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Another measurement of child well-being in North Carolina slipped in 2015.

The rate of child deaths, encompassing mortality for all children from birth to age 17, ticked upwards to 58.3 per 100,000 children, up from an all-time low in 2013.

Several of the negative trends pushing up North Carolina’s child death rate are the state’s stubbornly high infant mortality rate, which has ticked up in the past few years, and the rates of homicide and suicide among teenaged boys.

“The weak points are always the intentional deaths,” said Kella Hatcher, who manages the legislative Child Fatality Task Force. Hatcher presented the data to the task force on Tuesday morning. She said when it comes to intentional deaths, the group most vulnerable to suicide is 15- to 17-year-olds.

“There are more deaths to boys. There are more suicide attempts by females, but more deaths by males,” Hatcher said, noting that’s because boys tend to use firearms, an almost universally lethal means of suicide.

Suicides and homicides of children have hovered between 1.5 to 2 children per 100,000 for the past decade.

But the big driver of child death in North Carolina is infant mortality. Two-thirds of the child deaths in 2015 were in children under the age of one, said Michelle Hughes who heads the advocacy group NC Child.

2015 makes the fourth year running that child death numbers have worsened in North Carolina. The state ranks 41st in infant mortality, and in 2014 (the last year that comparative data is available), North Carolina had the 12th highest overall child death rate in the United States, tied with Wyoming.

“Our progress in preventing infant mortality has stalled in North Carolina and we are very concerned,” Hughes said.

Fewer car accidents

Hatcher said one of the bright spots of the annual tabulation is the fact that motor vehicle deaths have dropped. Currently, the rate of motor vehicle deaths for children has been cut in half since 2006, and the 2015 rate is the lowest motor vehicle death rate ever seen in the state.

cftf_ratesbyage“Certainly, cars have gotten safer, there’s no question,” Hatcher said. She also pointed to the graduated drivers license program, in which young drivers are restricted from driving at night or with their friends for several years after receiving permission to drive.

“The program definitely had an impact. Crashes definitely dropped after the graduated drivers license program went into effect [in 1997], that’s not just in the past decade,” she said.

Hatcher also pointed out that Task Force members championed the passage of child passenger safety laws, which has helped to push down deaths from motor vehicle accidents.

Birth defects up

Last year saw a sharp uptick in the rate of birth defects, with the number jumping nearly two points from 6.5 children with fatal birth defects per 100,000 children up to 8.1. All told, 185 North Carolina children died as the direct result of a birth defect last year.

Hatcher said the increase is concerning, but she was unable to say what might be driving it.

She acknowledged an increase in the number of pregnant women addicted to opiates – prescription pain relievers and heroin – could be a factor, but there are other things, such as smoking and the health of the mom before and during pregnancy, which probably have a bigger effect.

“We are very interested in figuring out how to support women’s health during preconception and while she’s pregnant and after,” said Hughes.

Hughes said tobacco is a huge factor in the deaths of infants, both from birth defects and after babies are born. Research has shown that smoking by pregnant women increases the risk of stillbirth, of babies being born prematurely, having low birth weight, and having lung and neurological problems. Also, tobacco use by mothers and others in a baby’s household greatly increases the risk of death from sudden infant death syndrome during the first year of life.

Policy Rx

Smoking cessation programs have been underfunded in North Carolina since 2012, when the General Assembly eliminated Tobacco. Reality. Unfiltered. a successful teen smoking cessation program, and cut funding for the Quitline and smoking cessation programs for pregnant women.

cftf_ratesbycause“About one in 10 babies born in North Carolina are born to a mom who smokes,” said Laila Bell, who does data and policy analysis for NC Child.

“We’ve cut it about 15 percent since 2011, but it’s still unacceptably high. [Smoking] is one of those measures that tell us that all women are not getting those kinds of preconception and prenatal care that they need.”

2012 also saw the legislature cut more than $400,000 from the Healthy Start Foundation, which was providing educational support statewide for clinicians working with pregnant women, along with helping families access health insurance.

Lack of health insurance is one of the socioeconomic issues that contribute to infant and child mortality, Bell said.

“One strategy would be to have more women of reproductive age to have health insurance,” she said, “because tobacco cessation counseling would be available for women who have health insurance coverage. They’d also be able to take advantage of preventive services provided.”

Bell also talked about the thornier issues beyond tobacco use, addiction, or insurance access that keep mothers and their children from being healthy – poverty, access to paid family leave, and child care.

“Decisions that are made that support or harm family economic security have real implications for child health,” she said.


This story originally appeared in North Carolina Health News and is shared by EdNC through a content-sharing agreement with nonprofit news organizations in North Carolina.

Rose Hoban

Rose Hoban spent more than six years as the health reporter for North Carolina Public Radio – WUNC, where she covered health care, state health policy, science and research with a focus on public health issues. After leaving WUNC, she founded North Carolina Health News. Hoban has been a registered nurse for 25 years and has masters degrees in journalism and public health policy from the University of California at Berkeley. Hoban’s work has been recognized both regionally and nationally with numerous awards, including the broadcast journalism’s highest award—the Columbia-DuPont, a Gracie Award, an Edward R Morrow award, and a Society for Professional Journalists Green Eyeshade award. In 2010, she was awarded a fellowship by the Association of Health Care Journalists to do in-depth reporting on North Carolina’s mental health system. She has also been a Knight Digital Media Fellow.