Survey Sources and Methods
Using the 50 largest cities in the country based on current U.S. Census Bureau population estimates, we analyzed the most recent statistics available at the time of the survey, which was conducted from June 2006 through October 2006. We assessed cities on the basis of 50 weighted categories (see below) recommended by Fit Pregnancy Advisory Board experts. The data we used were specific to each city except when statistics were available only for an entire metropolitan area or state. Averages, where cited, refer to the average for our 50-city sample unless otherwise specified.
Picking the Winners: What We Measured
Affordability
Housing affordability, as measured by ratio of median home price to median income
Daily hospital room cost
Doctor office visit cost
Laws affecting paid maternity leave, disability leave, paid and unpaid medical family leave
Child- and dependent-care tax provisions
Maternal and Infant Health Risk
Air quality
Access to specialty retailers of healthy/organic foods and vitamins
Percentage of women who receive late or no prenatal care
Percentage of women who smoke during pregnancy
Maternal mortality rate per 100,000 live births
Infant mortality rate per 100,000 live births
Percentage of babies born with low birth weight
Percentage of babies born preterm
Percentage of live births by C-section
Percentage of VBAC (vaginal birth after Cesarean) births
Laws requiring screening of newborns for nine treatable disorders as recommended by the March of Dimes
Breastfeeding
Access to lactation consultants
Access to breastfeeding-support stores
Proximity to Baby-Friendly Hospitals (those that meet UNICEF/WHO standards for supporting breastfeeding)
Laws supporting a mother's right to breastfeed or pump in public, including workplaces; laws excusing breastfeeding mothers from jury service
Percentage of mothers who initiate breastfeeding
Percentage of mothers breastfeeding at 6 months
Birthing Options
Access to doulas
Access to midwives
Percent of births attended by midwives
Proximity to National Association of Childbearing Centers member center
Proximity to accredited childbirth center
Stroller Friendliness
Climate
Access to pathways and trails
Park acreage per city population
Number of public parks per city population
Fertility Laws/Resources
Access to fertility clinics
Access to fertility specialists
State laws affecting health insurance coverage for infertility
Access to Hospitals/Doctors
Access to OB-GYNs
Access to neonatal intensive care units (NICUs)
Access to hospitals with dedicated birthing rooms
Access to children's hospitals
Access to perinatal pediatricians
Legislation affecting cord-blood education and research
Safety
Property crime rates
Violent crime rates
Pedestrian fatality rate
Availability of car seat check stations
Child Care
Ratio of licensed home day cares to children under 4
Ratio of licensed child-care centers to children under 4
Comparison of laws mandating ratio of caregivers to infants less than 9 months in licensed day-care centers
Comparison of laws requiring background checks for caregivers
Traffic congestion during commute hours
Number of family-friendly employers
OUR SOURCES
American Academy of Pediatrics
http://www.aap.org/
American Association of Birth Centers
http://www.birthcenters.org
American College of Nurse-Midwives
http://www.acnm.org/
American College of Obstetricians and Gynecologists
http://www.acog.org/
American Fertility Association
http://www.theafa.org/
American Hospital Association
http://www.aha.org/aha/index.jsp
American Medical Association
http://www.ama-assn.org/
Annie E. Casey Foundation
http://www.aecf.org/
City parks and recreation departments
Commission for the Accreditation of Birth Centers
http://www.birthcenters.org/open/bca/whatis.php
Cord Blood Registry
http://www.cordblood.com/
DONA International
http://www.dona.org/
Federal Bureau of Investigation Uniform Crime Reporting Program
http://www.fbi.gov/ucr/ucr.htm
International Board of Lactation Examiners
http://www.iblce.org/old/
La Leche League International
http://www.lalecheleague.org/
March of Dimes
http://www.marchofdimes.com/
National Association of Realtors
http://www.realtor.org
National Association of Children's Hospitals and Related Institutions
http://www.childrenshospitals.net/
National Center for Children in Poverty, Columbia University
http://www.nccp.org/
Mailman School of Public Health
http://www.mailman.hs.columbia.edu/
National Center for Health Statistics
http://www.cdc.gov/nchs/
National Conference of State Legislators
http://www.ncsl.org/
National Highway Traffic Safety Administration
http://www.nhtsa.dot.gov/
National Newborn Screening and Genetics Resource Center
http://genes-r-us.uthscsa.edu/
National Weather Service
http://www.nws.noaa.gov/
National Women's Law Center
http://www.nwlc.org/
ReferenceUSA
http://www.referenceusa.com/
UNICEF/World Health Organization Baby Friendly Hospital Initiative
http://www.unicef.org/programme/breastfeeding/baby.htm
U.S. Census Bureau
http://www.census.gov/
U.S. Centers for Disease Control and Prevention Assisted Reproductive Technology Success Rates and Fertility Clinic Reports
http://www.cdc.gov/ART/index.htm
U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR)
http://www.cdc.gov/mmwr/
U.S. Centers for Disease Control and Prevention National Immunization Program
http://www.cdc.gov/nip/
U.S. Centers for Disease Control and Prevention National Vital Statistics Reports
http://www.cdc.gov/nchs/products/pubs/pubd/nvsr/nvsr.htm
U.S. Department of Health and Human Services, Administration for Children and Families
http://www.acf.hhs.gov/
U.S. Environmental Protection Agency
http://www.epa.gov/
The Urban Institute
http://www.urban.org/
Research conducted exclusively for Fit Pregnancy by RFG Research.
http://www.rfgresearch.com/
Special thanks to Fit Pregnancy Advisory Board members Connie L. Agnew, M.D.; Jay N. Gordon, M.D., F.A.A.P.; Wendy Haldeman, M.N., R.N., C.L.C.; and Corky Harvey, M.S., R.N. C.L.C.; as well as to the Maternity Center Association; www.maternitywise.org/ and Julie Tupler, R.N.
