Issue #4 - September 2010
In this issue:

Women's Health - Healthy Pregnancies/Healthy Babies
Infant Safe Sleep - Ready for SIDS Awareness Month?
Adopt-A-Mom Program, Guilford County

Latina Health
Infant Mortality and the "Hispanic Paradox"
Foundation News
- Infant Mortality Challenges

Infant Mortality Awareness Month

The latest North Carolina Infant Mortality Rate (IMR) indicates we have cause for celebration and cause for concern.  The good news is in 2009 the state's IMR rate was the lowest in state history, 7.9% declining 3.7% from 2008. The bad news is racial disparities remain, with minorities continuing to have an IMR more than two times whites. This Happenings newsletter is dedicated to the issue of infant mortality. Find out what you can do to help more babies celebrate a healthy first birthday. Learn more about a unique program in Guilford County that helps uninsured women get prenatal care. And find out about the "Hispanic Paradox" when it comes to infant mortality. Read on…

Pregnant woman with flower

Women's Health

Healthy Pregnancies/Healthy Babies

How can you help more North Carolina women have healthy pregnancies and healthy babies? Will you talk to a young woman about the importance of being a healthy weight before she becomes pregnant? Will you organize a community health fair to share prenatal and basic baby care information? Since its inception the North Carolina Healthy Start Foundation has been dedicated to reducing infant death and illness in North Carolina, but we can’t do it alone. We need your help to educate young families about the need to take care of themselves and their infants so that more babies in our state can successfully celebrate a healthy first birthday.

September is National Infant Mortality Awareness Month, set aside to recognize and focus on our efforts as a nation to fight infant mortality. North Carolina has cause to celebrate this year in seeing the state's lowest infant mortality rate ever and an overall decrease of 37% since 1988. However, racial disparities remain, with minorities continuing to have an IMR rate more than two and half times higher than whites.  Minority women also continue to experience higher rates of low and very low birthweight births (13.5%) compared with whites (7.7%). These higher rates are responsible for much of the gap between white and minority birth outcomes.

In light of advanced medical technology, cutting edge birth centers and hospitals, these startling statistics cause us to wonder why North Carolina continues to lose the lives of so many babies. In 2009, 1,006 infant deaths were recorded.   More than one in ten (13.2%) of all resident births were premature (less than 37 weeks gestation). This is up slightly from 12.8% of all births in 2008. Premature and low birthweight babies account for the largest percentage of infant deaths (23.3%), birth defects (19%) and Sudden Infant Death Syndrome (9.7).

The North Carolina Healthy Start Foundation, in collaboration with the North Carolina Division of Public Health and numerous community based organizations, educate women and their families across the state on how to improve their health before and after pregnancy. We provide educational materials on a variety of topics that address both physical and emotional health.  Research shows that the more informed a woman is, the healthier she is before getting pregnant, and the better her access to prenatal care, the better her pregnancy outcome is likely to be.

There are many ways communities can support efforts to decrease infant mortality:

  • Help educate and encourage the importance of women's health (One Child, One Community brochure) before, during and after pregnancy
  • Support agencies and programs that offer family support
  • Provide emotional support to help decrease the stress of parenting
  • Plan activities and events for families in your community

Many infant deaths can be prevented.  However, major obstacles such as lack of health insurance and access to health care, high rates of poverty, stress and lack of education continue to be barriers in our state.  For years these challenges have helped to create major health disparities and continue to contribute to the loss of infant lives in North Carolina. By working together we can make a difference.

Expectant mother receiving an ultrasound

Infant Safe Sleep

Ready for SIDS Awareness Month?

October is National SIDS Awareness Month. While it's important to promote infant safe sleep throughout the year, SIDS Awareness Month provides a unique opportunity to encourage community members to remember the safety measures they can take to reduce the risk of SIDS and other infant sleep related deaths. Many of the same things that reduce infant mortality can also reduce the risk of SIDS such as early prenatal care, prenatal smoking cessation and a smoke-free environment. In addition, there are steps parents and caregivers can take after the baby is born that also reduce the risk of SIDS such as breastfeeding, use of firm bedding materials, and positioning the infant on his back when sleeping. We have some tips on how you can help promote SIDS Awareness Month.

SIDS Awareness Month is a time for action! Below is a sampling of the many activities that can be planned for the month of October.

Ideas for SIDS Awareness Month

  • Pitch the idea of recognizing SIDS Awareness Month to your local radio and TV news stations. Appear as a guest and talk about ways to reduce the risk of SIDS.
  • Spotlight a family that has suffered a SIDS death. Perhaps they might be willing to share their story with the local media about the sudden and unexpected death of their baby.
  • Write a letter to the editor of your community newspaper.
  • Submit articles and/or copy ready public service announcements to newspapers, magazines, or local professional newsletters.
  • Distribute free infant safe sleep materials from the
    North Carolina Healthy Start Foundation to expectant and new parents, grandparents and other caregivers.
  • Put out posters and SIDS educational brochures at health fairs, churches, local hospitals, childcare centers, public libraries and other places frequently visited by pregnant women and parents of infants.
  • Are you on Facebook or Twitter? Use social media to promote safe sleep.
  • Request a SIDS Awareness proclamation from your local elected officials (city or county government).

We can help you get started on these ideas. The North Carolina Healthy Start Foundation promotes safe sleep throughout the year by providing free educational materials, professional support, education and training across the state. Visit to get more information about the N.C. Infant Safe Sleep campaign or to order materials. Contact Marta Pirzadeh at or 919-828-1819 for more information or ideas about promoting infant safe sleep in your community. 

Sleeping baby



Before some of them smiled, crawled, walked or uttered their first word in 2009, 7.9 infants per 1,000 live births in North Carolina died before their first birthday. There were 1,006 infant deaths in 2009, which equates to almost three deaths per day. Charmaine Purdum, RICHES member and Executive Director of the Guilford County Coalition on Infant Mortality, is all too familiar with the state’s infant mortality rate. For nearly 18 years, Purdum Adopt-a-Mom group meetinghas worked tirelessly to improve the birth outcomes in Guilford County through community education and advocacy.

Purdum's drive comes from her passion for babies and making a difference in the lives of others. "I struggled with infertility for almost 10 years and I felt that if I could never get pregnant at least I could help others have a healthy baby," she said.  

Established in 1990, the Guilford County Coalition on Infant Mortality formed in response to North Carolina's ranking in the late 80's as the worst state in the nation for infant deaths. Purdum believes the Coalition's Adopt-A-Mom program has played a significant role in reducing the infant mortality rate in Guilford County. The Adopt-A-Mom program, which has received funding from the North Carolina Healthy Start Foundation's Small Community Grants program in the past, offers prenatal care to women who are not eligible for Medicaid or lack private insurance or personal funds to pay for prenatal care.

"Prematurity and low birthweight are the leading causes of death among children less than one year of age in Guilford County," she said. "This program ensures that all moms in Guilford County have access to prenatal care."  Since its inception in 1991, the Adopt-A-Mom program has served 4,174 women in Guilford County. Of those who completed the program an overwhelming 90 percent of the infants were born full-term.

Purdum encourages her clients to join the Moms Matter "Centering" Interconception group. This new Coalition program hosts meetings of mothers who meet on a regular basis during and after pregnancy to support each other and their babies. Participants learn about the importance of prenatal vitamins, maintaining a healthy diet while pregnant, and the benefits of breastfeeding.  Purdam says the Coalition plans to incorporate information from the North Carolina Healthy Start Foundation's RICHES Health Journal Tool Kit and use the My Health Journal to better educate participants on important women's health issues and help them keep track of their medical information.

As a recipient of the Monroe E Trout Premier Cares Award for the improvement of healthcare for the medically underserved, Purdum is proud of what the Coalition has achieved thus far, but looks forward to accomplishing more in the future.

"As a mother of two adopted boys, life is good and I am so happy and grateful to help others have a happy ending," she said. "It’s exciting to be in the arena of making a difference in the overall health of your community."

Dr. with expectant patient

Latina Health

Infant Mortality and the "Hispanic Paradox"

Consider these statistics:  62% of Latinas in North Carolina do not have health insurance, 32% start prenatal care late and 78% of Latinas do not take a daily multivitamin with folic acid. Latinas accounted for 16% of all births in 2009 and despite the socioeconomic barriers that they face they have good birth outcomes, such as a low infant mortality rate.  How is this possible? The phenomenon is known as the Hispanic Paradox. 

In 2009, North Carolina had an infant mortality rate of 7.9 and the rate for Latinas was 5.8. The rate for the period 2007-2009 was 6.3 deaths per 1,000 live births. The rate for African Americans was more than twice as high at 14.5. Latinas also tend to have a lower rate of births that are low birthweight. Part of the explanation given for these positive health outcomes is that recent immigrants are less likely to engage in unhealthy behaviors such as drinking and smoking, and more likely to follow healthy behaviors such as breastfeeding their infants. For example, only 1.2% of Latinas reported smoking during pregnancy and 87% of Latina mothers reported breastfeeding for some amount of time.

The Hispanic Paradox of good health outcomes despite the socioeconomic disadvantages faced by Latinas has been studied extensively and found to be true in particular for Mexican-American immigrants but not so true for Puerto Ricans. This is a reminder that even though Latinos share common traits, such as language, religion and some cultural beliefs, they also have a range of experiences and these experiences influence their health and health behaviors.

Despite the overall good birth outcomes and the protective factors that help Latinas achieve these outcomes, challenges remain. Acculturation studies show that health outcomes worsen the longer an immigrant is in the United States and recent data related to chronic diseases illustrates that case.

The 2009 Women’s Health Report Card gave Latinas an "F" in weight due to the high percentage of Latinas considered obese. Latinas got a "C" for physical activity and another "F" for not getting a pap test within the last two years. So, while the Hispanic Paradox may give us a sense of security that things are okay for Latinas, we should not be complacent. Give your Latina clients the tools to improve their health.  Consider one of the following the next time you meet with a Latina client:

  1. Help her to ask questions during appointments and make the most out of her medical visit (see Mujer Total for tips to share with your client).
  2. Take time to go through Mi Diario de Salud with your client. Show her how to keep track of her medical test results and how to make some lifestyle changes to improve her health. 
  3. If she is pregnant, help her sign up for Text4baby (text BEBE) to 511411 or share with her Mamá Saludable, Bebé Saludable (and the accompanying audio version available online).
  4. Refer her to or share information from there with her.

Providing this information can help improve the health of Latina moms and their babies no matter how long they have been, or plan to be, in North Carolina.

Expectant mom

Foundation News

Infant Mortality Challenges

Addressing an issue as complex and entrenched as infant mortality is done like the old joke: How do you eat an elephant?  The answer: bite-by-bite.  The North Carolina Healthy Start Foundation has been providing leadership to reduce infant deaths and improve the health of women and young children in North Carolina for the past 20 years.  The enormity of the problem, coupled with limited resources, means there’s been a bite-by-bite approach. What more can we do?  We have some ideas.

Much has changed since 1988 when North Carolina had the worst infant mortality rate in the nation.  But more remains to be done. This is a challenge at a time when state and local budgets are being cut and resources are drying up.  Leadership, collaboration and efficiency are required for success.  As a 501(c)(3) agency using a public/private partnership model, the Foundation is uniquely positioned for collaboration in a non-competitive manner with public and private agencies at the local, regional and statewide level.

What does this mean?

  • The Foundation regularly convenes advisory groups with broad professional representation to identify needs, best practices and effective strategies. These groups also serve as liaisons with networks across the state.
  • The Foundation advises policymakers on issues related to improving the health of women of childbearing age and young children.  Over the years, staff have been appointed to or advised a number of state-level task groups such as the:
    • N.C. Institute of Medicine’s  task forces and committees: N.C. Healthy People 2020 Maternal Health Committee,  Health Literacy Task Force and Adolescent Health Task Force

    • Child Fatality Task Force, Perinatal Committee

    • Justus-Warren Heart Disease and Stroke Prevention Task Force

    • N.C. Coalition to Promote Health Insurance for Children

    • N.C. Child Care Commission

    • Pregnancy Risk Assessment Monitoring System Advisory Group

    • Health and Wellness Trust Fund grant review team

    • N.C. Office of Minority Health and Health Disparities Latino Advisory Group

    • N.C. Reproductive Justice Coalition

  • The Foundation created a statewide network of more than 250 local and community-based organizations that provide health and health-related services to women of childbearing age.  The long-term goal is to improve the health of women of reproductive age by building the capacity of community-based organizations to educate, encourage and support women to adopt healthy lifestyles/behaviors and to seek appropriate healthcare services.
  • Recognized as a national leader, the Foundation works closely with childcare providers, hospitals, the media and public and private organizations to reduce infant sleep-related deaths by providing extensive training and educational materials to providers across the state.

Complex problems often require complex, multi-layered solutions.  North Carolina has taken many positive steps to address our infant mortality challenges. As evidenced by the latest infant mortality rate data, we have more to do, particularly as it relates to racial disparities. Working with its many partners across the state, the North Carolina Healthy Start Foundation is committed to doing everything in its capacity to educate, provide and lead the way in improving the health of women and young children in North Carolina.

Closeup of pregnant women's belly


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 N.C. Healthy Start Foundation | 1300 St. Mary's Street, Suite 204 | Raleigh, NC 27605 | 919-828-1819