Hawai'i ranked second nationally in percentage of total births to mothers with less than 12 years of education — 9.2 percent versus 21.5 percent nationally, and sixth in the percentage of mothers who smoked during pregnancy — 7.1 percent versus 11.4 percent nationally.

That's a significant improvement from 1990, when 12.5 percent of Hawai'i's mothers smoked during pregnancy, according to the Right Start report.

"We've had a lot of education in this area and that's paying off," said Momi Kama'u, chief of the state Department of Health's Maternal & Child Health Branch.

The state has a variety of anti-smoking programs aimed at pregnant women and mothers, and just last month, the Healthy Mothers Healthy Babies Coalition of Hawai'i launched the Hawai'i Perinatal Smoking Cessation Warmline to help link providers and consumers to resources on smoking and pregnancy.

The Right Start report shows Hawai'i also did well in terms of teen moms, ranking 11th with 8.9 percent of babies — or 1,555 infants — born to women under the age of 20 in 2002. That compares with 10.8 percent nationally.

The state scored in the middle of the pack in the percentage of births to teens who were already mothers, percentage of births to unmarried women, and percentage of births to mothers who received late or no prenatal care.

From 1990 to 2002, the percentage of babies born to unmarried mothers in Hawai'i increased from 24.8 percent to 33.6 percent, reflecting a national trend, according to the Right Start report.

Hawai'i ranked 34th and 45th, respectively, in low-birthweight (under 5.5 pounds) babies, 8.3 percent, and premature births, 13.7 percent.

Nancy Partika, executive director of the nonprofit Healthy Mothers Healthy Babies Coalition, said risk factors for premature and low-birthweight babies include substance abuse, smoking, and chronic conditions such as diabetes, which afflicts certain ethnic groups in Hawai'i at a much higher rate.

Kama'u also said more older women are having babies, increasing the risk of low birthweight or premature birth. Also, Partika noted that fertility treatments have increased the number of multiple births, which also a risk factor.

Access to healthcare and ethnicity also are considered risk factors. For example, Hawaiians and Filipinos have higher rates of premature and low-birthweight babies. But in a large number of cases, there is no identifiable cause, Partika said.

"It is still not as well understood as it should be," she said.

Honolulu, with 4,700 births in 2002, did considerably better when ranked among the 50 largest U.S. cities, finishing in the top seven in four of the eight indicators for maternal characteristics and birth outcomes, including percentage of births to teen mothers, births to unmarried moms, and births to mothers with less than 12 years of education.

The Honolulu numbers suggest that mothers in rural areas and on the Neighbor Islands aren't faring as well.

Partika said access to family planning and prenatal care may be an issue in these regions, where services may not be widely available or are difficult to reach because of inadequate transportation.

Reach Christie Wilson at cwilson@honoluluadvertiser.com or (808) 244-4880.