This story first published online at North Carolina Health News.
Since the Supreme Court overturned the constitutional right to abortion at the end of June, women’s health issues have been front and center in the news. That makes a report card on women’s health in North Carolina, which was released in May, even more timely.
Even as reproductive health issues loom large in the current debate, there are multiple other issues also affecting women’s health in North Carolina.
The report, from the UNC-Chapel Hill Center for Women’s Health Research, evaluates the current health and health care needs of North Carolina’s 5 million-plus women. Women currently outnumber men in North Carolina, and the state’s population of females is continuing to steadily increase. By 2030, there is projected to be over 6 million women in the state — women with a plethora of health care needs and conditions.
The 2022 North Carolina Women’s Health Report Card, which is released every two years, is the only report of its kind in the state, and this year’s report compiles and analyzes data from 2018-2022 from a dozen-plus sources to give a broad look at the health of women. The report card examines key measures such as preventative health, chronic disease, perinatal health, mental health and substance use disorders. And this year’s report spotlights where North Carolina is succeeding and opportunities for improvement that can propel the health of the state’s women forward.
“It’s very difficult to tell somebody ‘Oh, you have to be healthy’ when there’s not more education provided or more assistance provided on what needs to be done,” said Wendy Brewster, director of the Center for Women’s Health Research.
That’s where this report comes in. It’s a tool for education, and the findings can guide priorities and decision-making.
Disparities tinge promising trends
The good news is that North Carolina women ages 50 to 74 are exceeding the benchmarks for both colorectal cancer screenings and mammograms that were set by Healthy People 2030, a national set of data-driven objectives to improve health and well-being.
Nationally, North Carolina ranks 11th in well-woman visits and 12th in cervical cancer screenings, according to 2021 data from America’s Health Rankings.
“Those are benefits that pay off years and years ahead of time,” Brewster, also a gynecologic oncologist, said.
However, notable racial disparities in the data suggest differences in access to health care services and screenings. For example, although the rate of new cancer cases is nearly identical, non-white women are almost 50 percent more likely to die of breast cancer than white women and twice as likely to die of cervical and uterine cancer.
Another positive finding is that fewer N.C. babies are born preterm than the Healthy People 2030 target of 9.4 percent. Black women are more likely to experience preterm birth and have babies born low birth weight than white women.
These birth outcomes are disparities two UNC researchers are seeking to address with their study, Accountability for Care through Undoing Racism and Equity for Moms. The study will implement various data accountability methods and community-based doula support at 40 practices providing prenatal care across North Carolina. The researchers believe the interventions will decrease pregnancy complications, particularly for Black moms.
“Let’s not have race be a factor in the discrepancies of the outcomes,” said Angela Tatum Malloy, a certified doula and the founder of Momma’s Village Fayetteville, who will help facilitate training of the doulas needed for the study.
Chronic diseases, perinatal health remain concerns
North Carolina lags behind in perinatal health, according to the report.
N.C. women have a pregnancy-related mortality rate of 21.9 deaths per 100,000 live births in 2021 — above the national average of 17.3. North Carolina also ranks 40th in babies born low birth weight and 42nd in neonatal mortality, according to 2021 data from America’s Health Rankings.
There was also a sharp difference in the rates of women receiving prenatal care in the first trimester of pregnancy: 91 percent of white women saw a provider during early pregnancy, while the rates for Black and Latina women were 76 percent and 79 percent, respectively. Early prenatal care is important because people can be screened for potential complications, get started on prenatal vitamins and receive education on changes needed to ensure a healthy pregnancy.
Additionally, the average number of N.C. women reporting smoking during pregnancy from the years 2015 to 2019 is about 9 percent. Fifteen counties reported rates above double the state’s average, such as Graham and Mitchell counties, which had the highest rates of smoking while pregnant at 27 percent and 24 percent.
Smoking during pregnancy has been shown to increase the risk of health problems for developing babies, including preterm birth, low birth weight and birth defects. How a child enters the world is important, so the state needs to work on improving perinatal health, Brewster said.
North Carolina women also have high rates of chronic disease. Fifty-nine percent of women have one or more chronic diseases, and after age 65, over half of N.C. women are living with two or more chronic diseases.
Obesity is a pressing issue as more women are classified as either overweight or obese — 65 percent — than are within their recommended weight range.
“In our state, we need to be thoughtful about this because obesity lends itself to many other conditions that are going to be expensive for us to pay for,” Brewster said.
The average age of women in the state is steadily increasing. Twenty-five percent of N.C. women are over the age of 60 — a 6 percent increase over the past 15 years. The over-60 population is expected to increase by another 3 percent by 2030.
A growing aging population faces an increase in issues such as heart disease, cancer, diabetes and cognitive decline.
“How are we planning for care for our older female population 10 to 15 years from now?” Brewster said. “Do we have the resources? Do we have the structures that are going to be in place in order to support families who have elderly members who have cognitive decline?”
Mental health is also a growing issue. One in four N.C. women have been diagnosed with a depressive disorder. Contributing to depression are adverse childhood experiences, which a quarter of N.C. women reported having had three or more. Research has shown that such childhood traumas lead to increased rates of disease as people age and the more adverse childhood experiences reported by people the more risk they carry of disease later in life.
Additionally, access to care is an issue as insurance coverage for women ages 18 to 64 ranks 45th nationwide. In part, this low number is because North Carolina is one of 12 states remaining yet to expand Medicaid.
Although it was hoped for by many, Medicaid expansion was not part of this year’s budget, meaning the state’s Medicaid program will not add some 600,000 low-income North Carolinians. Medicaid expansion in the state remains unresolved due to distinctly different ideas from the Senate and House about how to implement it.
The biennial report card has been a critical component of the Center for Women’s Health Research’s work almost since its inception, Brewster said. The first report was released in 1998 and has continued in the years since.
Earlier versions of the report card assigned grades and were aimed at reaching scientists and researchers. But over the years, the report has changed and is now crafted to ensure the general population, policymakers and legislators understand factors shaping the health of women.
“I think what’s so valuable about the report card is it really covers a broad range of topics across the state and we can start to think about how they talk to each other,” said Hazel Nichols, an associate professor in the Department of Epidemiology at the UNC Gillings School of Global Public Health who served as an advisory committee member helping complete the report.
This year’s report was crafted by a 13-person advisory committee with an array of specialties and expertise. Brewster said this could have easily been a 100-page document but the center kept it to 24 pages of information deemed most meaningful and potentially actionable.
“I hope that this document will challenge patients to reflect on what issues they can change themselves or reach out to challenge their leaders to do better in the space,” said Brewster.
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