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The Experience

When we achieve this result:

  • All babies in Buncombe County are born healthy.
  • In their first year, babies are breastfed, safe, thriving, and nurtured in a healthy environment.
  • All women have access to the full spectrum of reproductive care, including preconception care and family planning services, ensuring that women are healthy before they get pregnant and during their pregnancy.
  • Thriving families are supported by living wages and resilient communities. Racial equity eliminates disparities in maternal and child health outcomes.
Why Is This Important?

In Buncombe County in 2015, 12 babies died before their first birthday. At 4.6 infant deaths per 1,000 live births, Buncombe County's infant mortality rate is lower than the rate of North Carolina (7.3 infant deaths per 1,000 live births) and the United States as a whole (6.0 infant deaths per 1,000 live births). While this is a decrease from the peak of 27 deaths in 2013, it is higher than the infant mortality rates for the six years prior. Because of this and the racial disparities in infant mortality, it is an area of great concern in Buncombe County. It indicates that not only are our infants becoming less healthy, but our women are becoming less healthy, too. Additionally, improving maternal and infant health as well as reducing unintended pregnancies are state objectives under Healthy North Carolina 2020.

According to the CDC, one of the main causes of infant mortality is most often caused by babies born preterm and/or at a low birth weight. Most often babies born early have a low birth weight simply because they have not had adequate time to develop. The March of Dimes reports that the primary risk factors that cause or influence prematurity and birth weight relate to the health of the pregnant mother including chronic health conditions, infections, placenta problems, weight, and smoking, alcohol and substance abuse.

An increased risk of low birth weights and prematurity means an increased risk of infant mortality. Note, these risk factors are primarily focused on the mother's health before and during pregnancy. Access to the full spectrum of reproductive care including preconception care, family planning services, and prenatal care can lead to healthy women with healthy pregnancies. 43% of pregnancies ending in a live birth in North Carolina are unintended. Planned pregnancies can help to decrease risk behaviors and screening for chronic conditions, while increasing women’s engagement in their health and positive behaviors such as taking folic acid and being up to date on protective vaccinations. Unintended pregnancies refers to mistimed or unplanned pregnancies and unintended pregnancies are associated with poorer birth outcomes and have been associated with late entry into prenatal care, low birth weight, and child abuse and neglect. Women under 17 and over 35 years old are at increased risk of complications.

However, social determinants have an impact on infant mortality. Social determinants are social and economic conditions that are not directly related to health, but have a great impact on an individual's or population's ability to be healthy. Poverty, unemployment, and low education levels of mothers and parents increase the risk of infant mortality. In addition, risks are further impacted by race and ethnicity as well as age. African Americans have 8.4 times the risk of infant mortality when compared to the white population in Buncombe County in 2014. While this yearly figure can be significantly influenced by one death due to small numbers, the five year aggregate still shows African American babies have 2.6 times the risk of infant mortality compared to white infants.

Infancy is a critical window of time that sets the stage for a child’s development and a person’s lifelong health. Because so much biological and psychological development occurs during this time, infants are particularly vulnerable the negative impacts of malnutrition, stress, poverty, and other risk factors.

For more information available at the follow sites:,

Healthy North Carolina 2020: A Better State of Health
March of Dimes, Your Premature Baby
Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality and here
North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) Results.

Partners

Asheville Buncombe Institute of Parity Achievement (ABIPA): providing education, health services and advocacy from a unique understanding of the African American experience and a demonstrated ability to increase collaboration, connection, awareness and trust across diverse segments of the community.

Child Protection/Fatality Prevention Team: Reviews the infant mortality cases to understand the cause of death and identifies gaps in services related to all child deaths

Buncombe County Health and Human Services:

Family Planning and STD Clinics: Women's wellness visits, family planning services and STD screening, education, treatment and follow-up

Nurse Family Partnership: NFP is an evidence-based community health program that helps transform the lives of vulnerable mothers pregnant with their first child. Each mother served by NFP is partnered with a registered nurse early in her pregnancy and receives ongoing nurse home visits that continue through her child’s second birthday.

Minority Health Equity Project: This project brings together five different community partners and the Buncombe County Department of Health to combine our resources to promote health equity.

HHS Community Service Navigators: The CSN initiative was created to connect people with Buncombe County Health and Human Services, strengthen the communities capacity to help meet citizen needs, empower citizens and communities as change agents to promote positive outcomes, build and enhance collaborative partnerships, and reduce over utilization of more costly services.

Children First/Communities in Schools: A not-for-profit organization that offers direct services to economically disadvantaged children, youth and their families. These services include: Family Resource Center at Emma, Learning Centers, Project POWER/AmeriCorps program, Student Support Specialist , The Success Equation

Community Care of Western North Carolina (CCWNC): OB Case Management through Pregnancy Medical Home working to reduce infant mortality in North Carolina.

Guardian Ad Litem: Guardian ad Litem volunteer is the eyes and ears for a judge and the person who tells the child's story to the court in maltreatment cases resulting in court intervention.

Mission Health: not-for-profit, independent community hospital system governed and managed exclusively in western North Carolina

Mountain Area Health Education Center (MAHEC): Family Health, Obstetrics & Gynecology, School Health Nursing Program, Buncombe County Prenatal Safety Net

Mt. Zion Community Development, Inc.: Project NAF (Nurturing Asheville & Area Families) is Buncombe County's Minority Infant Mortality Program that provides advocacy and support services to African American pregnant and post-partum women and their babies; Project EMPOWER (Education Means Power), one of Buncombe County's Teen Pregnancy Prevention Initiatives, which works in collaboration with the Asheville City Schools System and Foundation.

Pisgah Legal Services: provides free civil legal aid in WNC to disadvantaged children, seniors, at risk families & domestic violence victims

Planned Parenthood: women's health, reproductive health, and family planning services

Western North Carolina AIDS Project: offering supportive services for those who are living with HIV or AIDS

Western North Carolina Community Health Services (WNCCHS): Federally Qualified Health Center providing primary healthcare, dental, behavioral health, and support services

WIC: Women, Infants and Children (WIC) Supplemental Nutrition Program is designed to improve the health and well-being of low-income pregnant, breastfeeding and postpartum women, infants and children up to age five who are at nutritional risk by providing nutrition education, breastfeeding education and support, referrals for health care, and free language assistance.

YWCA MotherLove: MotherLove is a comprehensive program for pregnant and parenting teens. The goals of the MotherLove Program are that pregnant and parenting teens stay in school, access higher education and vocational training, develop the skills and knowledge needed to become strong parents and delay another teen pregnancy.

Community-level Indicators
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Data Holes

Identifying the root causes of infant death will direct community health improvement practices by indicating the areas of concern and the areas where improvement efforts need to be targeted. Quantitative data will illuminate what health issues and disparities are occurring. Qualitative data, from focus groups and interviews in the community, will bring information on what the community thinks are the the most important issues and barriers to health. Finally, mapping the data can highlight populations and geographic areas where new health improvement efforts need to be focused.

Community Partners have identified the following holes in data:

  • root causes of infant mortality
  • access to mental health services
  • access to community resources
  • ways to measure how programs help customers
  • customer experience of services, including if the customer feels respected and gets the help they need
  • community trust of service providers
  • community identity and pride
  • parent engagement

For data on additional indicators that impact infant mortality that are being monitored, click here.

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