Too many black in­fants are dy­ing

The News & Observer (Sunday) - - Opinion - BY THE EDITORIAL BOARD

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.

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