News: CJ Exclusives

Legislation may bring more prenatal health services to low-income areas

House Bill 88 would let more Advanced Practice Registered Nurses, including nurse-midwives, provide more services without direct doctor supervision

The infant mortality rate remains frustratingly high in North Carolina compared to the national average, a report from the state Department of Health and Human Services finds.

Loosening state regulations on medical practice may enable more health care providers to offer services where they’re needed most.

North Carolina reported 7.2 deaths per 1,000 live births in 2016, ranking it seventh from the bottom among states. The most recent data for the U.S. average is from 2015 and shows 5.9 deaths per 1,000 live births.

Last year, on average 331 babies were born each day in the Tar Heel State; two each day didn’t survive.

“We need to do more to address the true determinants of health, if we want to see improvements,” Dr. Elizabeth Tilson, state health director and chief medical officer, says  in a press release. “Our goal is to lower the infant mortality rate for all babies in North Carolina and decrease disparities within our populations.”

A scarcity of physicians in low-income, rural areas is one of the problems. Legislation in the General Assembly would ease the restrictions on some medical providers, including certified nurse-midwives, which should make their services more available in areas where obstetricians are hard to find.

The Child Fatality Task Force held its annual presentation at the Legislative Building, which included an update on infant mortality rates Oct. 25. It detailed the racial disparities still persistent in the state.

Black infants were 2.7 times more likely to die before their first birthday compared to white babies, and  the racial disparities are widening. The infant mortality rate for black babies increased by 7.2 percent from 2015 to 2016. Similarly, the rate increased by 11 percent for Hispanic infants. The mortality rate for white infants decreased by 12.3 percent during the same period.

The leading causes of death for infants in 2016 were prematurity and low-birth weight, a category comprising 20.6 percent of all infant deaths, according to data from N.C. DHHS. Congenital malformations, deformations, and chromosomal abnormalities were the second most common cause of death — 19 percent of all infant deaths.

Poverty is just one factor contributing to higher infant mortality rates, the Child Fatality Task Force says.

“The numbers (of infant mortality) are greatest in the eastern part of the state,” Karen McLeod, chair of the Child Fatality Task Force, told North Carolina Health News. “There seems to be a correlation around poverty in that area as it relates to death. This is something we really need to look at and investigate further and see what kind of interventions can be put in place to move North Carolina to a better place.”

A shortage of physicians hurts the eastern part of the state, McLeod said during the infant mortality presentation. According to North Carolina Health News, McLeod said, women often have to travel outside their home counties to see an obstetrician.

The N.C. Perinatal Health Strategic Plan 2020, launched in 2016, is seeking solutions that would lower the infant mortality rate and end the racial and income disparities. Through a 12-point plan, N.C. DHHS, along with perinatal health experts, intend to address not only the infant mortality rate but also the health of the parents.

A legislative fix is also in the works with House Bill 88, otherwise known as the Modernize Nursing Practice Act. The bill has stalled in the House Health Committee.

H.B. 88 would reduce regulations and allow Advanced Practice Registered Nurses the ability to practice without direct physician supervision in some circumstances. Certified nurse-midwives are just one type of APRNs who benefit by H.B. 88, says the North Carolina Nursing Association.

“The fact that so many mothers in rural areas are struggling to see any provider due to the status quo is unconscionable,” Tina Gordon, the chief executive officer of the North Carolina Nurses Association, said. “Passing House Bill 88 would remove the outdated regulations that prevent many Clinical Nurse Midwives from providing this essential care in parts of the state that need it most.”