Description: Ratio of Buncombe African American infant mortality compared to Buncombe White infant mortality using 5 year aggregate rates. Infant mortality (IM)

Calculation: (2015) 5 yr rate (per 1,000 live births) of African American IM = 17.0 and White IM = 5.5

Calculate ratio by dividing African American IM by White IM ( 17.0/5.5 = 3.1). Meaning African American infant mortality is 3 times that of White infant mortality.

Sources: County and State data: North Carolina State Center for Health Statistics (NC SCHS), Statistics and Reports: Vital Statistics, "Infant Mortality Statistics";http://www.schs.state.nc.us/data/vital.cfm

Note: Use this 5 year aggregate data for monitoring infant mortality trends because there is a small number of infant deaths yearly, one death can significantly impact the Infant Mortality Rate.

The disparity ratio between 5 year infant mortality rates for African American and White infant mortality has increased over the past year and in 2015 was 3.1. From 2012-2016 Buncombe County had 54 white infant deaths and 19 African American infant deaths. This translates in an infant mortality rate of 5.3 deaths/1000 live births for white infants and 19.0 deaths/1000 live births for African American infants.

In the United States, significant disparities in birth outcomes exist based on race and/or ethnicity. African American women experience higher rates of preterm birth, low birthweight and infant mortality. Racial disparities have diverse causes. According to the CDC, reported causes include differences in socioeconomic status, prenatal care, maternal risk behaviors, infection, nutrition, stress, and genetics. In Buncombe County the economic disparity between African Americans and Whites may be a significant contributor. As of 2016 in Buncombe County, the percent of African Americans in poverty is 27.2% compared to the non-Hispanic white population at 13.8%. Research into the factors influencing preterm birth is needed for developing effective intervention strategies. Some research has found a link between racism-related maternal stress, stress hormones, and infant and child health outcomes which may explain why preterm birth rate disparities between white and black infants persist even after accounting for known risk factors such as obesity, smoking, and hypertension. Disparities in poor birth outcomes have lifelong implications for the health and well-being of families in Buncombe County.

The Mothering Asheville Steering Committee includes the following partners:

• Mother to Mother
• Sistas Caring 4 Sistas
• MAHEC
• Pisgah Legal Services
• YWCA
• ABIPA
• Children First/Communities in Schools of Buncombe County
• North Carolina Center for Health and Wellness at UNC Asheville
• Nurse Family Partnership
• Buncombe County Health and Human Services
• Buncombe County Community Engagement Team
• Community Care of Western North Carolina
• Homegrown Babies
• Mission Health

Increase access to quality healthcare for African American women across the lifespan including interconception care, preconception care, quality prenatal care, and healthcare throughout the life course. Enhance family and community systems with strategies such as strengthening father involvement, systems integration, increasing reproductive social capital, and community building. Address social and economic inequities through closing the education gap, reducing poverty, and supporting working mothers. A life course approach which addresses both early life disadvantages and cumulative and chronic stress should be employed. It is necessary to look beyond behavior and the biomedical model to address inequities that underlie health disparities.

Programs that are working in other communities:

African-American maternal and child health program that encourages better birth outcomes by providing support to women during pregnancy and for one year after birth. Aims to assist local communities in improving health status by addressing the systemic causes, including lack of education, lack of social justice, and economic disparities compounded by institutional political and personal barriers. Birthing Projects actively engage community residents in identifying their needs; implementing and evaluating services; and working collaboratively with other agencies, organizations and individuals. Also provides guidance and support to fathers. The Birthing Project concept has grown into a nationally recognized model which has been replicated in more than 90 communities.

This is an additional indicator that the group has identified to monitor. Please see the infant mortality rate indicator for a detailed action plan.