1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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 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.

8. 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.

9. 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.

10. Reduce the infant mortality disparity

11. Reduce the infant mortality disparity

13. 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.

14. 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.

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

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

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

18. 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.

19. 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.

20. 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

21. 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

22. 12-Point Plan, continued Close the education gap
Reduce poverty among African American families
Support working mothers and families
Undo racism

23. 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

24. Preconception Health
TO BE RELEASED SOON – Check the SCHS website (

25. Tracking Preconception Health
New Web site at the State Center for Health Statistics
Indicators developed by a 7 state working group which included NC

29. Further Questions or Comments
Sarah McCracken Cobb
SSDI Project Coordinator
Women’s and Children’s Health
NC Division of Public Health