Adverse Childhood Experiences Among Wisconsin Mothers Data Dashboard

The Wisconsin Pregnancy Risk Assessment Monitoring System (PRAMS) collects information from people about their attitudes and experiences before, during, and after pregnancy.

The end of the PRAMS survey asks, "We would love to hear more about your story! Is there anything else you would like to share with us about your experiences around the time of your pregnancy?"

Many mothers share their thoughts and stories. These comments provide valuable insights into many maternal health topics, including severe maternal morbidity.

Many mothers in Wisconsin report economic stress and a lack of workplace supports both during and after pregnancy. Providing economic supports for families, including family friendly workplace policies like paid family leave and child care contributions, is a key strategy to prevent ACEs.

“Went through a domestic violence situation that put me behind on bills after I had the baby without having paid maternity leave and also felt like I couldn’t take off of work no matter how strenuous it was on me because of needing to pay bills before baby was born but couldn’t make enough to save up.”

“I wish insurance would cover more costs for pregnancies. I had a very high deductible and nothing was covered until I met the deductible. This was very hard to do when I have other bills to pay for on top of getting ready for my first child. Creating a human being should not have to be a stress for mothers to seek healthcare to make sure their baby is healthy just because they can't afford it. Creating lives is a gift, it shouldn’t be taken away from any female due to the fact of not affording it or having the insurance.”

“After having baby number two, finding childcare has been absolutely horrific. When Child Care Counts was cut, it truly affected our local center - prices skyrocketed. They want $430 A WEEK for our infant to attend. Once we are able to get our new baby into childcare, we are going to be living paycheck to paycheck. It’s sad for those of us who are considered ‘middle class wealthy’. We make enough so we can’t receive support from Wisconsin Access, or other programs but we are suffering just as much as other people who might only make 80/90K a year. It’s sad, and the reason we cannot afford any more kids (as we would have loved to have one more).”

“Going back to work at 12 weeks does not support exclusively breast fed babies. My baby struggles to take a bottle, so being away at work adds to the stress when baby is not eating well. Maternity leave needs to be better in the US. Moms and families need more support. My maternity was partially covered by short term disability and my PTO, which ran out 4 weeks before returning to work, meaning I no longer was being paid. Looking at other countries, the United States is pretty sad in terms of supporting young families having babies. It is not surprising that postpartum depression is so high, maternal and neonatal mortality is high, and exclusive breastfeeding is poor.”

“I wasn't able to receive [any] prenatal care while pregnant until the 20 week of my pregnancy because I could not find a doctor who would accept my Medicaid who as available. I would make an appointment and like 2 days before the appointment, the receptionist would call me and say they do not accept my insurance. I couldn't get any appointments. And all the Medicaid doctors were booked until next year. I had to drive really far to the appointment. I had to rely on store-bought prenatal vitamins and the internet.”

Mothers also noted the importance of supportive programs and care for new mothers and parents to reduce economic burden and support families.

“I do want to make note that for myself, and for many women in my family, Badgercare, state insurance, and/or Medicaid was essential in being able to afford pre and postnatal care as well as afford the cost of labor and delivery, and all the wellness checks for baby after they were born. I'm grateful we were able to qualify even though our income was slightly over the 'poverty' level and I hope all women in Wisconsin continue to get proper healthcare with Medicaid when needed during pregnancy.”

“I believe mental healthcare should be more available and accessible for both the mother and father, especially for first time parents, during and after pregnancy. I believe this would greatly help improve the quality of care the baby gets and help keep parents together.”

Preventing ACEs requires understanding and addressing the factors that affect their risk of experiencing violence.

Creating safe, stable, nurturing relationships and environments helps support new families, mothers, and children. A whole family, whole child approach includes services and supports for both the parent (who experienced ACEs in her childhood) and child. These resources can help prevent parents with ACEs heal and reduce their child’s risk of ACEs. Supports for parents should include resources to help the parent to heal and cope with trauma, time and resources to build a nurturing relationship with their child, and policies to reduce economic-related stress.

The Wisconsin Maternal Mortality Review Team (MMRT) reviews all deaths that occur during or within one year of the end of pregnancy. The team is composed of experts who represent organizations involved in the care of pregnant and postpartum people in Wisconsin. The MMRT makes recommendations for each pregnancy-related, preventable death. These recommendations are intended to prevent future similar deaths. MMRT recommendations address several topics, including ACEs and childhood trauma.

Many recommendations focus on recognizing and addressing ACEs and trauma in the medical setting to ensure patients have the care and support they need to heal from trauma.

• Health systems and community partners should provide support services, screen for substance use, and offer mental health counseling that is trauma informed to anyone with a history of sexual assault or adverse childhood experiences.
• Facilities should assign social workers to patients who are high risk and have a history of trauma to help them in navigating care systems.
• All levels of medical education should enforce training in trauma informed, non-biased care.
• Providers should connect pregnant people who have depression and/or history of trauma to culturally appropriate mental health services beyond medication treatment as soon as they are diagnosed.
• Providers should screen all patients for abuse and trauma during regular visits and provide referral to resources and wrap around services when necessary.

Other recommendations focus on changes at the system level to provide education and funding to address ACEs and trauma as their long-term impacts.

• Governmental agencies should continue to provide and prioritize funding to support positive youth development activities, mentorship programs, and resilience building activities in order to help families heal from and prevent future adverse childhood experiences over the life course.
• Schools should provide curriculum addressing violence prevention alongside other counseling classes and health classes throughout childhood education. This should include healing from ACEs/trauma.
• Community agencies and health care systems need to establish resources and ongoing counseling for victims of childhood trauma.
• Insurance payors and Centers for Medicare & Medicaid Services should support community based interventions and incentivize whole person, trauma informed care.

Data definitions

The first chart in the dashboard displays the percentage of mothers who have had specific types of ACEs. Each experience occurred before the age of 18.

Definitions of these experiences include the following:

• Physical abuse: Hit, beat, kicked or physically hurt in any way by a parent or adult in the home
• Emotional abuse: Sworn at, insulted, or put down by a parent or adult in the home
• Sexual abuse: Made to do sexual things (such as kissing, touching, or having sexual intercourse) by an adult or person at least five years older
• Neglect: Had no adult in the household who tried to make sure basic needs were meet
• Parental incarceration: Separated from a parent or guardian because they went to jail, prison, or a detention center
• Living with someone with mental illness: Lived with someone who was depressed, mentally ill, or suicidal
• Living with someone who struggled with substances: Lived with someone who had a problem with alcohol or drugs
• Witnessing domestic violence: Parents or adults in the home slapped, hit, kicked, punched or beat each other up

ACE Score: The total number of adverse experiences someone has before age 18.

Maternal health experiences: The third chart in the dashboard displays experiences the mother had around the time of pregnancy.

• Breastfed for eight weeks or more: Mother reported breastfeeding or feeding pumped milk to infant for at least eight weeks
• Gestational diabetes: Mother reported that a healthcare provider ever told her she had gestational diabetes
• Gestational hypertension: Mother reported that a healthcare provider ever told her she had high blood pressure that started during pregnancy
• Low birthweight: Baby’s birthweight (of PRAMS respondent) recorded as less than 2,500 grams on the birth certificate
• Postpartum anxiety symptoms: Mothers reported Always or Often feeling nervous, anxious, or on edge or being unable to stop or manage worrying since the birth of the baby.
• Postpartum depressive symptoms: Mother reported Always or Often feeling down, depressed, or hopeless or having little interest or pleasure doing things since the birth of the baby.
• Postpartum visit: Mother reported a regular health checkup up to 12 weeks after giving birth.
• Tdap vaccine during pregnancy: Mother reported receiving a Tdap shot (protects against tetanus, diphtheria, and pertussis [whooping cough]) during pregnancy.

Regions and urban vs rural counties

The maps in the dashboard show data based on where an individual lived at the time of their delivery. Urban versus rural counties are defined by the Wisconsin Office of Rural Health. Regions are defined by the Division of Public Health to align with the division’s regional offices.

Insurance

Insurance is defined at the time of delivery based on the primary source of payment listed within the hospital health care record.

Race and ethnicity

The race and ethnicity groupings used in the dashboard are not mutually exclusive, meaning that a person may be included in multiple groups. American Indian or Alaska Native includes everyone who identified as American Indian or Alaska Native, including those who also identified as Hispanic or another race. Hispanic includes everyone who identified as Hispanic.

Other data concepts

Percentages

The data in this dashboard are shown as percentages. A percentage represents a fraction of a whole where the whole equals 100. As an example, this dashboard tells us that 39.9% of Wisconsin mothers had zero ACEs according to 2023 data. The population of all Wisconsin mothers or people who gave birth represents the whole. If the population of all Wisconsin mothers was 100 people, then 39.9 people have zero ACEs.

While it is commonly understood that percentages add up to 100, the percentages shown within each graph in this dashboard do not always add up to 100. Specifically in the first chart, this is because mothers had the opportunity to select multiple ACEs meaning the percentages are not mutually exclusive.

Confidence intervals

Hovering over a data point within the dashboard gives a pop-up box with an interpretation of that data point. The pop-up box also gives two numbers that represent the 95% confidence interval. While a data point is the best estimate of the truth based on the information available, we cannot know with certainty that it is the true value for the entire population. A confidence interval is a range of numbers that likely contain the true value. The range of a confidence interval is impacted by the number of people included in the data, how much each person’s data differs from others, and the level of certainty that the range contains the true value (in this case, 95% certain).

ACEs may differ across populations due to differences in several factors, including social and environmental factors. The University of Wisconsin Population Health Institute’s Model of Health shows how community conditions impact health. It is important to remember that blame for ACEs or adverse health outcomes should not be placed on the individuals or populations who experience them.

ACE scores vary between population groups due in part to differing levels of stress experienced by different communities. Higher levels of stress are more likely among those living in environments shaped by segregation, underinvestment in neighborhoods and communities, and unequal exposure to poverty and crime. Fewer community assets, such as access to medical services, mental health services, and other social services, can also increase the risk of experiencing ACEs.

Data sources, including the ones used to create this data dashboard, may be limited in their ability to show data for all populations or for smaller geographies. Additional maternal health data may be also available that is not shown on the data dashboard.

If you have any questions around maternal health data or would like to request data, email DHSFHSData@dhs.wisconsin.gov.

Additional data and information related to maternal, infant, child, and adolescent health can be found on the Family Health Data webpage. This webpage contains resources that are freely available from state and national data sources. You will also find a guide for using WISH (Wisconsin Interactive Statistics on Health) to show you how to do your own data queries on a wide-range of health indicators in our state and communities.