Maternal and Infant Health Program Maternal and Infant Health Program

  SLC area: (801) 273-2871

  SLC area: (801) 274-0674

  Maternal and Infant Health Program
  P.O. Box 142002
  Salt Lake City UT


Prams Logo

What is PRAMS?

PRAMS, the Pregnancy Risk Assessment Monitoring System, is a surveillance project of the Centers for Disease Control and Prevention (CDC) and state health departments. PRAMS was initiated by the CDC in 1987 because infant mortality rates were no longer declining as rapidly as they had in prior years. In addition, the incidence of low birth weight infants had changed little in the previous 20 years. PRAMS is an ongoing, state-specific, population-based surveillance system designed to identify and monitor selected maternal experiences and behaviors prior to, during, and immediately following pregnancy among a stratified sample of mothers who have recently given birth to a live infant.

As of 2001, there are 31 states conducting PRAMS surveillance. PRAMS surveillance in Utah began in May 1999.

What is the purpose of PRAMS?

The goal of the Utah PRAMS project is to reduce infant morbidity and mortality by influencing maternal experiences during and immediately after pregnancy. Four specific objectives to achieve this goal are:

  • To collect population-based data of high scientific quality on topics related to pregnancy and early infancy
  • To conduct comprehensive analyses to better understand the relationships between behaviors, attitudes, and experiences during and immediately after pregnancy
  • To translate results from analyses into information for planning and evaluating public health programs and policy
  • To build the capacity of states to collect, analyze, and translate data to address relevant public health issues

Why is PRAMS important?

The Utah PRAMS project provides data for public health officials to use to improve the health of mothers and infants.

PRAMS enhances information from birth certificates and is used to plan and review state maternal and infant health programs.

PRAMS allows CDC and the states to monitor changes in maternal and child health indicators (e.g. unintended pregnancy, prenatal care, breast-feeding, smoking, drinking, infant health).

Maternal and infant health data can be compared among other participating states as the same data collection methods are used in all states.

 Why is it important to conduct PRAMS in Utah?

  • Utah has the highest fertility rate in the nation and often there is close spacing of children.1
  • In Utah, the general fertility rate in 1999 was 92.8 (the number of live births per 1000 women 15-44 years of age) compared to 65.8 nationally.1
  • Historically, Utah’s crude birth rate (the number of births per 1,000 population in a given year) has also been among the highest in the nation. In 1999, Utah’s crude birth rate was 21.8 compared with the national rate of  14.5.1
  • In Utah, low birth weight (LBW) rates and very low birth weight rates (VLBW) are experiencing an increasing trend (as is national).1
  • The incidence of LBW in Utah was 6.8% and 1.0% for VLBW in 1999.1 The Healthy People 2010 objective for LBW is to reduce the incidence to no more than 5% of live births and very low birth weight (VLBW) to no more than 1% of live births.

How does PRAMS work?

Every month, a systematic stratified sample of approximately 200 new mothers are selected from birth certificates. In Utah, the sample is stratified by birth weight and race in order to over-sample these populations.

PRAMS is a mixed mode surveillance system. The primary data collection method is by mail and the secondary method is by telephone. Approximately one out of every 18 new Utah mothers will be selected to participate in the PRAMS project.

Two to four months after delivery an explanatory letter that introduces the project is mailed to each woman in the sample. A questionnaire is mailed a week later. A second and third questionnaire are mailed to those who do not respond. A health research agency will then telephone mothers who have not responded to the mailings. Following this CDC developed protocol, a 70% response rate is expected. The responses are then weighted to be representative of all women giving birth in Utah.

What information does PRAMS collect?

The questionnaire consists of a core component used by each of the participating states and a state-specific component developed to address each state’s particular data needs. The questionnaire, which is comprehensive and contains topics not available elsewhere, includes the following:

  • Attitudes and feelings about the most recent pregnancy
  • Barriers to and content of prenatal care
  • Use of alcohol and tobacco before and during pregnancy
  • Physical abuse before and during pregnancy
  • Psychosocial support and stress
  • Infant’s early development, health care, sleep position, and exposure to passive smoke
  • Mother’s knowledge of pregnancy-related health issues, such as adverse effects of tobacco and alcohol; benefits of folic acid; and the risks of HIV
  • Maternal living conditions
  • Health insurance coverage

Data Analysis

Analysis of PRAMS data began after on full year of data was collected and birth certificate data were submitted to the CDC. The data was then weighed by the CDC and returned to Utah.

The PRAMS Perspectives Quarterly Newsletter provides important information about Utah mothers for health care providers and policy makers. The newsletter address specific topics such as unintended pregnancy in Utah, Medicaid funded pregnancy in Utah, low birth weight, and maternal characteristics and outcomes of teen pregnancy.

The following PRAMS Perspectives newsletters can be viewed in PDF format:

Barriers to Adequate Prenatal Care in Utah
Unintended Pregnancy in Utah
Tobacco Use Before, During, or After Pregnancy
Prenatal Education in Utah
Breastfeeding in Utah
Preterm Birth in Utah
Utah PRAMS Data Book 00 - 01
Maternal Prepregnancy Body Mass Index and Pregnancy Outcomes in Utah
Domestic Violence in Utah

How can data from PRAMS be used?

Findings from analyses of PRAMS population-based data can be generalized to an entire state’s population of women whose pregnancies resulted in a live birth. Findings from analyses of PRAMS data have been used in important ways:

  • To enhance understanding of maternal behaviors and experiences and their relationship to adverse pregnancy outcomes
  • To develop and implement new maternal and child health programs and to modify existing programs
  • To influence public health policy
  • To assist health professionals in incorporating the latest research findings into their standards of practice
  • To monitor progress towards local, state, and national health objectives and goals

What Surveyed Mothers Say…

"Thank you for caring".

"I think this is a great idea. I hope it will help to make mothers and babies healthier in the future".

For additional information…

If you have any questions or would like additional information about PRAMS, please call Joanne Barley, Utah PRAMS Operations Manager in the Salt Lake metro area at 273-2871 or our toll-free number at

Or write to us at:

Utah Department of Health
Maternal and Infant Health Program
Attention: Barbara Algarin, PRAMS Operations Manager
P.O. Box 142002
Salt Lake City, Utah 84114-2002
Fax: 801-274-0674


  1. Bureau of Vital Records, Utah Department of Health.