By Laila A. Bell

Special to the Salisbury Post

RALEIGH — More babies born in Rowan County could survive their first year and live healthier lives if their mothers got health care before pregnancy through Medicaid expansion, according to a new report by NC Child.

The report finds one in five women of reproductive age (19-44) statewide are uninsured, more than half of whom (about 175,000) fall in the health insurance coverage gap — their incomes are too high to qualify for Medicaid and too low to afford private health care.

Many factors contribute to infant mortality. The environmental, economic, and social conditions of the communities where parents live can play a big role, but we also know that women’s health is a strong predictor of future birth outcomes. Uninsured women are more likely to have unaddressed health issues including chronic conditions like diabetes, obesity, and hypertension that contribute to premature and low birthweight births—the leading causes of infant mortality in North Carolina.

“Healthy births start with healthy moms,” said Michelle Hughes, executive director of NC Child. “If we want to reduce infant mortality, we need to do a better job providing their mothers with access to health insurance before they get pregnant.”

In Rowan County, 27 percent of women of child-bearing age are uninsured and many of them fall in the health insurance coverage gap.  In 2014, 9.5 percent of Rowan babies were born at a low birthweight, and 11.0 percent were born premature, putting them at risk for long-term health challenges and infant mortality.

Over the past two decades, North Carolina’s infant mortality rate has dropped by more than 40 percent as a result of improved clinical practices and smart public policy. But North Carolina’s progress has plateaued and lags behind the rest of the nation, ranking 42nd for infant mortality. For every 1,000 babies born alive in North Carolina, seven die in their first year of life.

Moreover, a baby born in North Carolina is less likely to live to celebrate her first birthday than one born in the neighboring states of South Carolina, Virginia, or Tennessee.

The report shows stark racial and ethnic disparities mean African American and American Indian babies in North Carolina are more likely to die before reaching their first birthday than White babies. Although overall infant mortality rates have declined, the infant death gap between African American and White babies in North Carolina is wider today than in 1988. Furthermore, the mortality rates for Hispanic and American Indian children have worsened over the past several years.

“The difficult truth in this data is that babies of color are more likely to die before their first birthday than White babies,” said Laila A. Bell, director of research and data at NC Child and author of the report. “But we can implement evidence-based policies and programs to address this disparity, including closing the health insurance coverage gap for women of child-bearing age.”

Closing the health insurance coverage gap would provide about 175,000 women of reproductive age with health insurance, which would allow them to get early treatment for chronic conditions that have a negative impact on their babies’ health.

The health insurance coverage gap was created when Governor McCrory and the legislature refused to expand Medicaid under the Affordable Care Act. This decision left a coverage among people whose incomes are too high to qualify for Medicaid and too low to qualify for federal subsidies. Most people in the coverage gap are working, but they cannot afford to buy health insurance on the prevailing wages in industries such as retail, construction, or food service.

Laila A. Bell is director of research and data for N.C. Child.

To  access the full report, “Strengthening Women’s Health: A Key to Reducing Infant Mortality and Eliminating Racial and Ethnic Disparities,” visit: www.ncchild.org/wp-content/uploads/sites/9/2016/06/2016_NC-Child-Womens-Health-and-Infant-Mortalitymin-size.pdf.