ASHEVILLE — Kacey Rawson laid her 4-month-old daughter on the scale and smiled as she saw the numbers pop up.

“She's getting so big,” Rawson said as her baby, Audrina Craig, looked up at her as the display blinked 15 pounds, 8 ounces. “She's rolling over and sitting up.”

Standing next to her, Ginger Clough glowed like a proud mother. Clough, a nurse with the Nurse-Family Partnership, has been visiting Rawson every two weeks since she was three months pregnant.

Launched in Buncombe County last year, the Nurse-Family Partnership is a national program helping low-income, first-time mothers have healthier babies and children. One hundred women are enrolled in the program and 24 healthy babies have been born so far.

“Even with her, it's still scary,” said Rawson, 20. “But I'd be lost without her. I wouldn't know what to do … She (Audrina) wouldn't be like this if I didn't have help.”

Public health officials believe the program and others like it could help North Carolina improve its ranking for child well-being.

An annual report released last week ranks North Carolina 37th in the nation when it comes to child well-being. The Annie E. Casey 2010 Kids County Data Book ranked states based on 10 measures in the areas of health, education, family life and socio-economics.

“Good outcomes for children don't happen by accident,” said Barbara Bradley, president and CEO of Action for Children North Carolina, a statewide advocacy group that collects data for the data book. “It takes investments by the state government and communities.”

North Carolina has improved on five of the 10 measures since 2000, with more teenagers graduating from high school and fewer becoming pregnant. But the number of low-weight babies in the state has increased and the infant mortality rate, or the number of babies that die before their 1st birthday per 1,000 live births, has remained stagnant.

“North Carolina has come up a lot, but we're still in the bottom 15 in the nation,” Bradley said. “Are we satisfied with that? The answer is absolutely not.”

Buncombe County fares better than most of the state in many of the indicators, although the county does have a higher rate of low-income children who are obese. Earlier in the year, the county was ranked the 25th healthiest out of 100 counties in the state.

“These indicators tell us the same thing,” said Buncombe County Health Director Gibbie Harris. “We are doing a lot better than our sister counties but the fact that we have any unplanned teen pregnancies is not something to crow about.”

Infant mortality

Of all the indicators, the infant mortality rate may be one that shows best how children are doing as a whole. The rate can be affected by poverty, education, nutrition, sexual activity and other factors, many of which are other key indicators used in the annual data book report.

“In most societies, it's been an indicator of the overall health of children,” said Tom Vitaglione, a senior fellow at Action for Children.

North Carolina had the worst infant mortality rate in the country in 1988. State programs including better access to health care and family planning helped the rate decline sharply during the 1990s, but the infant mortality rate remained flat since 2000, and North Carolina still ranks toward the bottom.

The state also has a wide racial disparity when it comes to infant mortality. More than twice as many black babies die before their first year of life compared with white babies.

Today, experts believe that infant mortality rates in the state may start to rise for the first time in two generations, Bradley said.

The percentage of low birth weight infants, a measure closely associated with infant mortality, is rising. The recession means more families are struggling and the state has cut some programs aimed at reducing infant mortality.

“Some of the data in the report was before the recession and budget cuts,” Bradley said. “We are really worried about what we are going to see over the next few years.”

Improving the statistics

Clough, the nurse with the Nurse-Family Partnership, said 30 years of data from the program have shown that it can help improve a child's health. It has also been shown to improve the child's economic situation and school readiness, and lower rates of childhood injuries and subsequent pregnancies for the mother.

Since she's been in the program, Rawson has started working, cut down on her smoking and identified what kind of life she wants for herself and her baby.

“Audrina is so happy and really learning quickly and she's able to do that because Kasey has created a safe foundation for her,” Clough said.

While programs like these help to improve infant mortality and the overall health of children, Vitaglione said the next step to improving the statistics is focusing on the health of women before they have children, including lowering rates of obesity, smoking, high school dropouts and poverty.

“The interventions we've introduced — both prenatal and postnatal — have done what they can do,” he said. “The big breakthrough will come when healthier women are becoming pregnant.”