Too many black infants are dying
State programs and efforts by private organizations have reduced North Carolina’s infant mortality rate to its lowest ever, but the state still has a stubborn problem with high levels of black infant mortality. According to 2018 statistics, black babies are more than twice as likely to die than white infants.
Overall improvements haven’t changed that. Indeed, the gap was wider in 2018, the most recent year for available statistics, than it was 1999. An in-depth report by The News & Observer’s Lynn Bonner, with the support of a USC Annenberg Health Journalism Fellowship, recently explored why this sad disparity persists in a time of general improvements in health care for infants.
Of the 806 infants who died in 2018, 43 percent were black babies, although blacks are only 22 percent of the state’s population. In some counties the gap is stark. In Pitt County in 2018, no white infants died in their first year while 11 black infants died before their first birthdays.
Dr. Mandy Cohen, head of the state Department of Health and Human Services, said of the higher mortality rate: “It’s an atrocity and we need to address it.”
State officials, researchers and health care providers say there are several reasons for the difference. A higher level of poverty among blacks is the major cause, but there are others: a lack of rural hospitals, doctors who don’t listen well to pregnant black women and the stress of racism that affects black women of all education and income levels.
While the causes that put black babies at higher risk are many, one necessary response is clear: expand Medicaid. A study published in the American Journal of Public Health concluded that “Infant mortality rate decline was greater in Medicaid expansion states, with greater declines among
African American infants.”
This connection is not enough to move Republican lawmakers who are blocking Medicaid expansion under the Affordable Care Act. The federal government would pay 90 percent of the costs of making the insurance program available half a million low-income North Carolinians. But Republicans who control the General Assembly think the state’s 10 percent state share would be too costly.
Low-income pregnant women qualify for Medicaid coverage during their pregnancy and for 60 days after giving birth. Medicaid expansion would close gaps in health care for women in a state where 15 percent of women ages 19-44 are uninsured, the 10th highest level in the nation. Without regular access to health care, some women are unaware of health problems, such as diabetes or hypertension, that could affect developing babies.
The link between regular access to health care and healthy mothers giving birth to healthy babies is obvious. But some Republicans are still in denial. Sen. Ralph Hise, a Republican from Spruce Pine who opposes Medicaid expansion, told Bonner that a study showing ties between Medicaid expansion and lowered infant death rates wasn’t proof of an effect. “They’re showing a correlation, they’re not showing a causality,” Hise said.
If the senator and other Medicaid expansion opponents aren’t convinced about the causality, they ought to go to counties where mothers without insurance grieve for lost children. They can ask those mothers about the health care, if any, they had before getting pregnant and what happened when they lost Medicaid two months after giving birth. Otherwise, those lawmakers are turning a blind eye to what the state’s top health official rightly calls an atrocity.