Healthy North Carolina 2020 Objective: Maternal and Infant Health A State Public Health Perspective I work with in the Women’s and Children’s Health Section Office in the NC Division of Public Health. The mission of WCHS is to assure, promote and protect the health and development of families with emphasis on women, infants, children and youth. We monitor how well we are achieving this mission in a variety of ways. One way is through providing data on a number of national and state performance and outcome indicators for the federal Maternal and Child Health Block Grant, and it’s one of my job responsibilities to provide these data annually. Thus, I got invited to be on the subcommittee on Maternal and Infant Health for the Healthy NC 2020 Objectives.

Maternal and Infant Health 2020 Objectives Reduce the infant mortality disparity (Key Performance Indicator) Reduce the infant mortality rate Reduce the percent of women smoking during pregnancy While the final objectives won’t be released until later this year, I’ll share with you the working draft objectives that the subcommittee has proposed. These objectives are: 1. Reduce the infant mortality disparity 2. Reduce the infant mortality rate 3. Reduce the percent of women smoking during pregnancy. These sound simple enough, but I can tell you, it wasn’t simple to get the subcommittee to agree to these objectives. While of course reducing infant mortality, and in particular reducing the disparity between black infant mortality rates and white infant mortality rate, is the goal, discussing the best objectives to measure progress in this area showed how little we know about what is the most effective way of reducing the infant mortality rate and improving infant and maternal health. Certainly there are evidence based practices that the committee discussed – reduce smoking during pregnancy, putting an infant on his/her back to sleep, increase folic acid use, etc., but we wanted to also be able to put decrease poverty, end racism, and enforce a livable wage on the list. The bottom line is that there’s no easy answer to decreasing the infant mortality rate. Prenatal care was once thought of as the end all be all, but if a woman is not healthy before pregnancy, nine months of prenatal care is not going to fix the problem.

Reduce the infant mortality rate The infant mortality rate is the number of infant deaths per 1,000 live births. Infant death is defined as the death of an infant before his or her first birthday. I’m sure you all know this definition, but just to make sure we are all talking about the same thing, the infant mortality rate is the number of infant deaths per 1000 live births, with an infant death being that a child dies before his/her first birthday.

Reduce the infant mortality rate The leading causes of infant death include congenital abnormalities, pre-term/low birth weight, Sudden Infant Death Syndrome (SIDS), problems related to complications of pregnancy, and respiratory distress syndrome. I’m sure you all know this definition, but just to make sure we are all talking about the same thing, the infant mortality rate is the number of infant deaths per 1000 live births, with an infant death being that a child dies before his/her first birthday.

Importance of Infant Mortality in North Carolina IM is an issue of great magnitude In 2008, 68% of all child deaths in NC were infant deaths. IM is a good “proxy measure” for a community’s public health as IM has many causes with origins ranging from medical to socio-economic factors.

Importance of Infant Mortality in North Carolina IM is not just about deaths Infants who survive are our future school children. i.e. only 15.2% of low birth weight babies graduated from high school by age 19, compared to almost 60% of their normal birth weight siblings Infants who survive are prone to chronic disease.

Infant Mortality Rate North Carolina, 1988-2009 7.9 The 2009 state infant mortality rate was released in September. North Carolina’s overall infant mortality rate dropped again in 2009 to the lowest level in the state’s history at 7.9 deaths per 1000. This represents a decline of 3.7 percent from the 2008 rate of 8.2. Since 1988, when North Carolina ranked as one of the last in the nation for infant mortality with a rate of 12.6, the state has improved its overall rate more than 35 percent. However, while this graph shows good news, it also shows bad news. The disparity between the white and minority rates has not decreased over the years, and in fact increased even more in 2009.

Reduce the infant mortality disparity Defined as gap between the infant death rate for whites and African Americans (the largest disparity between two groups in North Carolina) expressed as a ratio.

Reduce the infant mortality disparity This ratio expresses the number of times greater the African American infant mortality rate is in proportion to the white infant mortality rate.

Reduce the infant mortality disparity

Reduce the infant mortality disparity

http://www.schs.state.nc.us/SCHS/pdf/MinRptCard_WEB_062210.pdf

Reduce the percent of women smoking during pregnancy Smoking during pregnancy can have a negative impact on the health of infants and children by increasing the risk of complications during pregnancy, premature delivery, and low birth weight. I’m sure you all know this definition, but just to make sure we are all talking about the same thing, the infant mortality rate is the number of infant deaths per 1000 live births, with an infant death being that a child dies before his/her first birthday.

Reduce the percent of women smoking during pregnancy I’m sure you all know this definition, but just to make sure we are all talking about the same thing, the infant mortality rate is the number of infant deaths per 1000 live births, with an infant death being that a child dies before his/her first birthday.

NC Public Health Efforts to Reduce Infant Mortality Improve infant health care Improve maternity care Increase planned pregnancies Improve women’s health

NC Public Health Efforts to Reduce Infant Mortality Improve infant health care Improve maternity care Increase planned pregnancies Improve women’s health

Planned Pregnancies Have Better Outcomes 44% NC pregnancies not planned [PRAMS 2006-08] By race African Americans (64%), Latinas (40%) and Whites (38%) Associated with late PNC, poor birth spacing, abuse/neglect

Healthy Women More Likely to Have Healthy Babies IM and disparities related to mother’s health including- socioeconomic status chronic stress chronic disease and infection smoking, and nutrition age Can’t undo in 9 months a lifetime of health choices and situations.

Life-Course Approach 12 point plan to reduce Black-White Disparities Described in article entitled Closing the Black-White Gap in Birth Outcomes: A Life-Course Approach in Ethnicity & Disease, Volume 20, Winter 2010 by authors Michael Lu, et.al.

12-Point Plan Provide interconception care to women with prior adverse pregnancy outcomes Increase access to preconception care to African American women Improve the quality of prenatal care Expand healthcare access over the life course

12-Point Plan, continued Strengthen father involvement in African American families Enhance coordination and integration of family support services Create reproductive social capital in African American communities Invest in community building and urban renewal

12-Point Plan, continued Close the education gap Reduce poverty among African American families Support working mothers and families Undo racism

12-Point Plan Provide interconception care to women with prior adverse pregnancy outcomes Increase access to preconception care to African American women Improve the quality of prenatal care Expand healthcare access over the life course

Preconception Health TO BE RELEASED SOON – Check the SCHS website (http://www.schs.state.nc.us/SCHS/)

Tracking Preconception Health New Web site at the State Center for Health Statistics http://www.schs.state.nc.us/SCHS/data/preconception.html Indicators developed by a 7 state working group which included NC

Further Questions or Comments Sarah McCracken Cobb SSDI Project Coordinator Women’s and Children’s Health NC Division of Public Health 919.707.5515 Sarah.Mccracken@dhhs.nc.gov