The State of Perinatal

Health in NC
Perinatal Quality Collaborative of NC
May 2015

NC Births - 2013
118,983 live births
Moms age range from 11 to plus 45+ years old
Most women were ages 25-29
Education level

17% less than high school

22.4% High School or GED
31.6% some college
18.7% bachelors degree
9.8% Masters or PhD

58.6% were married

33.8% first child; 19.6% fourth or greater child

Racial Distribution of
North Carolina Live Births, 2013
Approximately 24% of live births in North
Carolina were to African Americans, 1%
American Indians, 56% to Whites, 15%
Hispanic, and 4% to other races (nonHispanic)

2013 NC Resident Births: Trimester Prenatal Care Began

5% 2% 2%
1st Trimester
21%

2nd Trimester
3rd Trimester
70%

Source: State Center for Health Statistics

No Care
Unknown

Infant Mortality Rate

Number of Deaths From All
Causes in the 1st Year of Life
IMR =

----------------------------- x 1000
Number of Live Births

Low birthweight is defined as a baby born

weighing less than 2500 grams (5.5 lbs.)

Infant Mortality Rates:1975-2013

20.0
18.0
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
1975

1980

1985

1990

1995

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Source: State Center for Health Statistics & CDC/National Center for Health Statistics

2013

2011 U.S. Infant Mortality Rate

Rankings
Rank

State

Mississippi

Delaware

Louisiana

Alabama

Ohio

Indiana

District of Columbia

South Carolina

9 (tie)

Arkansas
Tennessee

11 (tie)

North Carolina
Oklahoma

Source: State Center for Health Statistics & CDC/National Center for Health Statistics

NC Resident Infant Mortality Rates, 1994-2013

30.0

25.0
Rate per 1,000 Live Births

20.0

15.0

10.0

5.0

0.0

Source: North Carolina State Center for Health Statistics

Total
White
NH
Af. Am.
NH
Am.
Ind. NH
Hispani
c

Leading Causes of Infant Mortality

Low Birth weight (babies born too small)

Prematurity (babies born too soon)
Birth Defects
Sudden Infant Death Syndrome (SIDS)
Maternal Pregnancy Complications

Why is infant mortality important?

Infant mortality is not just about death

Seen as a measure of a societys commitment to its
most vulnerable members our babies
Proxy measure for the broader issue of infant morbidity

Preterm Birth 1999 2009

North Carolina

Preterm is less than 37 completed weeks gestation. Source: National Center for Health Statistics,
final natality data. Retrieved July 27, 2012, from www.marchofdimes.com/peristats.

Preterm birth - 2013

11.5% of all births were preterm

Preterm birth rates were higher among African

American women

Low birthweight - 2013

Weighing less than 5.5 lbs. (2500 grams)

8.8% of babies were born low birthweight

Low birthweight rates were higher among African

American women

Low Birth Weight Concerns

Mental Retardation

Learning Disabilities

Vision Loss

Hearing Loss

Cerebral Palsy

Birth Weight Trends

Percentage of live births that are low birth weight

has increased steadily, but mortality rates in each
birth weight category have decreased dramatically
until recently.

The greatest increase in low birthweight has been

for babies born under 500 grams; steady for 2013
for a rate of .2%

Method of Delivery - 2013

Vaginal 69.6% (Hispanic births 75.7%)

C-Section 30.3% (Hispanic births 24.3%)

Level of Care for Infants - 2013

Infants born 501-1500 grams born in NC hospitals

Level III 80.8%
Other 19.2%

Women age 18 to 44 who had a routine checkup in the past year

NC 2012
90
80

80.4
72.2

70

69.5

69.4

60
50
40
30

Women age 18 to 44 who took a multivitamin, prenatal vitamin, or a folic acid supplement every day

20
10

50%

0
All

White

Black

Hispanic

45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
2011

2012

2013

Source: State Center for Health Statistics/

Behavioral Risk Factor Surveillance System (BRFSS)

Uninsured Population, 2012

50%

US

40%

NC

percent

30%
18%

20%
10%

9%

20%

18%

21%

9%

0%

Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the
Census Bureau's March 2012 and 2013 Current Population Survey (CPS: Annual Social and Economic

Where we live, learn, work and

play has a greater impact on
how long and how well we live
than medical care.

Robert Wood Johnson Foundation Commission on Health

www.commissiononhealth.org

Health potential

Life Course Approach

Optimal Life
Trajectory

Life Trajectory Affected

by Inequity

Early
Programming

Cumulative Pathways

With Equity, inputs may need

to be different to achieve equal
outcomes

This is Equity
MDCH, Health Equity Learning Labs 2013, provided by Hogan, V., Rowley, D., Berthiaume, R. and Thompson,
Y, University of North Carolina at Chapel Hill. Adapted from

Socio-Ecological Model
Public Policy
Community
Relationships between
organizations

Organizational
Organizations and social
institutions

Interpersonal
Families, friends and
social networks

Individual
Knowledge, attitudes
and skills

25

So What Do We Know?
Unintended pregnancies result in poorer
birth outcomes.
Healthy women tend to have healthier
pregnancies.
Preconception health is crucial.
Optimal prenatal care is essential.
Community involvement is necessary;
most of health is outside the clinical
setting.

National Focus

Collaborative Improvement and Innovation

Network (CoIIN) to Improve Infant Mortality
Interconception/preconception health
Perinatal regionalization
Social Determinants of Health

AMCHP Birth Outcomes Initiative

Focus on Perinatal Health Disparities

Questions?
Belinda Pettiford
Belinda.pettiford@dhhs.nc.gov
919-707-5699