The struggling economy has affected almost every facet of our lives. The worst part of it is the millions of Americans who are out of work and have no health-care insurance. This could worsen an already tragic and persistent problem in North Carolina -- the loss of babies at birth.

"Normally, when the economy goes bad, infant mortality goes up, even when your service system is in place," said Tom Vitaglione, the chairman of the Child Fatality Task Force in Raleigh.

North Carolina's service system has been severely hit by the economy. The task force says that about $10 million in services to fight infant mortality was cut from the state budget for 2009-2010. The new budget simply holds the line from the last one; none of the cuts were restored. That could mean trouble for North Carolina, which has one of the highest infant-mortality rates in the country, 8.2 deaths for every 1,000 live births in 2008. Forsyth County reached an 11-year high of 12 deaths for every 1,000 live births -- the highest rate among urban counties in the state. That's unacceptable for a county nationally known for its medical advances.

Rates for 2009 should come out this month. Those rates may have been negatively impacted by the economy. Or to put it bluntly, poverty and lack of services may have led to more babies dying. And as you read these words, the effects of the 2009-2010 cuts are being felt by expectant mothers statewide. "You just wait for the fallout," said Debbie Mason of the Forsyth County Infant Mortality Reduction Coalition.

The 2009-2010 cuts included a cut in reimbursement rates for providers under Medicaid, including OB/GYNs, causing many providers to stop serving Medicaid patients; elimination of a regional outreach program that provided education for high-risk pregnant women about the care of infants; elimination of a bilingual resource line that answered up to 40,000 calls annually requesting help with pregnancy-related issues; and cuts to a statewide public-education program aimed at promoting healthy lifestyles for women of childbearing age.

The Forsyth County health director, Tim Monroe, said the cuts are troubling, but it's difficult to predict what effect they will have on infant-mortality rates. The programs cut, while needed, are "finger-in-the-dike" measures, he said, and what's really needed to combat infant mortality are efforts that look at what he sees as its causes.

Monroe thinks the stress of institutional racism is one of those causes, as well as poverty disproportionately affecting black families.

In Forsyth County in 2008, there were 25.3 deaths of minority infants for every 1,000 live births, in stark contrast to 6.4 deaths of white infants per 1,000 births.

Many people say the issue of infant mortality boils down to personal responsibility, not race or poverty. It's true that too many pregnant women continue to smoke, drink, have poor eating habits and lose control of their weight. It's hard to persuade some of these women to improve their health. But others want to improve, but lack access to quality health care. The Triad's high level of unemployment -- 10.6 percent in June -- has led to more women going without health care, thus losing access to preventative care.

Monroe said local governments should take a lead role in adopting for their workers "a livable minimum wage" that includes health-care benefits. He said he supports a proposal from the N.C. Justice Center: A figure of $18.16 an hour for a one-adult, two-child household. That's more than twice the lowest wages for city and county workers.

Everette Witherspoon, who will be sworn in as a county commissioner in December, also supports the livable-wage concept. He made ramping up the fight against infant mortality part of his campaign. Witherspoon, who beat Commissioner Beaufort Bailey in the Democratic primary to win his seat, said the county should spend more money combating infant mortality and less on other things, such as Tanglewood Park. "The mothers are responsible, but at the same time we have a political responsibility, too."

For starters, Witherspoon said, the county should hire more maternity-care coordinators. And it should concentrate on areas of the county with especially high rates of infant deaths. Other cities, such as Durham, have had success with that strategy, he said.

Monroe said he's working out a plan for more of the maternity-care coordination, currently being done by 14 coordinators, to be done by his department's social workers. He has doubts about the lasting effects of a program concentrating on pockets of high infant mortality, because programs focusing on social issues are unlikely to make a permanent impact once their grants run out.

But we think those programs are worth considering. So are the roles poverty, education and personal responsibility have in the problem. And we must pressure state legislators to restore cuts made to programs to fight infant mortality.

There's plenty of work to go around, and it calls for people of widely varying talents. If we don't think creatively and work harder we'll continue to lose more babies.

That's a heartbreaking toll no community should accept.