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State of Alaska

Complete Health Indicator Report of Health Care - No Prenatal Care in First Trimester (HA2020 Leading Health Indicator: 21)

Definition

The percentage of women delivering live births who have not received prenatal care in the first trimester of pregnancy.

Numerator

Number of women delivering lives births who reported not receiving prenatal care in the first trimester of pregnancy for a specific time period.

Denominator

Number of live births for a specific time period.

Data Interpretation Issues

The transition from the 1989 revision of the U.S. Standard Certificate of Live Birth to the 2003 revision has multiple implications for tracking rates of prenatal care in the United States. First, the timing of prenatal care item has changed. For data collected using the 1989 revision (for Alaska, all data prior to 2013), the item was recorded as the month of pregnancy that prenatal care began as reported by the mother. With the 2003 revision, the item was changed to request the date (day/month/year) of the first prenatal care visit, as recorded in the prenatal care or medical record. As a result of these modifications, rates of prenatal care timing and adequacy from the 2003 revision may not be comparable to data collected using earlier birth certificate revisions.^1^ Alaska implemented the 2003 revision of the birth certificate in 2013. Some states began the revision process in 2003, but full implementation in all states was phased in over several years. By 2016, all states were using the same version. [[br]] [[br]] ---- {{class .SmallerFont 1. Calculations | PeriStats | March of Dimes. [http://www.marchofdimes.org/peristats/calculationsp.aspx?id=23]. Accessed October 12, 2018. }}

Why Is This Important?

Utilization of quality healthcare is influenced by a number of factors, including: having health insurance, having access to care, and being able to afford care.^2^ Inadequate prenatal care--including late initiation of care, infrequent prenatal visits, or no care at all--is associated with poor infant and maternal outcomes, including low birth weight or preterm infants and for the mothers an increased risk for pregnancy-related mortality and complications of childbirth.^3^ This report also includes data on early and adequate prenatal care using the Adequacy of Prenatal Care Utilization (APNCU) index that additionally accounts for the reported number of prenatal visits. [[br]] [[br]] ---- {{class .SmallerFont 2. DeVoe, Baez A, Angier H, Krois L, et al. Insurance plus Access Does not Equal Health Care: Typology of Barriers to Health Care Access for Low-Income Families. Ann Fam Med. 2007;5(6):511-518. [https://www.ncbi.nlm.nih.gov/pubmed/18025488] Accessed September 14, 2018. 3. Young MB, Perham-Hester KA, Kemberling MM. Alaska Maternal and Child Health Data Book 2011: Alaska Native Edition. Anchorage, AK: A collaboration of the Alaska Department of Health and Social Services, Division of Public Health, and the Alaska Native Tribal Health Consortium, Alaska Native Epidemiology Center. October 2011. [http://dhss.alaska.gov/dph/wcfh/Pages/mchepi/mchdatabook/2011.aspx] Accessed September 14, 2018. }}

Healthy People Objective: Prenatal care beginning in first trimester

U.S. Target: 77.9 percent (or 22.1 percent not beginning prenatal care in the first trimester)
State Target: Healthy Alaskans 2020 Target: 19.0% with no prenatal care in first trimester

Other Objectives

Healthy People Objective 10.2: Increase the proportion of pregnant women who receive early and adequate prenatal care. '''U.S. Target:''' 77.6 percent Healthy Alaskans 2020 Indicator 21: Reduce the percentage of women delivering live births who have not received prenatal care beginning in the first trimester of pregnancy to 19% by 2020.

How Are We Doing?

Statewide, there has been steady improvement in the rate of prenatal care beginning in the first trimester of pregnancy, In 2017, Alaska's rate for this indicator (19.2%) approached the Healthy Alaskans 2020 objective of 19%. That same year, 22.4% of Alaska Native women who had delivered live births had not received prenatal care beginning in the first trimester - a 9% decrease since 2013. Thirty percent of women giving birth in the southwest regions did not receive prenatal care beginning in the first trimester for the 5-year period of 2013-2017. In reviewing the 10-year average for 2008-2017 by boroughs and census areas, areas with approximately one-third or higher rates of not receiving prenatal care in the first trimester consisted of Kusilvak census area (38.3%), North Slope Borough (37.1%), Southeast Fairbanks census area (36.9%), Yukon-Koyukuk census area (36.0%), and Aleutians West census area (33.8%). Alaska PRAMS surveyed women who recently delivered a live birth about their ability to obtain prenatal care when they wanted it, and asked them to list the corresponding reasons if they were unable to. During 2002-2011, the prevalence of Alaskan women who received prenatal care as early as they wanted it increased from 80.4% to 85.0%. The most common reason that Alaskan women gave for not getting prenatal care as early in their pregnancy as they wanted was because they didn't know they were pregnant (36.5%). Not having a Medicaid or Denali KidCare card (35.6%) or not being able to get an appointment when they wanted one (35.0%) were also common reasons given.^4^ The Adequacy of Prenatal Care Utilization (APNCU) index makes use of two types of prenatal care information obtained from birth certificate data: when prenatal care began (adequacy of initiation) and the number of prenatal visits from when prenatal care began until delivery (adequacy of received services). In 2017, only 64.3% of Alaska women who had delivered a live birth were categorized as receiving adequate prenatal care.^5^ [[br]] [[br]] ---- {{class .SmallerFont 4. Newby-Kew AJ, DeLozier DP, Prince CB, Perham-Hester KA, Young MB. Alaska Maternal and Child Health Data Book 2014: Life Course Edition. Anchorage, AK. Maternal and Child Health Epidemiology Unit, Section of Women's, Children's, and Family Health, Division of Public Health, Alaska Department of Health and Social Services, September 2014. [http://dhss.alaska.gov/dph/wcfh/Documents/mchepi/pubs/databook/MCHDataBook2014toweb.pdf]. Accessed October 12, 2018. 5. Alaska Department of Health and Social Services, Division of Public Health, Health Analytics and Vital Records Section. Alaska Vital Statistics 2017 Annual Report. [http://dhss.alaska.gov/dph/VitalStats/Documents/PDFs/VitalStatistics_Annualreport_2017.pdf]. Accessed November 13, 2018. }}

How Do We Compare With the U.S.?

In 2017, 19.2% of Alaska women delivering lives births did not receive prenatal care in the first trimester of pregnancy, compared to 22.7% in the U.S. In 2016, 64.6% of Alaska women who had delivered a live birth were categorized as receiving early and adequate prenatal care (APNCU index), compared to 75.6% in the U.S.^6^ [[br]] [[br]] ---- {{class .SmallerFont 6. Osterman MJK, Martin JA. Timing and adequacy of prenatal care in the United States,2016. National Vital Statistics Reports, vol 67 no 3. Hyattsville, MD: National Center for Health Statistics. 2018 Available from [https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_03.pdf]. Accessed October 12, 2018. }}

Evidence-based Practices

As part of the Healthy Alaskans 2020 health improvement process, groups of Alaska subject matter experts met over a period of months in a rigorous review process to identify and prioritize strategies to address the 25 health priorities. Public health partners around the state are aligning work around these approaches adapted to Alaska's unique needs. '''Strategy 1:''' [[br]]Increase the number of women of childbearing age who report having access to health care providers who support them to plan their pregnancies. '''Strategy 2:''' [[br]]Increase the number of women who have their pregnancies confirmed by a health care provider in the first trimester. '''Strategy 3:''' [[br]]Improve systems and services that care for women with addictions (alcohol, drugs, tobacco). '''Source:''' [[br]]Agency of Healthcare Research and Quality. Patient Safety.[http://www.ahrq.gov/research/findings/nhqrdr/nhqr08/Chap3.html] In National Healthcare Quality Report, 2008 (Chapter 3).

Health Program Information

A listing of strategies, actions, and key partners on this measure can be found at: [http://hss.state.ak.us/ha2020/assets/Actions-Partners_21_Prenatal.pdf]. Accessed October 19, 2018.


Related Indicators

Relevant Population Characteristics

Pregnant teens 15-19 years of age, mothers with low level of education, race other than White, Hispanic ethnicity, being unmarried, lower socio-economic status, and women who lack health insurance are less likely to get early prenatal care.

Related Relevant Population Characteristics Indicators:


Health Care System Factors

Having health insurance improves availability of prenatal care services. Lack of health insurance affects both the timing and frequency of prenatal care visits, resulting in poor pregnancy outcomes such as premature birth, low birth weight, and complicated delivery. Availability of family planning services is another system factor that reduces the risk of unintended pregnancy. If a pregnancy is planned, a woman is more likely to seek early and adequate prenatal care.

Related Health Care System Factors Indicators:


Risk Factors

The risk factors for late entry identified by the Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) and from the birth certificate are: - women less than 20 years of age - women with less than 12 years of education - non-White women - Hispanic women - unmarried women - women with an annual household income less than $15,000/year - unintended pregnancy - women who had no private insurance prior to conception

Health Status Outcomes

Prenatal care can improve birth outcomes and prevent medical complications and their costs associated with premature births, low birth weight births, and maternal and infant mortality and morbidity.



Graphical Data Views

Women who did not receive prenatal care beginning in first trimester of pregnancy, all Alaskans, Alaska Native people, and U.S., 2000-2017

::chart - missing::
confidence limits

The measure shown in the graph is women who reported receiving prenatal care beginning in the second or third trimester of pregnancy. Excludes live births with missing data on timing of first prenatal care.
Alaska ComparisonsYearPercentage of women delivering live birthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 61
All Alaskans200019.4%18.5%20.3%1,8819,707
All Alaskans200119.0%18.2%19.9%1,8419,675
All Alaskans200219.5%18.6%20.4%1,8609,541
All Alaskans200319.8%18.9%20.7%1,9079,639
All Alaskans200418.9%18.0%19.7%1,8529,817
All Alaskans200519.4%18.5%20.3%1,98210,226
All Alaskans200618.6%17.8%19.5%1,99810,726
All Alaskans200719.6%18.8%20.5%2,10410,726
All Alaskans200820.6%19.8%21.5%2,26410,982
All Alaskans200919.8%19.0%20.7%2,04810,338
All Alaskans201021.3%20.4%22.2%2,24810,571
All Alaskans201122.5%21.6%23.4%2,45110,897
All Alaskans201223.4%22.5%24.3%2,46910,560
All Alaskans201321.5%20.6%22.4%2,34510,908
All Alaskans201422.4%21.5%23.3%2,46110,976
All Alaskans201521.1%20.2%21.9%2,31310,985
All Alaskans201620.4%19.6%21.3%2,25111,015
All Alaskans201719.2%18.4%20.1%1,96410,223
Alaska Native people200029.5%27.4%31.8%7122,411
Alaska Native people200127.6%25.5%29.7%6632,406
Alaska Native people200229.6%27.5%31.9%6882,321
Alaska Native people200329.1%26.9%31.3%6942,388
Alaska Native people200428.8%26.7%30.9%7152,486
Alaska Native people200528.0%26.0%30.1%7482,673
Alaska Native people200627.1%25.2%29.2%7182,648
Alaska Native people200729.8%27.8%32.0%8122,720
Alaska Native people200832.8%30.7%35.0%9302,837
Alaska Native people200927.1%25.2%29.1%7762,864
Alaska Native people201027.3%25.4%29.3%7662,808
Alaska Native people201125.4%23.6%27.4%6972,740
Alaska Native people201227.2%25.2%29.2%7392,721
Alaska Native people201324.8%23.0%26.7%7042,843
Alaska Native people201425.0%23.2%26.9%7162,865
Alaska Native people201524.3%22.5%26.2%6872,827
Alaska Native people201623.7%22.0%25.5%7042,968
Alaska Native people201722.4%20.7%24.3%6062,701
U.S.200729.2%
U.S.200829.0%
U.S.200927.9%
U.S.201026.9%
U.S.201126.3%
U.S.201225.9%
U.S.201325.8%
U.S.201423.3%
U.S.201523.0%
U.S.201622.9%
U.S.201722.7%
Healthy Alaskans Goal200115.0%
Healthy Alaskans Goal200215.0%
Healthy Alaskans Goal200315.0%
Healthy Alaskans Goal200415.0%
Healthy Alaskans Goal200515.0%
Healthy Alaskans Goal200615.0%
Healthy Alaskans Goal200715.0%
Healthy Alaskans Goal200815.0%
Healthy Alaskans Goal200915.0%
Healthy Alaskans Goal201015.0%
Healthy Alaskans Goal201419.0%
Healthy Alaskans Goal201519.0%
Healthy Alaskans Goal201619.0%
Healthy Alaskans Goal201719.0%

Data Notes

Data for prenatal care indicators updated by Maternal and Child Health Health Epidemiology Unit (MCH-Epi), Section of Women's, Children's and Family Health in December 2018. [SAS Analysis in December 2018] Birth certificate data updated by HAVRS on November 14, 2018.   Data from before 2013 were obtained using the 1989 revision of the U.S. Standard Certificate of Live Birth in which only the month in which prenatal care began was collected. Data from before 2013 may not be comparable to the information from 2013 and later based upon the 2003 revision of the certificate that requested the date of the first prenatal care visit.

Data Sources

  • [http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Health Analytics and Vital Records Section (HAVRS)], Division of Public Health, Alaska Department of Health and Social Services
  • U.S. Center for Disease Control and Prevention, on-line data - CDC WONDER


Women who did not receive prenatal care beginning in first trimester of pregnancy, by race, Alaska, 2000-2017

::chart - missing::
confidence limits

The measure shown in the graph is women who reported receiving prenatal care beginning in the second or third trimester of pregnancy. Excludes live births with missing data on timing of first prenatal care.
Race: Alaska Native, Asian/Pacific Is, Black, WhiteYearPercentage of women delivering live birthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 72
Alaska Native people200029.5%27.4%31.8%7122,411
Alaska Native people200127.6%25.5%29.7%6632,406
Alaska Native people200229.6%27.5%31.9%6882,321
Alaska Native people200329.1%26.9%31.3%6942,388
Alaska Native people200428.8%26.7%30.9%7152,486
Alaska Native people200528.0%26.0%30.1%7482,673
Alaska Native people200627.1%25.2%29.2%7182,648
Alaska Native people200729.8%27.8%32.0%8122,720
Alaska Native people200832.8%30.7%35.0%9302,837
Alaska Native people200927.1%25.2%29.1%7762,864
Alaska Native people201027.3%25.4%29.3%7662,808
Alaska Native people201125.4%23.6%27.4%6972,740
Alaska Native people201227.2%25.2%29.2%7392,721
Alaska Native people201324.8%23.0%26.7%7042,843
Alaska Native people201425.0%23.2%26.9%7162,865
Alaska Native people201524.3%22.5%26.2%6872,827
Alaska Native people201623.7%22.0%25.5%7042,968
Alaska Native people201722.4%20.7%24.3%6062,701
Asian/Pacific Islander200022.0%18.4%26.2%131594
Asian/Pacific Islander200122.4%18.7%26.5%135604
Asian/Pacific Islander200222.4%18.9%26.4%141629
Asian/Pacific Islander200324.5%20.8%28.7%155632
Asian/Pacific Islander200426.0%22.3%30.1%178684
Asian/Pacific Islander200529.5%25.7%33.7%217735
Asian/Pacific Islander200622.4%19.3%25.9%185825
Asian/Pacific Islander200725.7%22.3%29.5%206801
Asian/Pacific Islander200826.6%23.3%30.3%225845
Asian/Pacific Islander200928.2%24.6%32.0%232824
Asian/Pacific Islander201031.1%27.6%34.9%286919
Asian/Pacific Islander201136.5%32.8%40.5%352964
Asian/Pacific Islander201234.9%31.4%38.7%3541,014
Asian/Pacific Islander201333.1%29.8%36.8%3531,066
Asian/Pacific Islander201431.4%28.3%34.9%3561,132
Asian/Pacific Islander201532.3%29.2%35.8%3781,169
Asian/Pacific Islander201629.1%26.1%32.4%3441,181
Asian/Pacific Islander201725.0%22.3%28.1%2961,182
Black200018.3%14.6%22.8%82441
Black200117.4%13.6%21.9%73420
Black200215.4%11.8%19.8%62402
Black200317.5%13.4%22.4%63360
Black200414.0%10.4%18.5%49350
Black200516.9%13.0%21.5%65385
Black200615.1%11.6%19.3%63417
Black200718.8%14.9%23.4%81431
Black200821.1%16.8%26.2%83393
Black200920.0%15.9%25.0%79394
Black201017.0%13.2%21.6%67394
Black201127.0%22.5%32.1%126467
Black201224.4%19.6%30.0%91373
Black201323.7%19.5%28.5%111469
Black201424.6%20.2%29.6%109444
Black201522.4%18.1%27.3%95425
Black201620.4%16.4%25.1%90441
Black201715.0%11.7%18.9%72480
White200015.1%14.1%16.1%9286,157
White200115.4%14.4%16.4%9466,147
White200215.6%14.6%16.6%9436,063
White200315.7%14.8%16.8%9676,146
White200414.2%13.3%15.2%8806,186
White200514.6%13.7%15.6%9246,307
White200615.1%14.2%16.0%1,0006,635
White200714.7%13.8%15.7%9666,569
White200814.8%13.9%15.8%1,0096,799
White200915.1%14.2%16.1%9306,156
White201017.4%16.4%18.5%1,1096,374
White201118.8%17.7%19.8%1,2406,613
White201219.6%18.6%20.8%1,2416,315
White201318.0%17.0%19.1%1,1396,332
White201419.1%18.0%20.2%1,1846,199
White201517.4%16.4%18.5%1,0806,213
White201617.3%16.3%18.4%1,0706,185
White201716.8%15.7%17.9%9535,678

Data Notes

Data for prenatal care indicators updated by Maternal and Child Health Health Epidemiology Unit (MCH-Epi), Section of Women's, Children's and Family Health in December 2018. [SAS Analysis in December 2018] Birth certificate data updated by HAVRS on November 14, 2018.   Starting in 2013, Alaska birth certificates allowed for one or more races to be identified. We use a prioritized race classification starting with any mention of Alaska Native, followed by any mention of Black, then by any mention of Asian or Pacific Islander, and ending with any mention of White. All other or unknown races are excluded. This method is preferred over the race alone or bridged race methods because the denominators more closely align with the preceding years. It also eliminates the chance of including the same person in 2 or more races.


Women who did not receive prenatal care beginning in first trimester of pregnancy, by public health regions, all Alaskans, 2013-2017 (5-year average)

::chart - missing::
confidence limits

The measure shown in the graph is women who reported receiving prenatal care beginning in the second or third trimester of pregnancy. Excludes live births with missing data on timing of first prenatal care.
Percentage of women delivering live birthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 9
Anchorage19.6%19.0%20.2%4,32122,068
Gulf Coast23.1%21.8%24.4%1,1885,150
Interior21.0%20.0%21.9%1,9109,115
Mat-Su19.8%18.8%20.9%1,3486,792
Northern23.7%21.9%25.6%6552,760
Southeast16.1%14.9%17.4%6423,992
Southwest30.0%28.4%31.7%1,2614,200
Healthy Alaskans Goal19.0%
Statewide20.9%20.6%21.3%11,33454,106

Data Notes

Data for prenatal care indicators updated by Maternal and Child Health Health Epidemiology Unit (MCH-Epi), Section of Women's, Children's and Family Health in December 2018. [SAS Analysis in December 2018] Birth certificate data updated by HAVRS on November 14, 2018.   Region is determined by maternal residence at birth, not site of delivery.

Data Sources

  • [http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Health Analytics and Vital Records Section (HAVRS)], Division of Public Health, Alaska Department of Health and Social Services
  • U.S. Center for Disease Control and Prevention, on-line data - CDC WONDER


Women who did not receive prenatal care beginning in first trimester of pregnancy, by behavioral health regions, all Alaskans, 2013-2017 (5-year average)

::chart - missing::
confidence limits

The measure shown in the graph is women who reported receiving prenatal care beginning in the second or third trimester of pregnancy. Excludes live births with missing data on timing of first prenatal care.
Percentage of women delivering live birthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 12
Anchorage Muncipality19.6%19.0%20.2%4,32122,068
Fairbanks North Star Borough19.3%18.3%20.3%1,5648,106
City and Borough of Juneau10.5%9.1%12.0%1971,881
Kenai Peninsula Borough26.0%24.3%27.8%8943,435
Matanuska-Susitna Borough19.8%18.8%20.9%1,3486,792
Northwest Region23.7%21.9%25.6%6552,760
Other Interior Region29.2%26.7%31.9%4871,668
Other SE - Northern20.8%18.0%23.8%203977
Other SE - Southern21.3%18.7%24.2%2421,134
Y-K Delta Region30.8%28.9%32.7%1,0073,271
Southwest Region20.5%18.6%22.6%4071,985
Healthy Alaskans Goal19.0%

Data Notes

Data for prenatal care indicators updated by Maternal and Child Health Health Epidemiology Unit (MCH-Epi), Section of Women's, Children's and Family Health in December 2018. [SAS Analysis in December 2018] Birth certificate data updated by HAVRS on November 14, 2018.   Region is determined by maternal residence at birth, not site of delivery.


Women who did not receive prenatal care beginning in first trimester of pregnancy, by tribal health regions, all Alaskans, 2013-2017 (5-year average)

::chart - missing::
confidence limits

The measure shown in the graph is women who reported receiving prenatal care beginning in the second or third trimester of pregnancy. Excludes live births with missing data on timing of first prenatal care.
Percentage of women delivering live birthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 13
Aleutians and Pribilofs31.5%24.5%39.9%69219
Anchorage/Mat-Su19.6%19.1%20.2%5,66928,860
Arctic Slope29.2%25.3%33.5%200685
Bristol Bay27.4%23.8%31.4%206752
Copper R/Prince William Snd.21.6%18.2%25.4%144668
Interior21.0%20.1%22.0%1,9119,098
Kenai Peninsula26.0%24.3%27.8%89334.4
Kodiak Area14.5%12.3%17.0%1531,056
Northwest Arctic18.9%16.3%21.9%185977
Norton Sound23.2%20.4%26.3%2441,052
Southeast16.1%14.9%17.4%6423,992
Yukon-Kuskokwim30.7%28.9%32.7%1,0093,284
Healthy Alaskans Goal19.0%

Data Notes

Data for prenatal care indicators updated by Maternal and Child Health Health Epidemiology Unit (MCH-Epi), Section of Women's, Children's and Family Health in December 2018. [SAS Analysis in December 2018] Birth certificate data updated by HAVRS on November 14, 2018.   Region is determined by maternal residence at birth, not site of delivery.


Women who did not receive prenatal care beginning in first trimester of pregnancy, by boroughs and census areas, all Alaskans, 2008-2017 (10-year average)

::chart - missing::
confidence limits

The measure shown in the graph is women who reported receiving prenatal care beginning in the second or third trimester of pregnancy. Excludes live births with missing data on timing of first prenatal care.
Percentage of women delivering live birthsLower LimitUpper LimitNoteNumer- atorDenom- inator
Record Count: 30
Aleutians East Borough18.4%12.5%26.2%31168
Aleutians West CA33.8%27.6%41.0%103305
Anchorage Municipality19.6%19.2%20.0%8,45743,120
Bethel CA28.7%27.1%30.4%1,2154,233
Bristol Bay Borough26.5%17.3%38.9%2698
Denali Borough25.4%19.3%32.9%58228
Dillingham CA27.1%24.0%30.5%2771,022
Fairbanks North Star Borough19.4%18.7%20.0%3,12016,118
Haines Borough22.6%16.4%30.3%44195
Hoonah-Angoon CA28.8%22.1%36.8%63219
Juneau City and Borough12.4%11.3%13.5%4713,814
Kenai Peninsula Borough22.3%21.2%23.5%1,5386,890
Ketchikan Gateway Borough14.6%12.9%16.5%2501,711
Kodiak Island Borough18.1%16.3%20.0%3842,123
Kusilvak CA38.3%35.8%40.9%8942,336
Lake and Peninsula Borough22.9%17.9%28.9%72314
Matanuska-Susitna Borough20.7%19.9%21.5%2,68912,997
Nome CA24.4%22.4%26.5%5542,270
North Slope Borough37.1%34.3%40.1%6321,703
Northwest Arctic Borough23.9%21.8%26.2%4541,897
Petersburg Borough19.5%15.1%24.7%67344
Prince of Wales-Hyder CA28.3%24.7%32.4%212748
Sitka City and Borough14.8%12.5%17.4%146985
Skagway Municipality18.4%11.1%28.8%Statistically unreliable19103
Southeast Fairbanks CA36.9%33.4%40.8%3991,080
Valdez-Cordova CA20.6%18.2%23.3%2581,251
Wrangell City and Borough20.0%14.6%26.0%46230
Yakutat City and Borough28.6%17.9%43.3%2277
Yukon-Koyukuk CA36.0%32.0%40.3%298829
Healthy Alaskans Goal19.0%

Data Notes

Data for prenatal care indicators updated by Maternal and Child Health Health Epidemiology Unit (MCH-Epi), Section of Women's, Children's and Family Health in December 2018. [SAS Analysis in December 2018] Birth certificate data updated by HAVRS on November 14, 2018.   Region is determined by maternal residence at birth, not site of delivery. Rates based upon less than 20 cases are unreliable.

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Health Analytics and Vital Records Section (HAVRS)], Division of Public Health, Alaska Department of Health and Social Services


Women who received adequate prenatal care (APNCU index), all Alaskans, Alaska Native people, and U.S., 2000-2017

::chart - missing::
confidence limits

The measure shown in the graph is women who were categorized as receiving Adequate or Adequate Plus care (APNCU index). Excludes live births with missing data on prenatal care. Limited data for U.S. is available. Estimates for 2007 are based on 22 states (representing 53 percent of all U.S. births) that had adopted the 2003 version of the U.S. State Certification of Live Births, excluding AL, AK, AZ, AR, CT, GA, HI, IL, LA, ME, MD, MA, MI, MN, MS, MO, MT, NV, NJ, NM, NC, OK, OR, RI, UT, VA, WV, WI, DC, and New York City. The most recent estimate (2016) is the first report on the adequacy of PNC based on 100% of births registered to residents of the 50 states and the District of Columbia (D.C.) from the 2003 birth certificate.
Alaska ComparisonsYearPercentage of women delivering live birthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 55
All Alaskans200067.8%66.1%69.4%6,3769,411
All Alaskans200166.8%65.2%68.5%6,0959,121
All Alaskans200264.5%62.8%66.2%5,7778,959
All Alaskans200366.5%64.8%68.2%5,8568,806
All Alaskans200463.7%62.0%65.3%5,7649,053
All Alaskans200564.2%62.6%65.8%6,2399,720
All Alaskans200662.2%60.7%63.7%6,32910,179
All Alaskans200760.0%58.5%61.5%6,13910,231
All Alaskans200857.4%56.0%58.9%5,94510,357
All Alaskans200959.5%58.0%61.1%5,5689,352
All Alaskans201059.4%57.9%60.9%6,06810,214
All Alaskans201157.4%56.0%58.9%6,16910,742
All Alaskans201261.5%60.0%63.0%6,37410,363
All Alaskans201359.5%58.1%61.0%6,29110,568
All Alaskans201460.0%58.6%61.5%6,45210,749
All Alaskans201561.5%60.0%63.0%6,59710,728
All Alaskans201664.6%63.1%66.2%7,00810,842
All Alaskans201764.3%62.8%65.9%6,51710,129
Alaska Native people200051.3%48.5%54.3%1,2112,359
Alaska Native people200151.6%48.7%54.6%1,1942,316
Alaska Native people200246.8%44.0%49.7%1,0542,251
Alaska Native people200348.6%45.8%51.5%1,1282,321
Alaska Native people200442.3%39.8%45.0%1,0232,416
Alaska Native people200547.4%44.8%50.1%1,2432,621
Alaska Native people200645.6%43.0%48.3%1,1832,594
Alaska Native people200740.4%38.0%42.9%1,0782,669
Alaska Native people200840.3%38.0%42.7%1,1242,789
Alaska Native people200944.3%41.9%46.8%1,2532,829
Alaska Native people201046.6%44.1%49.2%1,2992,789
Alaska Native people201145.0%42.6%47.6%1,2382,748
Alaska Native people201251.6%49.0%54.4%1,3982,707
Alaska Native people201355.6%52.9%58.4%1,5492,786
Alaska Native people201454.5%51.8%57.3%1,5492,841
Alaska Native people201556.7%53.9%59.5%1,5822,791
Alaska Native people201660.1%57.4%63.0%1,7712,945
Alaska Native people201758.0%55.2%61.0%1,5582,686
U.S.200770.5%
U.S.201675.6%
Healthy People Target200190.0%
Healthy People Target200290.0%
Healthy People Target200390.0%
Healthy People Target200490.0%
Healthy People Target200590.0%
Healthy People Target200690.0%
Healthy People Target200790.0%
Healthy People Target200890.0%
Healthy People Target200990.0%
Healthy People Target201090.0%
Healthy People Target201177.6%
Healthy People Target201277.6%
Healthy People Target201377.6%
Healthy People Target201477.6%
Healthy People Target201577.6%
Healthy People Target201677.6%
Healthy People Target201777.6%

Data Notes

Data for prenatal care indicators updated by Maternal and Child Health Health Epidemiology Unit (MCH-Epi), Section of Women's, Children's and Family Health in December 2018. [SAS Analysis in December 2018] Birth certificate data updated by HAVRS on November 14, 2018.   Adequacy of Prenatal Care Utilization (APNCU) index classifies the adequacy of initiation as follows: pregnancy months 1 and 2, months 3 and 4, months 5 and 6, and months 7 to 9. To classify the adequacy of received services, the number of prenatal visits is compared to the expected number of visits for the period between when care began and the delivery date. The expected number of visits is based on the American College of Obstetricians and Gynecologists prenatal care standards for uncomplicated pregnancies and is adjusted for the gestational age when care began and for the gestational age at delivery. A ratio of observed to expected visits is calculated and grouped into four categories - Inadequate (received less than 50% of expected visits), Intermediate (50%-79%), Adequate (80%-109%), and Adequate Plus (110%). The final APNCU index measure combines these two dimensions into a single summary score.^5^

Data Sources

  • [http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Health Analytics and Vital Records Section (HAVRS)], Division of Public Health, Alaska Department of Health and Social Services
  • National Center for Health Statistics, Centers for Disease Control and Prevention


Women who received adequate prenatal care (APNCU index), by race, Alaska, 2000-2017

::chart - missing::
confidence limits

The measure shown in the graph is women who were categorized as receiving Adequate or Adequate Plus care (APNCU index). Excludes live births with missing data on prenatal care.
Race: Alaska Native, Asian/Pacific Is, Black, WhiteYearPercentage of women delivering live birthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 72
Alaska Native people200051.3%48.5%54.3%1,2112,359
Alaska Native people200151.6%48.7%54.6%1,1942,316
Alaska Native people200246.8%44.0%49.7%1,0542,251
Alaska Native people200348.6%45.8%51.5%1,1282,321
Alaska Native people200442.3%39.8%45.0%1,0232,416
Alaska Native people200547.4%44.8%50.1%1,2432,621
Alaska Native people200645.6%43.0%48.3%1,1832,594
Alaska Native people200740.4%38.0%42.9%1,0782,669
Alaska Native people200840.3%38.0%42.7%1,1242,789
Alaska Native people200944.3%41.9%46.8%1,2532,829
Alaska Native people201046.6%44.1%49.2%1,2992,789
Alaska Native people201145.0%42.6%47.6%1,2382,748
Alaska Native people201251.6%49.0%54.4%1,3982,707
Alaska Native people201355.6%52.9%58.4%1,5492,786
Alaska Native people201454.5%51.8%57.3%1,5492,841
Alaska Native people201556.7%53.9%59.5%1,5822,791
Alaska Native people201660.1%57.4%63.0%1,7712,945
Alaska Native people201758.0%55.2%61.0%1,5582,686
Asian/Pacific Islander200064.4%57.9%71.3%363564
Asian/Pacific Islander200161.8%55.4%68.6%344557
Asian/Pacific Islander200264.3%57.8%71.3%360560
Asian/Pacific Islander200366.1%59.4%73.2%360545
Asian/Pacific Islander200462.0%55.9%68.5%381615
Asian/Pacific Islander200563.4%57.6%69.8%427673
Asian/Pacific Islander200661.2%55.6%67.1%449734
Asian/Pacific Islander200760.2%54.7%66.1%438728
Asian/Pacific Islander200858.2%52.9%63.9%441758
Asian/Pacific Islander200961.4%55.7%67.5%427695
Asian/Pacific Islander201055.2%50.4%60.3%488884
Asian/Pacific Islander201151.9%47.4%56.7%491946
Asian/Pacific Islander201256.8%52.2%61.7%558983
Asian/Pacific Islander201351.8%47.5%56.4%5371,036
Asian/Pacific Islander201455.8%51.4%60.3%6211,114
Asian/Pacific Islander201554.8%50.6%59.2%6291,148
Asian/Pacific Islander201655.6%51.3%60.0%6401,152
Asian/Pacific Islander201759.2%54.9%63.8%6891,164
Black200073.2%65.3%81.8%311425
Black200172.5%64.3%81.4%285393
Black200268.8%60.6%77.8%256372
Black200372.8%63.5%83.2%217298
Black200467.4%58.5%77.4%203301
Black200570.0%61.4%79.6%236337
Black200667.3%59.3%76.1%253376
Black200760.2%52.9%68.3%242402
Black200853.4%46.0%61.7%186348
Black200956.9%48.9%65.8%181318
Black201058.9%51.3%67.2%219372
Black201158.2%51.4%65.7%262450
Black201262.9%55.0%71.6%229364
Black201359.0%52.1%66.5%266451
Black201457.1%50.2%64.7%246431
Black201563.4%55.9%71.5%261412
Black201667.1%59.6%75.3%290432
Black201772.0%64.6%80.1%340472
White200074.5%72.3%76.7%4,4435,967
White200173.2%71.0%75.4%4,2165,760
White200271.3%69.1%73.5%4,0375,662
White200373.7%71.5%76.0%4,0855,543
White200472.9%70.6%75.1%4,0945,619
White200571.2%69.0%73.3%4,2585,983
White200668.5%66.5%70.6%4,3126,292
White200768.3%66.3%70.4%4,2676,245
White200864.9%62.9%66.9%4,1286,361
White200967.7%65.5%69.9%3,6695,421
White201066.0%64.0%68.1%4,0236,093
White201163.6%61.7%65.6%4,1296,491
White201266.6%64.5%68.6%4,1096,173
White201362.9%60.9%64.9%3,8396,102
White201463.9%61.9%65.9%3,8596,042
White201564.9%62.9%67.0%3,9156,032
White201668.3%66.2%70.4%4,1536,080
White201767.8%65.7%70.0%3,8175,628

Data Notes

Data for prenatal care indicators updated by Maternal and Child Health Health Epidemiology Unit (MCH-Epi), Section of Women's, Children's and Family Health in December 2018. [SAS Analysis in December 2018] Birth certificate data updated by HAVRS on November 14, 2018.   Adequacy of Prenatal Care Utilization (APNCU) index classifies the adequacy of initiation as follows: pregnancy months 1 and 2, months 3 and 4, months 5 and 6, and months 7 to 9. To classify the adequacy of received services, the number of prenatal visits is compared to the expected number of visits for the period between when care began and the delivery date. The expected number of visits is based on the American College of Obstetricians and Gynecologists prenatal care standards for uncomplicated pregnancies and is adjusted for the gestational age when care began and for the gestational age at delivery. A ratio of observed to expected visits is calculated and grouped into four categories - Inadequate (received less than 50% of expected visits), Intermediate (50%-79%), Adequate (80%-109%), and Adequate Plus (110%). The final APNCU index measure combines these two dimensions into a single summary score.^5^

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Health Analytics and Vital Records Section (HAVRS)], Division of Public Health, Alaska Department of Health and Social Services


Women who received adequate prenatal care (APNCU index), by public health regions, all Alaskans, 2013-2017 (5-year average)

::chart - missing::
confidence limits

The measure shown in the graph is women who were categorized as receiving Adequate or Adequate Plus care (APNCU index). Excludes live births with missing data on prenatal care.
Percentage of women delivering live birthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 9
Anchorage66.0%65.4%66.6%14,29321,652
Gulf Coast57.7%55.7%59.9%2,9355,083
Interior59.2%57.6%60.8%5,2708,907
Mat-Su72.3%70.2%74.4%4,7126,519
Northern54.6%51.8%57.4%1,4932,736
Southeast63.0%60.6%65.6%2,4893,949
Southwest40.0%38.1%42.0%1,6574,141
Healthy People Target77.6%
Statewide62.0%61.6%62.4%32,86553,014

Data Notes

Data for prenatal care indicators updated by Maternal and Child Health Health Epidemiology Unit (MCH-Epi), Section of Women's, Children's and Family Health in December 2018. [SAS Analysis in December 2018] Birth certificate data updated by HAVRS on November 14, 2018.   Adequacy of Prenatal Care Utilization (APNCU) index classifies the adequacy of initiation as follows: pregnancy months 1 and 2, months 3 and 4, months 5 and 6, and months 7 to 9. To classify the adequacy of received services, the number of prenatal visits is compared to the expected number of visits for the period between when care began and the delivery date. The expected number of visits is based on the American College of Obstetricians and Gynecologists prenatal care standards for uncomplicated pregnancies and is adjusted for the gestational age when care began and for the gestational age at delivery. A ratio of observed to expected visits is calculated and grouped into four categories - Inadequate (received less than 50% of expected visits), Intermediate (50%-79%), Adequate (80%-109%), and Adequate Plus (110%). The final APNCU index measure combines these two dimensions into a single summary score.^5^ Region is determined by maternal residence at birth, not site of delivery.


Women who received adequate prenatal care (APNCU index), by behavioral health regions, all Alaskans, 2013-2017 (5-year average)

::chart - missing::
confidence limits

The measure shown in the graph is women who were categorized as receiving Adequate or Adequate Plus care (APNCU index). Excludes live births with missing data on prenatal care.
Percentage of women delivering live birthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 12
Anchorage Muncipality66.0%65.4%66.6%14,29221,428
Fairbanks North Star Borough62.0%60.3%63.7%4,9017,907
City and Borough of Juneau63.4%59.8%67.1%1,1761,856
Kenai Peninsula Borough56.8%54.3%59.4%1,9283,392
Matanuska-Susitna Borough72.3%70.2%74.4%4,7126,519
Northwest Region54.6%51.8%57.4%1,4932,736
Other Interior Region42.8%39.7%46.1%7041,644
Other SE - Northern61.9%57.0%67.1%596963
Other SE - Southern63.4%58.9%68.2%7171,130
Y-K Delta Region37.1%35.1%39.3%1,1963,221
Southwest Region57.6%54.3%61.1%1,1331,967
Healthy People Target77.6%

Data Notes

Data for prenatal care indicators updated by Maternal and Child Health Health Epidemiology Unit (MCH-Epi), Section of Women's, Children's and Family Health in December 2018. [SAS Analysis in December 2018] Birth certificate data updated by HAVRS on November 14, 2018.   Adequacy of Prenatal Care Utilization (APNCU) index classifies the adequacy of initiation as follows: pregnancy months 1 and 2, months 3 and 4, months 5 and 6, and months 7 to 9. To classify the adequacy of received services, the number of prenatal visits is compared to the expected number of visits for the period between when care began and the delivery date. The expected number of visits is based on the American College of Obstetricians and Gynecologists prenatal care standards for uncomplicated pregnancies and is adjusted for the gestational age when care began and for the gestational age at delivery. A ratio of observed to expected visits is calculated and grouped into four categories - Inadequate (received less than 50% of expected visits), Intermediate (50%-79%), Adequate (80%-109%), and Adequate Plus (110%). The final APNCU index measure combines these two dimensions into a single summary score.^5^ Region is determined by maternal residence at birth, not site of delivery.


Women who received adequate prenatal care (APNCU index), by tribal health regions, all Alaskans, 2013-2017 (5-year average)

::chart - missing::
confidence limits

The measure shown in the graph is women who were categorized as receiving Adequate or Adequate Plus care (APNCU index). Excludes live births with missing data on prenatal care.
Percentage of women delivering live birthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 13
Aleutians and Pribilofs55.0%45.6%65.8%120218
Anchorage/Mat-Su67.5%66.9%68.0%19,00428,171
Arctic Slope50.7%45.5%56.4%345680
Bristol Bay46.9%42.1%52.1%349744
Copper R/Prince William Snd.52.1%46.7%57.9%340653
Interior59.2%57.6%60.8%5,2608,890
Kenai Peninsula56.9%54.3%59.5%1,9283,391
Kodiak Area64.2%59.4%69.2%6721,047
Northwest Arctic51.7%47.3%56.4%503973
Norton Sound61.0%56.4%66.0%6331,037
Southeast63.0%60.6%65.5%2,4893,949
Yukon-Kuskokwim37.3%35.2%39.4%1,2053,234
Healthy People Target77.6%

Data Notes

Data for prenatal care indicators updated by Maternal and Child Health Health Epidemiology Unit (MCH-Epi), Section of Women's, Children's and Family Health in December 2018. [SAS Analysis in December 2018] Birth certificate data updated by HAVRS on November 14, 2018.   Adequacy of Prenatal Care Utilization (APNCU) index classifies the adequacy of initiation as follows: pregnancy months 1 and 2, months 3 and 4, months 5 and 6, and months 7 to 9. To classify the adequacy of received services, the number of prenatal visits is compared to the expected number of visits for the period between when care began and the delivery date. The expected number of visits is based on the American College of Obstetricians and Gynecologists prenatal care standards for uncomplicated pregnancies and is adjusted for the gestational age when care began and for the gestational age at delivery. A ratio of observed to expected visits is calculated and grouped into four categories - Inadequate (received less than 50% of expected visits), Intermediate (50%-79%), Adequate (80%-109%), and Adequate Plus (110%). The final APNCU index measure combines these two dimensions into a single summary score.^5^ Region is determined by maternal residence at birth, not site of delivery.


Women who received adequate prenatal care (APNCU index), by boroughs and census areas, all Alaskans, 2008-2017 (10-year average)

::chart - missing::
confidence limits

The measure shown in the graph is women who were categorized as receiving Adequate or Adequate Plus care (APNCU index). Excludes live births with missing data on prenatal care.
Percentage of women delivering live birthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 30
Aleutians East Borough74.8%62.3%89.2%125167
Aleutians West CA53.8%44.9%62.8%162301
Anchorage Municipality65.0%64.6%65.5%26,66841,016
Bethel CA36.9%35.1%38.8%1,5464,187
Bristol Bay Borough40.6%28.9%55.5%3996
Denali Borough47.4%38.9%57.2%108228
Dillingham CA35.4%31.8%39.2%3581,012
Fairbanks North Star Borough59.7%58.5%60.9%9,46515,866
Haines Borough51.6%41.9%62.9%98190
Hoonah-Angoon CA45.1%36.6%55.0%97215
Juneau City and Borough65.2%62.7%67.9%2,4553,764
Kenai Peninsula Borough60.1%58.3%62.0%4,0736,775
Ketchikan Gateway Borough63.6%59.9%67.5%1,0821,701
Kodiak Island Borough68.9%65.4%72.6%1,4402,089
Kusilvak CA28.5%26.4%30.8%6632,325
Lake and Peninsula Borough58.4%50.2%67.5%181310
Matanuska-Susitna Borough72.4%70.9%74.0%8,97012,383
Nome CA53.2%50.2%56.3%1,1942,245
North Slope Borough39.0%36.0%42.1%6601,694
Northwest Arctic Borough43.4%40.4%46.4%8191,889
Petersburg Borough55.0%47.3%63.6%182331
Prince of Wales-Hyder CA44.8%40.1%49.9%335743
Sitka City and Borough75.1%69.7%80.7%735979
Skagway Municipality52.0%38.7%68.4%5198
Southeast Fairbanks CA37.5%33.9%41.3%4001,067
Valdez-Cordova CA50.8%46.8%54.9%6101,202
Wrangell City and Borough53.7%44.6%64.2%122227
Yakutat City and Borough46.0%31.8%64.2%3474
Yukon-Koyukuk CA35.8%31.9%40.2%296826
Healthy People Target77.6%

Data Notes

Data for prenatal care indicators updated by Maternal and Child Health Health Epidemiology Unit (MCH-Epi), Section of Women's, Children's and Family Health in December 2018. [SAS Analysis in December 2018] Birth certificate data updated by HAVRS on November 14, 2018.   Adequacy of Prenatal Care Utilization (APNCU) index classifies the adequacy of initiation as follows: pregnancy months 1 and 2, months 3 and 4, months 5 and 6, and months 7 to 9. To classify the adequacy of received services, the number of prenatal visits is compared to the expected number of visits for the period between when care began and the delivery date. The expected number of visits is based on the American College of Obstetricians and Gynecologists prenatal care standards for uncomplicated pregnancies and is adjusted for the gestational age when care began and for the gestational age at delivery. A ratio of observed to expected visits is calculated and grouped into four categories - Inadequate (received less than 50% of expected visits), Intermediate (50%-79%), Adequate (80%-109%), and Adequate Plus (110%). The final APNCU index measure combines these two dimensions into a single summary score.^5^ Region is determined by maternal residence at birth, not site of delivery.

References and Community Resources

'''References:''' 1. Calculations | PeriStats | March of Dimes. [http://www.marchofdimes.org/peristats/calculationsp.aspx?id=23]. Accessed October 12, 2018. 2. DeVoe, Baez A, Angier H, Krois L, et al. Insurance plus Access Does not Equal Health Care: Typology of Barriers to Health Care Access for Low-Income Families. Ann Fam Med. 2007;5(6):511-518. [http://www.medscape.com/viewarticle/567154] Accessed September 14, 2018. 3. Young MB, Perham-Hester KA, Kemberling MM. Alaska Maternal and Child Health Data Book 2011: Alaska Native Edition. Anchorage, AK: A collaboration of the Alaska Department of Health and Social Services, Division of Public Health, and the Alaska Native Tribal Health Consortium, Alaska Native Epidemiology Center. October 2011. [http://anthctoday.org/epicenter/publications/prams/pramsFullVersion.pdf] Accessed September 14, 2018. 4. Newby-Kew AJ, DeLozier DP, Prince CB, Perham-Hester KA, Young MB. Alaska Maternal and Child Health Data Book 2014: Life Course Edition. Anchorage, AK. Maternal and Child Health Epidemiology Unit, Section of Women's, Children's, and Family Health, Division of Public Health, Alaska Department of Health and Social Services, September 2014. [http://dhss.alaska.gov/dph/wcfh/Documents/mchepi/pubs/databook/MCHDataBook2014toweb.pdf]. Accessed October 12, 2018. 5. Alaska Department of Health and Social Services, Division of Public Health, Health Analytics and Vital Records Section. Alaska Vital Statistics 2017 Annual Report. [http://dhss.alaska.gov/dph/VitalStats/Documents/PDFs/VitalStatistics_Annualreport_2017.pdf]. Accessed November 13, 2018. '''Resources:''' Alaska Department of Health and Social Services, Division of Public Health, Health Analytics and Vital Records Section. Alaska Vital Statistics 2017 Annual Report. [http://dhss.alaska.gov/dph/VitalStats/Documents/PDFs/VitalStatistics_Annualreport_2017.pdf].

More Resources and Links

Alaska and national goals may be found at the following sites:

Alaska health promotion resources may be found at the following site:

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Maps of health indicators for various subdivisions of Alaska may be found at the following site:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

AK-IBIS Web Citation

Use and reproduction of the information published on this website are encouraged and may be done without permission. The following citation should accompany information from this website whenever it is used, reproduced, or published:

AK-IBIS Indicator Citation:
"[Indicator name]. Retrieved on [insert date] from Alaska Department of Health and Social Services, Indicator-Based Information System for Public Health (AK-IBIS) website: http://ibis.dhss.alaska.gov/.

Example:
Diabetes Prevalence. Retrieved on March 25, 2016, from Alaska Department of Health and Social Services, Indicator-Based Information System for Public Health (AK-IBIS) website: http://ibis.dhss.alaska.gov/.

Page Content Updated On 02/14/2019, Published on 02/14/2019
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Fri, 23 August 2019 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Thu, 14 Feb 2019 13:26:09 AKST
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Fri, 23 August 2019 16:00:39 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information System for Public Health Web site: http://ibis.dhss.alaska.gov/ ".

Content updated: Thu, 14 Feb 2019 13:26:09 AKST