NC Child

RALEIGH — North Carolina’s persistently high fetal and infant mortality rates require new strategies to make further progress ensuring successful pregnancies and healthy births, according to a new report from NC Child. To improve birth outcomes, policymakers should close the health insurance coverage gap to promote maternal health pre- and post-conception.

“By utilizing available federal funding to expand access to affordable health care for women of childbearing age, the state can influence both fetal and infant mortality simultaneously, effectively doubling the positive impact for North Carolina families,” said Whitney Tucker, research director at NC Child.

NC Child published a report in 2016 that examines the link between infant mortality and closing the health insurance coverage gap; this report builds on that report and includes lesser-known data about fetal mortality, which is defined as the death of a fetus occurring at 20 or more weeks of gestation. In 2016, nearly as many fetal deaths (818) as infant deaths (873) occurred in North Carolina.

In Rowan County from 2012 to 2016, the annual fetal mortality rate was 7.5 per 1,000 live births (plus fetal deaths) and the infant mortality rate was 7.5 per 1,000 live births. During the same time period, the statewide fetal mortality rate was 6.9 and the statewide infant mortality rate was 7.2, ranking 39th in the nation.

Poor birth outcomes are often tied to maternal health challenges pre- and post-conception, such as diabetes, obesity, hypertension and smoking. These chronic conditions and risk factors can be addressed most effectively when women have access to health insurance.

Unfortunately, 23 percent of Rowan County women of childbearing age lacked health insurance in 2016. Statewide, 20 percent of North Carolina women ages 18-44 lack health insurance.

“Without access to health insurance, it’s incredibly difficult to manage chronic conditions that can adversely impact birth outcomes. That’s why it’s critical for North Carolina policymakers to close the health insurance coverage gap,” said Tucker.

More than 20 percent of all women of reproductive age in North Carolina earn too little (less than 100 percent of the federal poverty line) to access subsidized coverage in the marketplace, and only a small percentage qualify for Medicaid. Using available federal funding as allowed by the Affordable Care Act to expand health care coverage to all adults under 133 percent of the federal poverty line (FPL) would significantly reduce the number of uninsured women of childbearing age and improve their pre- and post-conception health, thereby promoting healthy births.

“Carolina Cares” is a bipartisan bill (House Bill 662) that would expand insurance to all adults under 133 percent FPL and is currently under consideration in the legislature.

While the proposal includes elements that will negatively impact enrollment (premiums and work requirements), it has the potential to provide currently unavailable health care options for women of childbearing age at high risk of experiencing fetal or infant mortality.

“Whether it’s ‘Carolina Cares’ or a different bill, the legislature should act quickly to close the health insurance coverage gap and support healthy pregnancies and healthy babies,” said Tucker.

NC Child is a nonprofit advocacy group based in Raleigh.