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After reaching an historic low rate in 2013, the data show more babies are dying in their first year.

By Rose Hoban

After years of continual improvement in the health and birth outcomes for newborns in North Carolina, the rate of babies who died in their first year of life has inched upwards for the second year running.

An intubated female premature infant born prematurely 26 weeks 6 days gestation, 990 grams. Photo taken at approximately 24 hours after birth. Premature birth is a leading cause of infant mortality. Photo courtesy Chris Sternal-Johnson, flickr creative commons

After reaching an all-time low of 7.0 deaths per 1,000 live births in 2010, and hitting that mark again in 2013, the rate crept upwards to 7.3 deaths per 1,000 babies. This keeps North Carolina with one of the worst infant mortality rates in the country.

“It’s not a great surprise, but it’s still frustrating,” said Janice Freedman, head of the North Carolina Healthy Start Foundation, who described the increase more as a “stagnation” than an outright increase. “We’re doing a lot but the need is so much greater than the resources.”

All told, the new data from the North Carolina State Center for Health Statistics show that 884 babies died in their first year of life in 2015, out of an approximate 121,000 births. To make those numbers more concrete, every day in North Carolina, 331 babies are born, 2.4 of them die at birth, 1.6 babies who are less than a month old die and 0.8 babies who are in their first year of life die.

“We know infant mortality is a social problem with medical consequences,” Freedman said. “We see a host of problems that come together, that lead to women not being healthy, pregnancies not being planned and babies being born in a compromised situation.”

Disparities

One problem that’s persisted in North Carolina’s infant mortality rates is the wide gap between birth outcomes for white women and those for African-American women. This past year, the infant mortality rate for whites was 5.7 per 1,000, slightly lower than last year’s national rate, but the rate for African-Americans was 12.5 per 1,000.

Nowhere is the problem worse than in Eastern North Carolina, where the infant mortality rate for African-American women was 16.6 deaths per thousand births, compared to only 5.4 deaths per thousand for whites.

“When you look at a map by region and poverty and educational attainment and life expectancy, that same region keeps popping out,” said Sarah Verbiest, who’s on the maternal and child health faculty at the School of Medicine at UNC-Chapel Hill.

“When we look at poverty, it goes hand-in-hand with infant mortality,” she said. She pointed out that there were similar disparities in outcome in counties where there are other large populations of low- income African-American women, such as Durham and Wake Counties.

“But really, it’s pretty much Eastern North Carolina,” she said. “Infant death, we say this over and over, it’s a reflection of the health and wellness of women in a region.”

There are a host problems in that part of the state that intersect to produce poor outcomes, Freedman said. “Eastern North Carolina has fewer resources, greater poverty and greater needs.”

This year’s numbers do show that the difference between black and white rates have narrowed some, but the reason why isn’t a good one.

“The black rate has come down a little, but the white rate has gone up,” Freedman said. “That’s not how we want to reduce the gap.”

Not budging

The data were presented Thursday morning at a meeting of the Child Fatality Task Force, a legislative committee that’s been meeting since 1991, when North Carolina had the worst infant mortality rate in the nation. Since that time, the rate has come down from 10.6 deaths per 1,000 births to where it is today. But Freedman said a lot of that improvement was due to medical advances in the 1990s.

“For example, doctors developed techniques to improve infant lungs when they’re born premature,” she said. “But there’s not more medical technology that will get the number lower.”

Because some counties have so few births, state statisticians group together infant mortality data by region in order to get a more accurate picture of the trends. Data courtesy, NC State Center for Health Statistics

Instead, both Verbiest and Freedman said the issues that keep the rate stubbornly stuck about where it is have to do with more intractable societal issues.

“We could look at different factors, poverty, nutrition, prenatal care, but it’s also heart disease, obesity, diabetes,” Freedman said.

In many counties with more infant deaths, Freedman noted there are higher rates of pregnant women on Medicaid, being served by fewer obstetricians and gynecologists. Women in Eastern North Carolina are also more likely to be overweight or obese, more likely to deliver by cesarean section, and to live in poverty.

In far western counties, the next highest region for infant mortality, women who delivered were more likely to have smoked, to be uninsured, and to have delivered by C-section.

Freedman said the healthier women are, the healthier the babies will be, and those will grow up to be healthier children, and young women; it’s an intergenerational problem.

Another way to get a clearer picture of infant mortality trends in a county is to aggregate together infant mortality data over several years in order to get a more accurate picture. Data courtesy, NC State Center for Health Statistics

“We need to intervene at all places on that cycle. Pregnancy is such a short time to correct things that have been occurring for generations,” she said.

Verbiest said at the CFTF meeting, state health director Randall Williams, himself an obstetrician/ gynecologist, expressed eagerness to take on the problem. Part of doing that is a new state strategic plan about a year in the making.

“I’d be more upset if we didn’t have this plan,” she said. “I’d like to see lawmakers supporting this work, like they did before when we were the bottom of the barrel. We’re not going to see these numbers budge until we see another push across sectors.”

Verbiest noted state legislators did allocate funds for the You Quit, Two Quit perinatal tobacco cessation program in the most recent budget.

“Their ongoing commitment to cessation resources for mothers and women is key – as is ongoing support for the state’s Quitline,” she wrote in a follow-up email. “This is an example of how we need to fully deploy all of the evidence-based practices we have at the same time that we must innovate.”

She noted that maternal smoking is related to the four leading causes of infant death, namely preterm birth, low birth weight, birth defects and other perinatal conditions.

“There are still women who smoke or are exposed to secondhand smoke, and that’s a significant factor in how healthy that baby will be,” Verbiest said.

Rose Hoban

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...