The current administration of the state Department of Health and Human Services is not noted for its openness in communications, so it was no surprise that the news release indicating that the infant mortality rate in our state had increased in 2012 was short, relatively incomplete, and buried in a recent weekend news cycle. Since infant mortality is not only tragic in its own right, but also considered to be an indicator of our community’s overall health status, it is a disservice to the people of the state to give short shrift to the release of this important information.
We are fortunate that the North Carolina Child Fatality Prevention System is in place to convene experts and community advocates to give serious study to the infant mortality data and to developing recommendations for improvement. The infant mortality rate in our state has dropped by more than thirty percent since this system was implemented in 1991, and its recommendations have been a big part of this success.
Infant mortality rate increases in each of the last two years are a bump in the overall downward trend. Ignoring the possibility of an upward trend however would be hazardous. That’s why it is particularly disappointing that the data release was downplayed.
Here are some highlights that need to be considered:
- The release indicated that the infant mortality rate had “ticked up” to 7.4 infant deaths per 1,000 live births, up from the 2011 rate of 7.2, and the 2010 rate of 7.0, which was the lowest ever reported in our state. These somewhat sanitized rates do not make it clear that 45 infants died in 2012 that would have survived if the 2010 rate had been maintained. In fact, if our rate had continued to improve as expected, perhaps as many as 100 more infants would have survived. Each one of these deaths is a family tragedy and –cumulatively – a societal tragedy.
- Almost all of the increase is due to a 7.8% increase in the African-American infant death rate, which remains more than twice the rate for white infants. This continuing disparity should be a source great disappointment, if not outrage.
- Infant mortality rates, as with so many other important indicators, are not the result of happenstance; they are the result of years of investments made by the General Assembly, and the hard work and perseverance of public and private providers. That’s what led to the 7.0 rate in 2010, when North Carolina ranked 37th among the states, the first time we had climbed out of the bottom ten.
- Perhaps not surprisingly, 2010 is also the year in which the General Assembly began reducing investments in infant mortality prevention services. Positive health behavior education, including infant safe sleep and smoking cessation, as well as high-risk maternity clinic services in the eastern part of the state were dramatically reduced or eliminated (though the clinic services have been restored). Since almost half the deliveries in 2012 were to women who were overweight/obese (with the risk complications of hypertension and diabetes), and 10% smoked during pregnancy, it is no wonder that infant mortality is increasing.
- These high-risk behaviors and conditions need to be under care before pregnancy occurs, but a large percentage of our women are uninsured. That’s why it is particularly disappointing that the Governor and the General Assembly chose not to accept the Medicaid expansion offered cost-free to the state under the Affordable Care Act. Many of the states with a worse infant mortality rate in 2010 are adopting the Medicaid expansion. It is thus likely that North Carolina will slip back into the bottom 10 states with regard to this important indicator. It may also mean that Governor McCrory will be the first governor in 30 years to leave office with a higher infant mortality rate that when he took office.
- Finally, the release is misleading with regard to the supposed ongoing reduction in Sudden Infant Death Syndrome (SIDS), a designation that has traditionally been used when no other cause of death could be determined. In the last few years, however, infant death scene investigations have significantly improved, which has allowed medical examiners to decide that a homicide occurred, or that an “undetermined” designation should be made. Both of these categories have increased in recent years – a fact that likely offsets the SIDS numbers. Thus, more study of issues around infant sleep environments is needed.
The controversies that have put the Department of Health and Human Services in the news are not only unfortunate in their own right, but they distract Department leadership from other issues of critical importance, such as an increase infant mortality. Let’s hope that these controversies are resolved soon, so that more attention can be placed on meeting the needs of North Carolina’s children and families.
Tom Vitaglione is a Senior Fellow at Action for Children North Carolina.
Image:Newborn infant, October 2011, courtesy of Taxiarchos228, Free Art License 1.3 and Wiki commons.