By Philip Rucker
Washington Post Staff Writer
Thursday, June 19, 2008; HO09

Maryland's rate of teenagers giving birth and the number of children dying have fallen in the past five years, helping the state boost its standing in a national ranking of children's well-being from 24th last year to 19th this year.

But children's health advocates said they are troubled that Maryland -- the wealthiest state in the nation, according to U.S. Census Bureau estimates -- remains mired in the middle of the pack of the 50 states and the District in the annual Kids Count study.

The report, released annually by the Baltimore-based Annie E. Casey Foundation, measures the well-being of U.S. children in 10 categories, including high school dropout rates, infant mortality and babies with low birth weight.

In most categories, Maryland's ratings this year were stagnant. The state's standings did not fall significantly in any category, and the state showed improvement in some areas. The infant mortality rate fell from 8.4 deaths per 1,000 live births to 7.3. The national average is 6.9.

Maryland's high school dropout rate fell from 11 percent five years ago to 6 percent, mirroring a decline nationally, the report said.

"This year, Maryland continued to see an increase in the overall well-being indicators," said Laura Beavers, national Kids Count coordinator. "Things are getting better in Maryland overall."

But although Maryland is ranked first for having the lowest percentage of children in poverty, the state is among the nation's worst in other indicators, such as the percentage of babies with low birth weight.

"Although Maryland is a wealthy state, there's still a lot of room for improvement as far as overall well-being goes," Beavers said. "I think it points also to some of the income disparities in the state, that there are certainly pockets of extreme wealth and pockets of extreme poverty in Maryland."

Matthew Joseph, executive director of Advocates for Children and Youth, a Maryland nonprofit organization, said he is disappointed with the state's ranking in the report, despite its gains.

"We're in a uniquely disappointing position, with our children not doing nearly as well as the wealth of our state would predict," he said.

He said some communities in Maryland, especially Prince George's County and Baltimore, have "extraordinary barriers for pregnant women getting access to care." Joseph said the situation could be improved if the state reassessed the way it allocates funds in these areas.

"Maryland is spending a lot of money on services for children, but those services are generally to address problems long after they have occurred, and not to prevent them from occurring in the first place," Joseph said. "States that are getting better outcomes, even with tougher populations, they're spending much more on the front end."

The percentage of newborns weighing less than 5.5 pounds, who are at greater risk of dying in infancy or having long-term problems, increased in Maryland over the past five years, from 8.6 percent to 9.1 percent, according to the study. The national average is 8.2 percent.

Beavers said it is crucial to improve the health of women who are of childbearing age, even before they become pregnant.

"We've found that the research is showing that there's really a connection between rates of obesity in women, diabetes, exposure to environmental toxins, things like that that have got a negative impact on babies," Beavers said.

To advance in the rankings, Maryland will have to address "the gap between the people who have the resources and those who don't," said Lori Kaplan, executive director of the Latin American Youth Center, which serves residents of the District and Montgomery and Prince George's counties.

"It ranks in the middle, when it could be ranking at the top," Kaplan said. "In order to get to the top, we're going to have to address some of the issues, the low-income and perhaps the immigrant and African American, multicultural communities that are not always able to take advantage of the rich opportunities the state offers."