Black Maternal Health in North Carolina

Black maternal health in North Carolina reflects persistent gaps in access, quality of care, and workforce representation. In many rural eastern counties, families face hospital closures, provider shortages, and transportation barriers that limit consistent prenatal and postpartum care. Maternal health outcomes are shaped not only by clinical services, but also by trust, cultural responsiveness, and sustained support beyond delivery.

Policy changes such as Medicaid expansion increase coverage, but coverage alone does not eliminate disparities. Addressing the Black maternal health crisis requires long-term investment in access, accountability, and community-based solutions.

Lactation Ambassador Program

We advance this work through our Lactation Ambassador Program, which focuses on workforce development rather than direct service. The program expands the pipeline of trained lactation professionals in Eastern North Carolina, equipping women, particularly women of color, with evidence-based breastfeeding education and community outreach skills.

By strengthening local capacity, we help ensure that Black mothers can access breastfeeding support from professionals who reflect their lived experiences and cultural context. This approach builds trust, improves postpartum support, and strengthens maternal and infant health outcomes over time.

Quick Points

• The Black maternal health crisis is an access to healthcare issue. Access to quality maternity care is a critical component of overall maternal health and helps to produce positive birth outcomes. 
• Black women are 3 to 4 times more likely to die during childbirth. Black infants are 2.4 times more likely to die in the first year. 
• 60 percent of pregnancy-related deaths are preventable. 
• In Medicaid expansion states, the uninsured rate is nearly half the rate in non-expansion states. 
• Rural areas in northeast and southeast North Carolina have low access to maternity care or live in a maternity care desert where obstetric care is unavailable. 

Resources

• Black women at the center of breastfeeding success
• March of Dimes Premature Birth Report Card 
• March of Dimes Maternity Care Deserts 
• Preventing Pregnancy-Related Deaths

OUR State of Health

OUR State of Health is a community-centered health equity initiative that examines how access to healthcare shows up across North Carolina—particularly in Black and Brown communities and in rural counties that have long faced barriers to care.

Through town halls and community conversations, we connect policy to lived experience. Medicaid expansion has opened new pathways to coverage for hundreds of thousands of North Carolinians, especially in rural communities where uninsured rates have historically been highest. But coverage alone does not guarantee access.

OUR State of Health focuses on what it takes to turn expanded coverage into real, measurable improvements in people’s lives—access to providers, maternal and behavioral health services, chronic disease management, and culturally responsive care. By centering community voice and local context, the program ensures that health policy reflects the realities of the communities most impacted.

The goal is not only to celebrate progress, but to strengthen and protect it—so that expanded access leads to healthier families, stronger rural communities, and lasting health equity across our state.

Resource links: 

• Three A’s of Healthcare NCBA One-Pager 

Rooted in Wellness Day

Rooted in Wellness Day is a statewide, community-centered health event hosted in partnership with local organizations across North Carolina. Held in both rural and urban communities, the event brings together residents, faith leaders, healthcare providers, and advocates for a day of education, connection, and access to trusted resources.

The focus is simple and intentional: connect Black communities, particularly those not consistently reached by the traditional healthcare system, to health-promoting services, local providers, and culturally responsive information. From maternal health and preventive screenings to environmental health and chronic disease management, Rooted in Wellness Day meets communities where they are.

Why Rooted in Wellness?

Health outcomes are shaped by more than individual choices. They are influenced by access to care, local infrastructure, policy decisions, and whether communities have the resources to make informed decisions about their well-being. Rooted in Wellness Day creates space to understand how health connects to the broader systems that shape daily life.

Because the event takes place each September, it also serves as a moment of preparation. By equipping communities with health education, service connections, and clear information, we encourage residents to consider how public policy and civic participation influence access to care and long-term community health.

Rooted in Wellness Day strengthens partnerships, builds trust, and reinforces that when communities are informed and connected, they are better positioned to advocate for their health and their future.

Resources

• Rooted in Wellness Day brings health care closer to the people
• Photo Gallery

What is Environmental Health?

Environmental Health is the intersection of the impact of health factors on health outcomes. It is when our environment causes and exacerbates health outcomes and lived inequities. Our physical environment, social and economic factors, access to care, and the quality of care influence health outcomes and the quality and length of life individuals and communities experience. The landscape of environmental health varies across the state, with rural and urban communities experiencing differences in the cumulative health impacts from their lived environments on their well-being. The absence or presence of things such as environmental contaminants, access to healthy foods, affordable and safe housing, availability of healthcare providers and services, and income and economic resources that shape our choices about housing, food, and medical care create and impact our lived environments.

Quick Points

• CAFOs (Concentrated Animal Feeding Operations) are predominantly concentrated in low-income areas in southeastern North Carolina. The odor produced by CAFOs affects air quality and water quality, which directly impacts respiratory health and contaminates local water supply. The contamination of local water supply is particularly hazardous for communities that use private wells to supply their water. CAFOs also affect the mental and physical health of those who live nearby in the form of depression and anxiety, sleep disorders, and higher stress levels.
• Coal Ash is an environmental toxin often stored by impoundment or landfill, both with harmful impacts on communities’ health. Impoundments are typically located near waterways and become exposed to groundwater, contaminating our rivers and streams. Landfill storage allows for the dust from dry coal ash to be blown into neighboring communities, contaminating their air with a known carcinogen, harming their lungs.
• PFAS are thousands of human-made chemicals used in everyday consumer products. They are labeled as “forever chemicals” because they cannot be boiled or removed, and they break down very slowly in the environment. PFAS can be found in food and food packaging, household items like carpets, some firefighting foams, and drinking water. Some PFAS have been linked to many serious health effects, such as cancer, liver and kidney damage, hormone disruption, and developmental and reproductive harm. This means that PFAS can be found in the blood of newborn babies and passed down through breast milk. Parents who are pregnant or breastfeeding are at greater risk of exposure to PFAS because their water intake is greater than non-pregnant individuals.

Resources:

• Background on these Issues
• Environmental Justice is a Reproductive Justice Issue