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Facts on the Status of Reproductive Health in Communities of Color in NC

Modified: 04/14/2005

The reproductive health needs of North Carolina women of color and low-income women are going unmet. North Carolina women of color and low-income women face a complex array of barriers, ranging from egregious historical discrimination to socioeconomic constraints that work to restrict access to critical health services. Although women of color and low-income women represent two distinct groups, in North Carolina both groups are disproportionately affected by policies that restrict access to the full range of reproductive health information and services, including prenatal care, contraception, and abortion.

ENSURING REPRODUCTIVE HEALTH EQUITY FOR NORTH CAROLINA WOMEN OF COLOR AND LOW-INCOME WOMEN: THE NEED FOR ACTION TO ELIMINATE DISPARITIES

REPRODUCTIVE HEALTH DISPARITIES IN NORTH CAROLINA ARE APPARENT IN:

  • Rates of unintended pregnancies

  • Teen birth rates among young women

  • Access to contraception and family planning

  • Rates of sexually transmitted diseases

  • Access to early prenatal care

  • Incidence and mortality rates of breast and cervical cancer

The reproductive health needs of North Carolina women of color and low-income women are going unmet. North Carolina women of color and low-income women face a complex array of barriers, ranging from egregious historical discrimination to socioeconomic constraints that work to restrict access to critical health services. Although women of color and low-income women represent two distinct groups, in North Carolina both groups are disproportionately affected by policies that restrict access to the full range of reproductive health information and services, including prenatal care, contraception, and abortion.

In North Carolina, women of color make up approximately 32 percent all women in the state. African American women, Latinas, Asian and Pacific Islander women, and American Indian women face some of the same health issues as white women. However, systemic obstacles – such as the lack of research on minority women’s health, language barriers, the lack of cultural competency training, and the shortage and maldistribution of minority and female health care professionals – disproportionately and adversely affect their access to and quality of reproductive health care.

Similarly, North Carolina low-income women face a number of barriers. North Carolina ranks 41 out of all 50 states and the District of Columbia in the percentage of women who live above the federal poverty line. Fifteen percent of all North Carolina women aged 15-44 live below the poverty level. Notwithstanding the fact that many North Carolina low-income women are working, 22 percent of North Carolina women lack private health insurance or Medicaid, which unduly affects their ability to obtain reproductive health care on a regular basis. Low-income women are more likely to face barriers to health care and have a poorer health status. For low-income women of color in North Carolina, socioeconomic obstacles are exacerbated by systemic obstacles and vice versa.

NARAL Pro-Choice North Carolina is committed to ensuring every woman’s reproductive freedom. To that end, NARAL Pro-Choice North Carolina is promoting policies to ensure that all women have the ability to make responsible and informed choices about their reproductive health, irrespective of race, ethnicity, socioeconomic status, education, religion, age or language.

PREGNANCY IN NORTH CAROLINA

Reducing unintended pregnancies benefits women’s and children’s health, as unintended pregnancy has serious health consequences for both mother and child.

UNINTENDED PREGNANCIES

In North Carolina, nearly 70 percent of African American women and American Indian women, 42.9 percent of Asian and Pacific Islander women, and 38.6 percent of Latinas reported that their pregnancies were unintended compared to 36.7 percent of white women.

In 2002, the percentage of abortions obtained by white women was 44.6 percent. In contrast, the percentage of abortions obtained by women of color was nearly 52 percent.

EFFECTS OF TEENAGE PREGNANCY

The probability that a teen mother will graduate from high school by age 25 is less than 60 percent as compared to 90 percent for those who postpone childbearing.

Twenty-eight percent of teen mothers are poor in their 20s and early 30s as compared to seven percent of women who have their first child after adolescence.

TEENAGE PREGNANCY

Teenage girls have a higher risk of pregnancy complications and are less likely to obtain prenatal care. North Carolina has the ninth highest teenage pregnancy rate in the nation. Each year, 24,790 North Carolina teens become pregnant. Sixty-two percent of these pregnancies result in births, and 23 percent result in abortions.

Babies born to teen mothers are at greater risk of low birth weight, childhood health problems, and developmental delays. In 2002, the teen birth rate in North Carolina for Latinas was almost four and one-half times higher than the teen birth rate for young white women. Similarly, the teen birth rate for African Americans was almost two times higher than the teen birth rate for young white women.

ACCESS TO PRENATAL CARE

Prenatal care allows health providers to prevent, detect and treat problems early in a woman’s pregnancy. Early and regular prenatal care is beneficial to both a woman and her pregnancy.

Women of color in the state disproportionately face access barriers to adequate prenatal care. Nearly 25 percent of African American women and 30 percent of Latinas did not receive prenatal care in their first trimester. In contrast, 9 percent of white women in North Carolina did not receive prenatal care in their first trimester of pregnancy. Lack of health insurance, unintended pregnancy, and cultural factors all act as barriers to early and adequate prenatal care.

Lack of prenatal care can negatively affect infant birth weight. Socioeconomic factors, including low income, are also associated with low birth weight infants. In 2002, 14.1 percent of African American infants in North Carolina were born with a low birth weight. In contrast, 7.6 percent of white infants were born with a low birth weight.

From 1998-2002, the infant mortality rate in North Carolina for African Americans and American Indians was more than two times higher than the white rate.

FAMILY PLANNING IN NORTH CAROLINA

The average woman will spend five years pregnant or trying to get pregnant, and more than four times that long trying to avoid pregnancy. Family planning services, including contraception are essential to helping women achieve their goal.

According to the Alan Guttmacher Institute, nearly 924,450 women in North Carolina need contraceptive services and supplies. Of these women, 455,030 women, including 136,500 teenagers, need publicly supported contraceptive services.

Title X of the Public Health Service Act is the only federal program exclusively dedicated to family planning and reproductive health services. In North Carolina, family planning clinics serve 194,250 women, including 53,480 teenagers. Publicly supported family planning clinics, including Title X clinics, help North Carolina women avoid 41,800 unintended pregnancies annually.

SEXUALLY TRANSMITTED DISEASES (STDS) AND HIV/AIDS

Women are biologically more susceptible to STDs than men and are more likely to bear negative long-term consequences, such as infertility, tubal pregnancy, and cervical cancer. Minorities in North Carolina disproportionately suffer from STDs and HIV/AIDS compared to whites.

THE COST OF SEXUALLY TRANSMITTED DISEASES IN NORTH CAROLINA

Each year in North Carolina an estimated 416,2000 new STD cases will be diagnosed, resulting in an estimated $228.4 million in direct medical costs.

In North Carolina, African American women have an HIV-infection rate that is 14 times higher than white women.

In 2003, African American women had a gonorrhea rate that was 12.6 times higher than that of white women. Similarly, American Indian women had a gonorrhea rate that was nearly five times higher than white women, and Latinas had a gonorrhea rate that was one and one-half times higher than white women.

In 2003, African American women had a chlamydia rate that was 7.5 times higher than that of white women. Similarly, Latinas had a chlamydia rate that was four times higher than white women, and American Indian women have a chlamydia rate that is 3.2 times higher than white women.

ACCESS TO ROUTINE PREVENTATIVE HEALTH TESTS

Women of color generally have lower usage rates of routine preventative health tests and screenings compared to white women because of systemic, socioeconomic, and cultural barriers. Routine Pap tests and regular screening mammograms can detect cervical and breast cancer at early stages, rendering them easier to treat.

In North Carolina, Latinas have a cervical cancer incidence rate more than twice as high as white women’s rate (20.3 versus 8.3). Similarly, the incidence rates for African American women (12.7), Asian and Pacific Islander women (12.8), and American Indian women (10.7) are higher compared to white women. Most cervical cancers are treatable with early detection with a Pap test, which if provided universally, could prevent virtually all deaths resulting from this disease.

Nearly 5,870 new cases of breast cancer are diagnosed each year in North Carolina, and over 1,090 women will die as a result of the disease. Breast cancer mortality rates in North Carolina are nearly one and one-half times higher for African American women compared to white women.

ACCESS TO CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH SERVICES

Cultural and linguistic competence involves “the ability by health care providers and health care organizations to understand and respond effectively to the cultural and linguistic needs brought by patients to the health care encounter.”

DID YOU KNOW?

The 2002 Office for Civil Rights Title VI/LEP compliance review of the North Carolina Department of Health and Human Services (NCDHHS) found that “overall, NCDHHS fails to provide adequate language assistance to Hispanic/Latino, Hmong and national original groups who speak a primary language other than English” and concluded that NCDHHS would likely be found in violation of Title VI.

Notwithstanding North Carolina’s diverse population, over half of all nonfederal physicians in the state are white. Five percent are Asian and Pacific Islander, four percent are African American, and less than two percent are Latino or American Indian. For people with a choice of doctor, minority adults are more likely to say that a doctor’s nationality, race, or ethnicity influenced their choice (12 percent) than white adults (5 percent).

Approximately half of North Carolina Latinos have limited English proficiency or do not speak English very well. Further, almost a third of Latinos in the state recently immigrated (since 1995) and may not be as familiar with the U.S. health care system.

CONCLUSION

This briefing paper documents some of the health needs and health care barriers that North Carolina women of color and low-income women experience. As evidenced above, women of color and low-income women in North Carolina are facing a reproductive health crisis. In an effort to address these reproductive health disparities, NARAL Pro-Choice North Carolina has formed a diverse coalition to come up with best practices and policies to improve the reproductive health of women of color and low-income women in the state.

For more information, please contact , Statewide Organizer, NARAL Pro-Choice North Carolina; 919.829.9779.



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