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Report links women’s health before and between pregnancies to  birth outcomes

RALEIGHHealthier women before and between pregnancies would lower infant mortality and close racial gaps in birth outcomes, according to a new policy brief from Action for Children North Carolina.

The brief finds that addressing women’s health needs and improving the quality and continuity of care received throughout childbearing years would prepare low-income women to have healthier pregnancies, safer deliveries and give newborns a stronger start in life. Yet under existing policy low-income women without children only qualify for Medicaid if they become pregnant.

“Protecting the lives of infants is paramount to having a healthier state, said Alan Stiles, MD, pediatrician and chair of Action for Children North Carolina’s board of directors. “Regrettably, too many women in North Carolina enter pregnancy in poor health, leaving their newborns at risk for serious health conditions.”

Twenty-five years ago, North Carolina had the worst infant mortality rate in the nation, losing nearly 12 babies for every 1,000 live births. Today, infant deaths have declined by more than 40 percent to 7.4 deaths per 1,000 babies. While advocates applaud this progress, they warn that recent data shifts are a cause for concern. After achieving a record low in 2010, North Carolina’s infant mortality rate has climbed for two consecutive years. The state continues to rank poorly (about 40th) for infant deaths when compared with other states.

Maternal risks associated with infant mortality can be treated with appropriate preventive care like regular doctor visits, information about making healthy food choices and help to stop smoking. More than one in five (22 percent) women in North Carolina ages 18 to 44 currently smoke, nearly two in five (36 percent)  suffer from one or more chronic health diseases and approximately three in five (58 percent) are overweight or obese. Studies link these complications with higher risk pregnancies that can cause health issues among newborns including birth defects, preterm labor or low birthweight–the most frequent causes of infant and neonatal death in North Carolina.

Stiles said racial gaps in women’s health propel disparities in birth outcomes. African American babies born in North Carolina are 2.5 times more likely to die within their first year of life. Strategies to improve the health of African American women throughout their childbearing years would result in better survival and long-term health for African American babies.

In 2010, the North Carolina General Assembly began cutting key investments in infant mortality prevention services, and earlier this year legislators voted to reject Medicaid expansion. Under the Affordable Care Act, the federal government would fund 100 percent of the cost to expand Medicaid for individuals who earn less than 138 percent of the federal poverty line ($15,856 for an individual). Expansion would provide health care to an estimated 500,000 North Carolinians, including 178,000 low-income women of childbearing age.

North Carolina has until 2016 to adopt Medicaid expansion at no cost to the state. If implemented, expansion would reduce infant deaths by targeting more resources to improve the overall health of low-income women before they become pregnant.

Approximately half of all pregnancies in North Carolina are unplanned, and women are often unaware that they are pregnant until midway through their first trimester. Because it can take several weeks to qualify for Medicaid once a pregnancy is detected, many low-income women find themselves without prenatal care during the most critical period of their babies’ development as they wait to qualify for coverage.

“Pregnancy is simply too small a window to reverse longstanding health issues,” explained Stiles. “Delivering health care to women early and often would make a world of difference in the birth outcomes of their babies.”

Healthy Women, Healthy Babies: Expanding Medicaid Would Lower Infant Mortality and Reduce Racial Disparities, is available on

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