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Child-health advocates work all year to determine the best policies to improve the health of North Carolina’s youngest citizens.
By Rose Hoban
Medication to prevent preterm births, a service to help pregnant women quit smoking, funding for a high-risk pregnancy clinic in Greenville: What all the above have in common is that advocates for children are asking lawmakers to fund these programs and four others intended to promote healthy birth outcomes during this year’s short legislative session.
Throughout the legislative interim, members of the North Carolina Child Fatality Task Force gather several times a month to puzzle out ways to help kids in North Carolina be healthier. Along with lawmakers, the group convenes researchers, policy experts and people who are practicing medicine to talk about ways to do so.
This year, that process resulted in a handful of priorities that take aim at North Carolina’s dismal infant-mortality rate. And even though 2014 is shaping up to be a challenging budget year, task force chair Karen McLeod said she thinks lawmakers will find ways to fund the seven initiatives in the “baby bundle.”
“What we’ve been telling lawmakers is that there’s no silver bullet” to bringing down the infant-mortality rate, McLeod said. “It’s no one thing; instead, it’s the combination of things that we’ve seen ultimately move the needle on poor perinatal outcomes.”
North Carolina’s infant-mortality rate ranks about 45th in the nation, with a marked difference in outcomes for whites versus outcomes for blacks.
In 2012, 883 babies died in North Carolina before their first birthdays, giving the state an infant-mortality rate of 7.4 deaths per 100,000 births. For blacks, the rate was 13.9 deaths per 100,000 births, more than twice the rate for whites: 5.5 per 100,000 births.
Competition for dollars
McLeod said she knows that the $1.7 million to cover the services in the baby bundle is a difficult request in a year in which there’s a $445 million budget shortfall. But her argument is that preventing problems in the first year of life saves money down the road. According to data collected by East Carolina University, the cost of hospitalization for a very preterm baby is upwards of $300,000.
“We’re focusing on what we thought would bring the best return on investment for state dollars,” McLeod said. “When there are limited funds available, we had to be super focused on the evidence that showed what would bring the best return and outcomes.”
Services in the bundle include several line items eliminated in last year’s budget: funding for the You Quit Two Quit prenatal smoking-cessation program and the N.C. Healthy Start Foundation, which provides educational services to pregnant women to promote healthy births.
According to the N.C. State Center for Health Statistics, about 11 percent of women smoked all the way through pregnancy. Low birth-weight babies were more likely to be born to those smokers than to nonsmokers.
“You Quit Two Quit is more than a social media program,” said Peter Morris, a pediatrician and co-chair of the task force. “Smoking is shown to be detrimental to mothers’ and babies’ health, and too many North Carolina women still smoke during pregnancy.”
Morris said the statistics show that about half of women who are smokers will quit or cut back during pregnancy, but often restart after giving birth.
“I can say that’s bad for the baby as well – increased rates of asthma and respiratory diseases,” he said. “Anything we can do to help these women quit for good is going to be a good investment.”
Planning for health
The task force has several other budget priorities, including $1 million in funding for the UNC-Chapel Hill Horizons program, a substance-abuse treatment program for women who are pregnant or have newborns.
“Their current space is not permanent; they do training all around the state and their space is limited,” said Elizabeth Hudgins, the task force’s executive director.
The money would allow the program to receive an additional $2 million in matching funds from other sources that would facilitate expansion.
Another funding priority for the task force is to provide $12 million in state dollars to county departments of social services to help replace federal funds lost from the Temporary Assistance for Needy Families programs. Last year, the departments received $4.8 million.
The governor’s budget would move $3.6 million of TANF funds into the state’s Pre-K program to provide for about 800 new slots for 4-year-olds.
McLeod said social service agencies were looking for those dollars to provide funding for child-abuse early-intervention and prevention programs.
She explained that state dollars fund only 3 percent of child-welfare activities at the county level. About half comes from federal funds and the rest from county coffers.
“North Carolina is unique in that we’re one of the few states in the nation that funds child welfare this way,” McLeod said. “We’ve put more fiscal responsibility on the counties.
“We know that the counties are strapped, and with federal dollars, which make up a little over half of their budgets, decreasing, there’s just not a lot a wiggle room.”