Rising NC infant mortality underscores need to expand Medicaid


By Rob Thompson - NC Child



The word “consistency” suggests stability, predictability, normalcy. It implies that we can move on and not worry.

When the State of North Carolina announced our 2014 infant mortality data this week, the official release said “the 2014 statistics are consistent with previous years.” But for our state, consistency in the infant mortality rate is not good—stalled would be a more forthright description.

North Carolina’s infant mortality rate of 7.1 infant deaths for every 1,000 live births remains well above the national average of 5.96 and hasn’t improved since 2010. Furthermore, racial and ethnic disparities in infant mortality persist year after year.

Big problems, like North Carolina’s consistently high infant mortality rate, demand bold solutions. Closing the health insurance coverage gap for working North Carolinians, particularly women of childbearing age, would be a good start.

The Most Recent Data

The 2014 infant mortality rate for African American babies in North Carolina is 12.8 deaths for every 1,000 births, which is unacceptable on its face and even more so when compared to the rate for white babies, which is 2.5 times lower at 5.1. Nationally, the infant mortality rate for African Americans is 11.22, too high, but significantly better than North Carolina’s.

For American Indians, the infant mortality rate is essentially the same as 20 years ago—nearly 10 deaths for every 1,000 births. The rate for Hispanics spiked in 2014, but it’s too early to tell if that’s the beginning of a trend or an aberration.

The rate of infant death also correlates with where you live, and this is no surprise to researchers who study how our health is affected by where we work, go to school, and sleep at night. This map shows five years worth of data—not just a blip on the radar—by county, and it’s clear that the same challenges that affect local economic development, infrastructure, environmental health, and educational opportunity also come to bear on infant health.

Connection to Women’s Health

Not surprisingly, the infant mortality rate is also directly connected to women’s health—a baby is much more likely to be born healthy if her mother is healthy. Statewide, 22 percent of infant deaths are related to prematurity and low birth weight, and 16 percent are related to maternal factors and complications of pregnancy. Access to care before conception and between pregnancies could substantially reduce our high infant mortality. And improving a mother’s health is best done before she gets pregnant, when it is easier to fight diabetes, high blood pressure and other chronic conditions.

The State news release noted the positive pieces of the recently enacted state budget that help take better care of mothers and infants. We have high hopes for this funding but there are many questions about how the money will be used. If we want to move the needle, our actions must be bold and not just “consistent” with what we have been doing.

We know there is one big step we could take as a state that would likely show big results.

Specifically, North Carolina—Governor McCrory and the General Assembly—should take advantage of the opportunity to eliminate the health insurance coverage gap for adults, as our neighbors West Virginia, Arkansas and Kentucky have done. The Affordable Care Act allows states to devise their own plans for making insurance available at very little cost to the state for people who earn too much to get the tax credits for middle income workers, but who aren’t destitute enough to qualify for Medicaid as it is now defined.

Closing the insurance coverage gap would provide over 300,000 North Carolina adults, including women of childbearing age, with health insurance, which would help prevent and treat many of the chronic conditions, like obesity, high blood pressure, and diabetes, that lead to infant mortality.

Ensuring that all women in North Carolina have access to affordable health insurance would have a profound impact on birth outcomes for families of every race and ethnicity. Any serious attempt to improve upon our infant mortality rate must include this step.

Governor McCrory and the Legislature should take a bold step and close the health insurance coverage gap now to save children’s lives.

Rob Thompson is the Senior Policy and Communications Advisor for NC Child.

By Rob Thompson

NC Child

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