The racial gap in infant death rates in NC widened, while the overall infant mortality rate plateaued

The state’s infant mortality rate has dropped significantly in the three decades since getting babies to their first birthdays became an official goal for the state back in the early 1990s. But in the years the state’s plan for healthy communities targeted the racial gap between Black and white babies’ death rates, that gap has just gotten wider.

Even with the overall decline, the state still has one of the highest infant mortality rates in the nation – seventh from the bottom according to the latest CDC data. The chances that a Black baby will live long enough to see that first birthday candle is significantly lower than it is for a white infant.

The latest issue of the North Carolina Medical Journal focuses on life expectancy and includes the commentary “Back to the Future: Reflecting on Three Decades of Healthy North Carolina Infant Mortality Goals,” by Kathleen Jones-Vessey and Sarah McCracken Cobb. Both work at the state Department of Health and Human Services.

The infant death rate, measured in deaths per 1,000 birth, is higher in the United States than it is in most other industrialized countries. Infant mortality is considered an indicator of overall community health.

Every 10 years, health policy experts adopt a set of goals for the state called Healthy North Carolina. The 2030 goals include decreasing the poverty rate, increasing the primary care workforce, and increasing life expectancy. The goal for infant mortality is to lower the overall rate to 6 – it was 6.8 in 2020 – and the Black/white disparity ratio to 1.5.

Jones-Vessey and Cobb write that the state has had reducing infant mortality in all of its Healthy North Carolina plans and met it once, in 2010. The target was a 7.4 infant mortality rate while the state reached 7. The state did not meet its 2020 goal of 6.3. North Carolina’s infant mortality rate largely plateaued between 2010 and 2020, and the disparity ratio between Black and white infant death rate of 2.67 was wider in 2020 than it was in 1990, when it was 2.01.

Infant health is tied to the health of birthing people, they wrote. North Carolina likely won’t meet its 2030 goals without more investments and programs aimed at improving maternal health, “as well as a strategic focus on maternal health equity and reproductive justice.”

North Carolina has had a number of committees and task forces working over the years on lowering the infant mortality rate and improving maternal health.

The Perinatal Health Equity Collective, which got its start in 2016, drafted a plan for 2022-2026 that uses data to monitor progress toward goals for lower death rates and improved maternal health, according to another journal paper by Cobb, Jessica Landes Johnson and Belinda Pettiford. Johnson and Pettiford also work at NC DHHS.

The three authors counted as a policy win allowing people who give birth to continue to have their health care expenses covered by Medicaid for up to a year. Until this year, people who used pregnancy Medicaid were cut from the government health insurance program two months after a birth.

Goals include greater availability of doula services, the authors wrote. Some of the pre-paid Medicaid plans offer them and Gov. Roy Cooper included doula reimbursement in his budget proposal, but that spending did not make it into the final budget.

A statewide doula summit is planned, and Medicaid reimbursement for doulas remains a DHHS priority, according to the commentary.

Also include in Cooper’s budget proposal was funding for group prenatal care, a strategy for reducing health disparities.  That money was not in the final budget.