Infant mortality remains a concern in Forsyth

by Jordan Green

Winston-Salem/Forsyth County Schools has improved graduation rates while maintaining one of the tightest administrative budgets in the state in the urban county where infants are most likely to die and children are most likely to grow up poor.

That’s good news for conservative board members who are interested in cost control, but cause for concern among those who worry about growing challenges faced by children.

Forsyth County, with most of its population in Winston-Salem, leads the eight most populated counties in the state in infant deaths per 1,000 live births, according to data compiled by the NC Center for Health Statistics. That includes the cities of Greensboro, Charlotte, Raleigh, Durham, Fayetteville, Wilmington and Asheville. Forsyth County had 10 infant deaths per 1,000 live births in 2011, compared to 7.4 in Guilford, 6.4 in Durham and 5.8 in Mecklenburg.

And Forsyth is among the 27 counties in the state with the highest infant mortality rate. Of the 26 counties that rank worse, all have populations that are at least half as large as Forsyth.

Ayotunde Ademoyero, director of epidemiology and surveillance for the Forsyth County Department of Public Health, said after a presentation to the county commission last week that a significant driver of infant mortality is premature births. She confirmed that such births are related to poverty in that the problem can be linked to health challenges and stress experienced by expectant mothers.

County commissioners also heard a presentation from Assistant Superintendent Darrell Walker — likely not news to any of them — that the school district has the highest percentage of students living in poverty among the state’s four largest public school systems: about one in four. That compares to about one in five in Guilford and Mecklenburg, and 15 percent in Wake.

While Forsyth still lags other urban counties, the trend line is improving.

The number of child fatalities peaked at 83 in 2007 and has steadily declined every year, dropping to 59 in 2012. Among children up to age 18, fatalities among infants comprised 80 percent.

Combating poverty is beyond the scope and ability of a public health agency, but the department has worked to bend the curve in limited areas. The department reported that fatalities from Sudden Infant Death Syndrome, or SIDS, and unsafe sleep dropped from a total of 20 in 2009 to a total of four in 2011. The improvement coincided with a marketing campaign involving advertising displays on the outside and inside of city buses that emphasized an “ABC” message, which is short for “Your baby is safest when sleeping… Alone, on his/her Back aand in a Crib or bassinet.”

Last year, there was only one case of SIDS, but the number of deaths from unsafe sleep increased from two to five. As a result, the department is resuming the “ABC” marketing campaign this month. The department offers parenting and breastfeeding classes on an ongoing basis.

“Are you finished, or you got more?” Commissioner Richard Linville, the Republican chair, asked Ademoyero after she concluded her presentation.

Walker outlined population trends recorded in the 2010 Census that bear upon planning for new school construction. He displayed a map that showed significant growth — more than 50 percent — in the southwest outskirts of Winston-Salem roughly between Peters Creek Parkway and Stratford Road, as well as east of the city along the Kernersville Road corridor. In contrast to what the district identifies as a “perimeter growth ring,” an “urban core” in the center of the county shows significant population losses. Exceptions include downtown Winston-Salem and areas around Winston-Salem State University, UNC School of the Arts and Wake Forest University.

Commissioner Walter Marshall, a Democrat who represents urban District A, expressed concern that several east-side schools, including Carver High School, Atkins High School and Winston-Salem Prep, are underutilized.

“We’re going to have a real candid conversation with our board on April 13 about where the needs are, where the real growth is,” Walker told the commissioners. He added, “The real heartburn for us right now is some of the inner-city schools.”

Walker said that when the district accepts Title I money from the federal government for poor schools, administrators make a choice between hiring additional teachers to reduce class size and purchasing additional technological equipment. Reducing class size strains capacity. Walker added that enrollment increases are projected next year at Winston-Salem Prep, Atkins and Carver, the latter expected to jump from 700 to 1,000 students.

While inner-city neighborhoods have emptied out, the student population has dramatically diversified since 1994, with whites declining from 60 to 42 percent and blacks falling from 35 to 29 percent, while the Hispanic population exploded from 2 to 22 percent. The population of Asian and multiracial students has also increased.

The distribution of poor schools across the system reflects the class stratification of Forsyth County. Of the 74 schools in the system, four have a student population with less than 20 percent eligible to receive free and reduced lunch. More than half are distributed through the middle of the spectrum. But about a third of the schools have more than 80 percent of students on free and reduced lunch. The district refers to this type of sorting as “socio-economic segregation.”

Walker characterized the number of schools with high percentages of students on free and reduced lunch as “really concerning.” He added, “Those 25 schools with high poverty pose some challenges for staff and administrators.

In 2012, Winston-Salem/Forsyth County Schools graduated 80.9 percent of its students, overtaking Wake County by a nudge for second place among urban school systems. Neighboring Guilford County Schools maintains the highest graduation rate — 84.5 percent.

Walker attributed Guilford County’s comparably favorable graduation rate to its large number of early and middle colleges.

“They have a lot of opportunities to capture those kids that might possibly drop out,” Walker said.

Notwithstanding improvements, Walker said Winston-Salem/Forsyth County Schools’ current graduation rate is “not acceptable.”

Moving on to another indicator, Walker said the system’s ratio of administrators per 1,000 students is among the 15 lowest in the state — a point of particular pride for Don Martin, the outgoing superintendent.

Commissioner Bill Whiteheart, a Republican elected at large, praised the school district.

“Two things that I think are worthy of commendation are the graduation rate — the first item is the graduation rate, which you mentioned is the second highest in the state; I think that’s worthy of bragging about,” Whiteheart said. “The other item was the efficiency rate you talked about. In the private sector we call that the A&G — administrative and general. Your graduation rate — performance — is up. Efficiency — costs go down. You have actually hit the ball out of the park. So congratulations, Babe Ruth.”

Walker quipped in response: “I didn’t tell you we have to stay at work every night until 10 o’clock.”

Commissioner Everette Witherspoon, the second Democrat who represents District A, synced with Whiteheart’s praise.

He said the district’s improved graduation rate — up from 70.8 percent in 2008 — is notable “especially because we have the highest rate of children in poverty, and we know the correlation between children in poverty and dropout rates.”

Witherspoon asked Walker about the district’s population of students labeled “EC,” or “exceptional children” — a term to designate students with disabilities.

“A lot of those kids don’t die,” Witherspoon said. “But a lot of those kids with low birth weight are more likely to be depressed, more likely to be ADHD, more likely to have anger management issues. What percentage of kids in those classes — EC, ADHD and the special education classes — are higher than the other urban counties?” Walker did not answer the question directly, instead responding, “It’s a fast growing population.”