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By Laila A. Bell, Director of Research and Data

Every expectant mother hopes for a healthy birth and baby.

NC Child’s latest brief shows not all women in North Carolina have access to resources that support healthy pregnancies, deliveries, and newborns, putting their babies at greater risk for poor birth outcomes, including infant mortality. The good news is that closing the health insurance coverage gap has to potential to provide many women with access to care that can promote the healthy birth of their babies.

For decades, efforts to promote healthy births in North Carolina successfully focused on prenatal care and medical interventions to improve infant mortality. This strategy resulted in a more than 40 percent decline in infant deaths. But improvements in infant mortality have plateaued over the last five years, and racial and ethnic disparities in infant death are growing. The data show North Carolina needs a new strategy to jumpstart stalled progress in infant mortality prevention.

Many factors influence infant mortality, including the social, economic, and environmental conditions of the homes and neighborhoods where families live. Research also shows women’s access to health insurance and their physical and mental health play a big role in promoting healthy births. Women’s health before pregnancy is a strong predictor of their future birth outcomes, and healthier women deliver healthier babies.

Unfortunately, too many women lack access to health insurance. One in every five adult women in North Carolina is uninsured and two-thirds of them are of reproductive age. Uninsured women are less likely to receive the preventive care they need to achieve and maintain good health, and are more likely to suffer from untreated physical conditions like diabetes, obesity, and high blood pressure that contribute to premature and low birthweight births–the leading causes of infant mortality in North Carolina.

Women’s access to health insurance and access to care vary greatly according to where they live, among other factors. For example, 13 percent of women of reproductive age in Orange county are uninsured, compared to 47 percent of women in Cherokee county. African American and other minority women are less likely to have regular access to health care than White women and are more likely to experience pregnancy complications and adverse birth outcomes.


For many uninsured women financial barriers prevent them from receiving the physical and mental health care they need. In 2014, 19 percent of North Carolina women reported being unable to seek medical care when they needed to see a doctor due to cost. More than half of uninsured women of reproductive age in North Carolina are caught in the health insurance coverage gap–they earn too much to qualify for Medicaid, but too little to afford private health insurance in the Marketplace.

The Governor and legislature’s refusal to close the health insurance coverage gap means these women currently lack access to medical care that would support their physical and mental health and increase their odds of having healthy pregnancies and babies. Extending Medicaid eligibility to low income adults up to 138 percent of the federal poverty line, which is paid for almost fully by previously allocated federal funds, would not only strengthen women’s opportunities to improve their health and wellness, it could improve birth outcomes and address race and ethnic disparities in infant mortality as well.

To learn more, read Strengthening Women’s Health: A Key to Reducing Infant Mortality and Eliminating Racial and Ethnic Disparities online at


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