Equity in Birth Outcomes & Infant Mortality - or "Birth Equity" for short - and the related result are aligned with the following Healthy NC 2030 Indicators.

• Reduce the infant mortality racial disparity between whites and African Americans
• Access to prenatal care

How would we experience this result in our community if we are successful?
Our community partners identified the following themes as key elements of our desired result:

• Healthy babies: 100% healthy births (full term, healthy weight, no infant deaths)
• Healthy parents: Healthy, supported mamas and babies. Parents feel empowered with emotional well-being. Supported, educated, and engaged fathers/partners.
• Healthy community: Thriving safe community where everyone gets along, & has what they need to be healthy. Household stability. Health care for all. Reparations made.

If we achieved our desired result, we would feel:

• Peaceful, with more time and energy to engage with community
• More relationship driven
• People listening to each other & respecting each other
• Less stress
• Families can earn a real living wage to live in Asheville
• No drugs, alcohol, vandalism
• Respect, honoring each other
• Emotional and physical safety
• Less fear
• Children can safely play outside with their friends
• More connection with nature
• Less coal ash
• Less light polution
• More edible gardens
• Quiet - no sirens
• Nicer police
• History of structural racism has been reconciled and repaired

Equity in Birth Outcomes and Infant Mortality was one of 5 standout health conditions based on the size and severity of the issue in
our community.

In utilizing a public health life course approach,racial and ethnic disparities in birth outcomes and infant mortality can be strongly correlated with the transfer of historical and cumulative racial trauma intergenerationallyand also the present lifetime exposure to systems that are rooted in racism and discrimination. These disparities are further compounded when early life experiences expose infants and young children (and their developing brains and nervous systems) to adverse childhood and community stressors with limited opportunities for experiences that build resilience. Relatedly, public health research has continued to highlight that individuals who experience systemic oppression, racism, a high pair of ACES exposure, and barriers to accessing health resources face significant challenges to health equity throughout their lifetime (Geronimus, et al, 2006).

More specifically, racism accounts for the disparities of Black/African American birthing outcomes even when Black/African American birthing women/individuals are highly educated, have access to pre-natal care, and do not have underlying health conditions. Black/African American mothers and birthing individuals often experience negative health impacts during pregnancy and post-partum, primarily due to factors outside of their control (i.e., experiences of intergenerational trauma, pair of ACES, and the eroding effects of systemic racism and white supremacy culture) – studies have continued to see these disparities even when accounting for age and socio-economic status across groups (Burris & Hacker, 2017). What this means is that Black, Indigenous, and babies of color not only encounter the cumulative harms of interacting with and living within racists systems across their lifetime, they also have an increased likelihood of in utero exposure to toxic stress due to the historical and intergenerational trauma of racism in the United States.

Secondary data revealed significant disparities in are present in birth outcomes, infant mortality and preconception health for African American and Latinx residents.
 

Key findings related to Birth Equity included:

Access to Pre-Natal Care (NCSCHS, 2021b)

 • 85% of White pregnant individuals, 77% of Black/African American, and 76% Hispanic/Latin/Latinx individuals accessed prenatal care in the first 1-3 months of pregnancy

Low Birth Weight (NCSCHS, 2020b)

• 9% of births in Buncombe were classified as low birth weight (under 2,500 grams)

• 1% of births in Buncombe were classified as very low birth weight (under 1,500 grams)

 Pre-Term Births (NCSCHS, 2020b)

• Pre-term births (less than 37 weeks gestation) in Buncombe for 2014-2018 was 10% vs. 90% of births (37+ weeks of gestation)

Infant Morality (NCSCHS, 2021d)

o Overall infant mortality rate in Buncombe is 4.8 for 2015-2019 compared to 5.1 for 2014-2018

o For the period of 2014—2018 there were 38 White babies that died, 15 Black/African American babies that died, and 9 Hispanic/Latin/Latinx babies that died.

Burris HH, Hacker MR. Birth outcome racial disparities: A result of intersecting social and environmental factors. Semin Perinatol. 2017 Oct;41(6):360-366. doi: 10.1053/j.semperi.2017.07.002. Epub 2017 Aug 18. PMID: 28818300; PMCID: PMC5657505

Geronimus, A. T., Hicken, M., Keene, D., & Bound, J. (2006). "Weathering" and age patterns of allostatic load scores among blacks and whites in the United States. American journal of public health, 96(5), 826–833. https://doi.org/10.2105/AJPH.2004.060749