



Advocates express satisfaction at the improvement, but warn that efforts need to continue to keep trend continuing.

By Rose Hoban

Fewer newborns and infants died last year in North Carolina than ever before, as the infant mortality rate hit a historic low of 7.0 per 1,000 live births.

The most recent rate is the continuation of an overall trend that advocates said is the result of years of efforts to address North Carolina’s stubbornly high rate of infant deaths.

“It’s definitely going in a much better direction than last year,” said Sarah Verbiest, head of the Center for Maternal and Infant Health at UNC-Chapel Hill.

The past two years’ rates, which climbed up from 7.0 per 1,000 in 2010 were disturbing upticks in what has been a mostly steady decline in the infant mortality rate since the late 1980s, when North Carolina had the highest infant mortality rate in the country.

“These are not fall-off-your-chair results, but it turned us around from the blip last year that kept me awake some,” Verbiest said.

The rate for African-American infant deaths is also at an all-time low of 12.5 per 1,000 live births. But even with the improvement, death rates for black children remains more than twice as high as that for white children.

White infants die at a rate of 5.5 per 1,000, a number that’s remained roughly the same for about five years.

“We have a disproportional number of deaths for African-American infants and in the rural population, particularly in the east,” said Karen McLeod, a child health advocate who leads the legislative Child Fatality Task Force. “Those are areas we know we need to work on.”

Latino babies die at the lowest rate of any ethnic grouping in North Carolina, with an infant mortality rate of 3.7 per 1,000. Meanwhile, at 11 deaths per 1,000 live births, American Indian rates almost match those of African-Americans.

Bellwether

Verbiest explained that infant mortality is seen in public-health circles as a symbolic indicator of larger issues.

“[Infant mortality] is used globally as an indicator of the overall health of women and children,” she said.

Verbiest said there have been some improvements to the care for women and children, namely, the establishment of “pregnancy medical homes” for pregnant women receiving Medicaid. The medical homes coordinate care for pregnant women, helping them carry their babies to full term and helping women improve their health during pregnancy.

“Before the establishment of the pregnancy medical homes, our OB/GYNs didn’t have strong ties to one another,” she said. Community Care of North Carolina, the program that manages many of the state’s Medicaid patients, coordinates care and keeps providers informed on best practices.

“It’s laying the groundwork for improved infant mortality numbers in the future,” Verbiest said.

“The health of women before, during and after pregnancy directly influences the health of their infants,” said Penny Slade-Sawyer, director of the state Division of Public Health, in an email statement. “We look forward to continue working with our partners across the state to further these initiatives.”

More work to come

Verbiest said the easy interventions to improve the infant mortality rate have already been done and now advocates and policymakers need to look at societal issues that contribute to high infant mortality rates.

“We need to look at the social determinates of health, things like racism and poverty and working conditions for women; we can’t just look at the easy interventions like clinical care,” she said, noting that research is showing that the structure of a community contributes to a baby’s well-being.

“We need to support fathers and create supportive communities that can welcome children into healthy families. We also need to look at policies around working moms,” Verbiest said.

McLeod said there’s no one quick fix to decrease the number of infant deaths.

“It’d be great if you had one trick horse that you have to train, but it doesn’t work that way,” she said.

Both noted that North Carolina’s rate is still in the bottom fifth of all states in the U.S. Other states are also doing work to improve their rates.

“It’s not a time for us to drop our vigilance,” McLeod said. “My concern is that people will think it’ll naturally keep continuing in [the right] direction, but that’s not been the case in the past. We have to keep doing this work and doing it better.”