Infant mortality is considered a key indicator of the overall health of the population, and both infant and maternal mortality are multifaceted problems impacted by factors such as access to care, poverty, systemic racism, and housing.

Racial disparities have long plagued the state’s infant mortality rate and many other health indicators, now including those associated with the current pandemic. And at the same time, as with COVID-19, we know how to prevent many infant deaths. Other states have prioritized addressing racial gaps in infant deaths and have moved to expand Medicaid, address the impacts of racism on birth outcomes, and implement a number of policies that improve family economic security. Here in North Carolina, it is beyond time to implement critical policy interventions that we already know will work to prevent unnecessary infant deaths. 2022 NC SHIP, pg. 112.

Participants in the 2021 NC SHIP Community Council Meeting and Symposia expressed the following thoughts about infant mortality:

• “It’s hard to understand the root causes.”

• “Physiological stress due to racism, adverse childhood experiences, and social determinants play a huge role.”

• “Many children who died in the first year of life had no father listed on the birth certificate.”

• “The father’s name not being on the birth certificate may be an important predictor of risk – what does it mean?  Is there economic, emotional stress?”

• “There are barriers to getting the father added: access to a notary, transportation, affidavit of parentage is not easily found, cost of DNA test.”

• “Indicator rates for fertility suffer from small counts. Rates are sensitive to small counts and should be interpreted with caution. How do we navigate issues of equity if we can’t measure with small numbers?”

• “We need attorneys that understand statutes for adding father to the birth certificate.”

2022 NC SHIP, pg. 114

• Consider recommendations from the Perinatal Health Strategic Plan
• Improve access to, and use of, prenatal care, including group prenatal care and evidence-based home visiting programs
• Improve individual preconception routine medical check-ups and reproductive life planning counseling with a focus on intimate partner violence, substance use, immunizations, depression, body mass index, blood pressure, and diabetes
• Increase access to health insurance
• Reduce maternal obesity
• Reduce maternal tobacco use before, during, and after pregnancy
• Support training on health equity including implicit bias and determinants of health.
• Take advantage of the Children’s Health Insurance Program option to provide coverage for comprehensive prenatal care to undocumented immigrant women

NC State Center for Health Statistics, Vital Statistics

• Communities that participate in all aspects of the research process
• Research that leads to a better understanding of the drivers of health and well-being with attention to health equity/ health disparity issues