infant mortality rising in wnc
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8/6/2019 Infant Mortality Rising in WNC
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of the women and children’shealth section at the NorthCarolina Department of Public Health.
While medical care andprograms aimed at improving
birth outcomes have reachedmore mothers, more babiesare being born prematurely orwith low birth weights, whichare the main causes of infantdeath.
In the past, public healthofficials focused on increasingaccess to prenatal and postna-tal care as the way to combathigh infant mortality. Ryansaid that while North Carolinahas made good progress ingetting more women into pre-natal care earlier in theirpregnancies, there hasn’t beenas much improvement ininfant mortality rates as healthexperts expected.
He said more public healthexperts are realizing that the
rising infant mortality ratesare not a result of fewerwomen accessing prenatalcare or premature babies notgetting the help they need.Instead, they are starting tolook to chronic, lifestyle issueslike obesity, diabetes andhypertension to help explainthe increasing number of deaths.
“It’s something that peopleare coming in the door with,”Ryan said. “For some reasonor another they are not asphysiologically able to carrythose babies to term.”
The challenge that facespublic health officials now isdetermining which of thesefactors — from smoking toobesity to chronic disease —has the greatest effect oninfant mortality.
“If you take a thousandwomen who are optimal in allthose ways, that’s not hard toprove that they’re going tohave a better birth outcomethan people who are chal-lenged in all those ways,” Ryansaid. “But teasing out is it part-ly this, is it partly that … thoseare hard things to determine.”
Race, health factorsHealth departments use the
infant mortality rate, or thenumber of deaths by age 1 per1,000 live births, to measure thehealth of a population and the
quality of its medical system.There are many reasons
babies die before their firstbirthday. These include birthdefects, infections, suddeninfant death syndrome andaccidents, but prematurityand low birth weight, whichcan be the products of poorprenatal care, might be thebiggest reasons.
As health care in the UnitedStates improved over the pastseveral decades, infant mortal-ity drastically declined. Therate went from 26 per 1,000live births in 1960 to 6.9 per1,000 live births in 2000. Butsince 2000, the number of infant deaths nationally and inNorth Carolina has remainedrelatively constant.
In 2005, the latest year forwhich data is available,Buncombe County saw infantmortality rates increase to arate of 10.7 from 5.4 the previ-ous year. Infant mortalityrates in the 16-county western
part of the state jumped to 9.8from 6.0 in 2004.
Minority babies also con-tinue to die at twice the rate of white babies, both in WNCand in the United States.
“All over thestate, all over thenation, I don’tcare where youlook, you’regoing to see dis-parities in infantmortality,” saidSharon West,executive director of theAsheville Buncombe Instituteof Parity Achievement.
West said factors fromsocioeconomic status to gen-eral health could contribute to
poor birth outcomes. She saidstudies show African-Americans are also more like-ly to be disenfranchised by themedical system from years of racism and stereotyping andare less likely to receive prop-er medical care.
Dr. Susan Mims, medicaldirector at Mission Children’sHospital and the former med-ical director atthe BuncombeCounty HealthDepartment, saidthese trends arenot unique toWNC.
“The trendsthat we’re seeing
are constant throughout ourregion,” Mims said.
Janice Freedman, executivedirector of the North CarolinaHealthy Start Foundation, saidthe Southeast has a higherproportion of African-Americans, poor people andpeople living in rural areas,demographics that can allinfluence a person’s access tocare. She said more peoplesmoke, are obese and sufferfrom chronic health problemsin the Southeast than in otherparts of the country.
“We’ll never look like aVermont or Minnesota,” shesaid of the states with lowinfant mortality rates.
Programs to addressthe problem
In 2003, North Carolinaranked 40th in the UnitedStates in infant mortality.
To reduce infant mortality,Freedman said North Carolinahas programs aimed atincreasing access to prenatalcare, promoting a healthylifestyle during pregnancy,reducing smoking and sub-stance abuse and, after a babyis born, helping new parentslearn proper care to reduceaccidents, improve nutritionand reduce sudden infantdeath syndrome.
One of these initiatives isthe Baby Love program inBuncombe County.
The program pairs mater-nity care coordinators withhigh-risk pregnant women.
The coordinators help thewomen find services, includ-ing transportation, housingand domestic violence pro-grams, as well as medical care.
Candler resident ChristinaRathbone, 24, attributes hersuccessful pregnancy to thesupport she received throughthe Baby Love program.
“Anytime I get stressed out,I stop taking care of myself,”she said. “I would have endedup miscarrying or in the hos-pital numerous times if I did-n’t have (Mirlie Greene’s)help.”
Rathbone said Greene, hermaternity care coordinator,helped her deal with emotion-al and physical issues.
“She told me that you needto put yourself first,”Rathbone said. “You need totake care of yourself for yourbaby.”
Even with success storieslike Rathbone and increasedenrollment in these programs,infant mortality rates are notfalling.
“We are doing the rightthing,” Freedman said, “But alot more can be done.”
New approachesFreedman said she doesn’t
think there will be a drasticreduction in infant mortality
rates if North Carolina contin-ues what it has been doing.
Despite having a betterhealth care system andincreased access to prenatalcare, more babies are beingborn premature and at lowerbirth weights than in the past.
Ryan said the rising infantmortality rates are causingpublic health officials to lookfor a new approach.
“I think the original ideawas suspect,” he said. “Theright way to think about it isthat … if you have a lifecyclewhen from birth a person hasbeen exposed to poverty,stress, perhaps poor housing,perhaps poor nutrition,sedentary lifestyle, you’re not
going to correct that witheight months of good prenatalcare.”
Public health experts arenow starting looking at a
women’s entire health leadingup to pregnancy as a factor forinfant mortality. They sayincreased rates of diabetes,obesity, high blood pressureand increasingly sedentarylifestyles may all play a role.
“There are so many factorsthat go into infant mortality,and the general health of awoman going into a pregnan-cy is a huge factor and proba-bly more so than the smallerthings that we’ve addressed inthe past,” Mims said. “I thinkwe still need to continue tofocus on those things thatwe’ve done that have helped,but we need to kind of take astep back and look at the big-ger picture.”
Ryan said initiatives likeGov. Mike Easley’s plan toincrease access to health carefor all children, the GeneralAssembly’s proposal toincrease sex education inschools, programs aimed atreducing unplanned pregnan-
cies, and promoting exerciseand healthy eating are some of the best ways to try to combatinfant mortality.
“It’s not an either-or typeof strategy,” he said. “Infantmortality is a common end-point for a variety of factorsthat can be very different fromeach other. You need a varietyof strategies.”
The challenge that publichealth officials face now isdetermining which of thesefactors are contributing mosttoward the rising infant mor-tality rates and developingthose strategies.
“We should expect moreand we should do better, andwe need to look at every
aspect that we can influence,that we can control, that couldhelp improve the chance thata baby who is born can live,”Mims said.
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INFANT: Lifestyle issues, socioeconomic factors at play in WNC WHERE TO GET HELP■ North Carolina Department of
Public Health: (919) 707-5000.
■ North Carolina Healthy Start
Foundation: (919) 828-1819.
■ North Carolina Department of
Health and Human Services:
Women’s and Children’s Health:
(919) 707-5510.
■ North Carolina Department of Health and Human Services:
Women, Infants and Children:
(919) 707-5800.
■ Buncombe County Health
Department: 250-5000.
■ Baby Love maternity care program
in Buncombe County: 250-5689.
■ Smart Start of Buncombe
County: 285-9333.
BY THE NUMBERS■ The infant mortality rate for the
United States was 6.8 per 1,000
live births in 2004.
■ In 2005, North Carolina’s infant
mortality rate was 8.8 per 1,000
live births.
■ In 2003, Mississippi had the
highest infant mortality rate in thenation at 10.7, while New
Hampshire had the lowest rate in
the nation at 4.0.
■ In 2004, the United States
ranked 35th in the world in terms
of infant mortality.
■ In 2004,Hong Kong had the low-
est infant mortality rate in the world;
Sierra Leone has the highest at 165
deaths per 1,000 live births.
■ In 2005, the infant mortality rate
for white babies in North Carolina
was 6.4 while the infant mortality
rate for non-white babies was 14.9.
■ 20 percent of infant deaths in
North Carolina in 2005 were
attributed to prematurity and low
birth weight.Source: N.C. Department of PublicHealth, Centers for Disease Controland Prevention, United NationsDevelopment Programme.
Sharon West
Susan Mims