As part of the long-standing effort to reduce both the overall infant mortality rate and the racial disparity in infant mortality within the state, North Carolina was selected along with four other states to participate in the New State Infant Mortality (SIM) Collaborative. This Collaborative was supported by the Centers for Disease Control and Prevention, the Association of Maternal and Child Health Professionals, and the March of Dimes along with other national and state partners. The purpose of this unique collaborative was to assist States in investigating and addressing their own infant mortality issues; to develop a state-based research agenda; to produce common resource guides, protocols, and tools; and to publish and disseminate findings.
In North Carolina the SIM Collaborative consisted of a wide variety of professionals from across the state. Collectively, the group has developed a detailed plan to study the state’s recent infant mortality experience. In addition to examining quantitative trends, the Collaborative plans to exam existing and original qualitative data from across North Carolina.
To date, most women’s health and infant mortality reduction interventions have relied heavily on quantitative data in their development. Given the long-standing high rates of infant mortality in North Carolina and the complex nature of the problem, the North Carolina SIM Collaborative decided to compliment the quantitative analysis of infant mortality with an examination of qualitative data. By using this approach the Collaborative hopes to understand the beliefs and opinions of the people of North Carolina regarding women’s health and infant mortality. This understanding may then lead to a greater understanding of the reasons for the current infant mortality trends and ultimately lead to solutions.
The Governor appointed Child Fatality Task Force has assumed the role of supporting and reviewing the work of the SIM Collaborative. It is hoped that the key strategies that emerge will be considered for policy and programmatic implementation by this body.
The North Carolina State Infant Mortality Collaborative met several times since it began work in September 2004. The full collaborative has meet on October 22, 2004 in Raleigh, on February 17, 2005 at UNC Hospitals, by conference call on April 21, 2005 and on June 16th, 2005 at the Pitt County Public Health Center in Greenville. The committee along with member of the Perinatal Health Committee (part of the Child Fatality Task Force) met on November 30, 2005 at the Paul Rizzo Conference Center in Chapel Hill. Click here to view the minutes.
Five members of the North Carolina State Infant Mortality Collaborative traveled to Atlanta July 24-26 to meet with national experts to discuss next steps. North Carolina's presentation and information from the meeting are posted in the data and findings section of this site. The next meeting of the North Carolina State Infant Mortality took place on September 30, 2005. During this time the group examined a large amount of information and began to determine key strategies.
A meeting of members of the SIM along with members of the Child Fatality Task Force and several guests met on Wednesday November 30, 2005 to discuss a list of potential recommendations for the upcoming legislative session. The meeting was sponsored by the March of Dimes and Glaxo Smith Kline.
Continued discussions via email and a meeting on March 6, 2006 took place. The group will be presenting some recommendations to the Child Fatality Task Force on April 10, 2006. The SIM group will reconvene in May 2006.
North Carolina State Infant Mortality Presentation - Atlanta, July 2005
Please click here to view the presentation given at the national meeting in July.
Inventory of Existing Qualitative Data in North Carolina
A total of 25 Qualitative Data Activities were cataloged according to the five Geographic Perinatal Regions (Westeren, Triad, Southwestern, Northwestern, and Eastern). A significant number of qualitative data activities have been conducted in the Eastern region due to their high rates in infant mortality. In addition there have been numerous interventions implemented in this area of the state. Qualitative Data is lacking from the Southeast and Southwest Regions as these are areas with low infant mortality rates.
Summary of Existing Qualitative Data in North Carolina
The findings from qualitative data gathered in North Carolina over the past ten years were summarized, analyzed and cataloged in May 2005. As part of these studies, hundreds of providers, consumers, and community leaders participated in discussions about a broad range of issues pertaining to women’s health and infant mortality. Based on the content that emerged from these studies, the data were organized into five categories and recommendations were made for each category. A sample of significant factors and recommendations is listed below. For a full copy of the report, contact Sarah Verbiest at sarah_verbiest@med.unc.edu.
1. General Health Factors
Perceptions of Preventive Healthcare, Sexually Transmitted Infections, Healthy Weight, Use of Vitamins (folic acid)
Recommendations: improve and simplify access to health services, educate women about preventive health in public schools, churches, and in communities
2. Lifestyle Factors
Stress, Social Support, Substance Use, Domestic Violence, Role of Men in Women’s Lives Recommendations: Extend health clinic hours for working mothers, mandate a living wage, improve health literacy of education material
3. Socioeconomic Factors
Poverty, Education, Access to Healthcare, Insurance, Medicaid Eligibility, Job Loss, Child Care, Transportation
Recommendations: Involve men/partners throughout pregnancy, provide support groups to deal with relationship issues, pregnancy, and motherhood, educate about healthy eating habits, develop alternative activities for drug use, teach time-management to prevent stress
4. Family Planning Factors
Beliefs about Contraceptive Use, Intendedness of Pregnancy, Access to Family Planning Services Recommendations: Educate about the importance of birth spacing, discuss birth control options throughout health system (not just post-partum) and include women’s partners in the discussion
5. Other Factors
Customer Service Issues, Patient/Provider Trust, Disconnected Systems that Serve Women (health, housing, insurance, child care)
Recommendations: Increase availability of affordable and available childcare, eliminate racism, raise community awareness concerning maternal and infant health, use media campaigns to promote healthy lifestyles and healthy pregnancies
Key Findings from Analysis of Quantitative Data Related to Infant Mortality
The neonatal survival advantage of low birthweight African American babies has decreased over time. This could be contributing to the increasing racial disparity in infant mortality.
The percentage of live births that are multiple births has increased dramatically over time and there is very little difference in the percentages between whites and African Americans. Therefore, the multiple birth rate is not having much effect on racial disparities.
Births that were "wanted" (PRAMS data) had a significantly higher percentage of low birthweight than all other births overall and for whites. But there was not a significant relationship between unwantedness and low birthweight among African Americans.
Half of the "excess" infant deaths in North Carolina occur in 13 of the 100 counties. This presents opportunities for targeting programs and interventions.
Paul Buescher, Ph.D
Head, Statistical Services Unit, State Center for Health Statistics
NC Division of Public Health
1908 Mail Service Center
Raleigh, NC 27699-1908
Joe Holliday, MD, MPH
Head, Women’s Health Branch
Women’s and Children’s Health Section
NC Division of Public Health
1929 Mail Service Center
Raleigh, NC 27699-1929
Sarah Verbiest, MSW, MPH
Executive Director
UNC Center for Maternal and Infant Health
308 Medical School Wing E, CB# 7181
Chapel Hill, NC 27599-7181
Belinda Pettiford, MPH
Supervisor, Perinatal Health and Family Support Unit
Women’s Health Branch, Women’s and Children’s Health Section
1929 Mail Service Center
Raleigh, NC 27699
Sheila Bunch, PhD, MSW
Assistant Professor, School of Social Work
East Carolina University
216 Ragsdale Building
ECU School of Social Work
Greenville, N.C. 27858
Kevin Ryan, MD, MPH
Chief, Women’s and Children’s Health Section
NC Division of Public Health
1916 Mail Service Center
Raleigh, NC 27699
Cathy Melvin, PhD, MPH
Director, Child Health Services Research Program and Smoke-Free Families National Dissemination Office
Cecil G. Sheps Center for Health Services Research
University Of North Carolina
Chapel Hill, NC 27599-7590
Janice Freeman, MPH
Executive Director, NC Healthy Start Foundation
1300 Saint Mary’s Street, Suite 204
Raleigh, NC 27605
Merry-K Moos, RN, FNP, MPH, FAAN
Professor, Maternal Fetal Medicine Division,
Department of Obstetrics and Gynecology
UNC School of Medicine
Campus Box #7516, 214 MacNider Building
Chapel Hill, NC 27599-7516
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