report of Fetal Death: The Fetal Death Report was also revised with changes similar to birth - Standardized worksheets - Recommendations for electronic systems - Recommendations for electronic systems

13. The New Report of Fetal Death: Cause of Fetal Death Cause of fetal death now captures the single initiating cause as well as other significant causes. Other additions include: – whether autopsy or histological placental examination was performed – if autopsy or histological placental examination results were used in determining cause of death

14. Implementation Revision requires comprehensive overhaul of State electronic vital registration systems ( $$$!) – Phased; beginning in 2003 with 4-5 States – 2 data systems, current & revised for several years – NCHS will collect and publish data for both – Some items (e.g., prenatal care, gestational age) may not be comparable between systems

15. Revision Web-site For everything you always wanted to know about the revision but were afraid to ask… www.cdc.gov/nchs/vital_certs_rev.htm

16. The Future of Birth Statistics The quality of birth and fetal death data will be greatly enhanced by the recommended changes to the collection process and to individual data items Result: a much Result: a much richer national richer national perinatal data base perinatal data base 19401950 1960 1970198019902000 0 20 40 60 80 100 Birth rate per 1,000 women aged 15-19 0 100 200 300 400 500 600 700 Number of births (in thousands) Number of births Birth rate Number of births and birth rates for teenagers aged 15-19 years: United States, 1960-2000