The grass is almost 3 feet high and piled with garbage. Boarded-up houses missing doors and filled with smelly trash sit scattered among the row houses in one of West Baltimore's poorest neighborhoods.
Denise Gaither and Judy Washington, in tennis shoes and carrying notebooks, walk through Sandtown-Winchester every day, rain or shine, with one mission in mind: to find pregnant women.
"Most of the mothers in this area are poor; some are homeless and some abuse drugs," said Ms. Gaither, one of eight "neighborhood health advocates" for the Baltimore Project, a pilot program to reach and monitor high-risk pregnant women.
"They're at great risk for having a miscarriage or their baby dying during labor," said Ms. Gaither, 38, who, like the other advocates, lives in the community. "We're here to help them make things change."
In Baltimore, 18.9 of every 1,000 babies born from 1984 through 1986 died in their first year of life, according to the most recent figures available from the Advocates for Children and Youth Inc., a non-profit agency operating statewide. Among black infants, the rate was even higher: 21.1 deaths per 1,000 births in 1987. Both figures are more than double the national average of nine deaths per 1,000 births. Maryland, the nation's fifth-wealthiest state, ranks 41st in infant mortality and 42nd in low birth weight.
The project's first client, Lillian Armstrong, was recruited at the outset by Daisy Morris, executive director of the program.
"Daisy spotted me during the Sandtown-Winchester parade and said, 'Look, there's the first pregnant woman I've seen all day,' " said Ms. Armstrong, 30. "She handed me a flier and asked me to come down."
Ms. Armstrong's 8-month-old son, Andre, is the first baby born to the project.
"They helped me during my pregnancy and changed my outlook on life," she said. "They're always there to help with all my problems."
The Baltimore Project, with offices on North Carey Street, was created by the Baltimore Health Department, the mayor's office and the National Institutes of Health in an effort to reduce the city's infant mortality rate.
Working with a $650,000 annual budget from the city Health Department, the federal Office of Substance Abuse Prevention and private foundations, the project began in November with eight full-time advocates, two nurses, two social workers and five addiction specialists.
The Sandtown-Winchester area, bordered by North, Lafayette and Pennsylvania avenues and Monroe Street, was chosen as a demonstration site. In this predominantly low-income neighborhood, pregnant women are considered at high risk.
"A lot of mothers don't think it's a big deal being pregnant," Mrs. Morris said. "They have a lot of other problems, and being pregnant isn't one of the top five they worry about. We're here to help the mother focus on her pregnancy."
The center is counseling more than 200 clients and working toward helping 300 by the end of November.
"If it works here, hopefully we'll get other projects started throughoutthe city and eventually the rest of the nation," she said.
The innovative idea behind the project is training and supervising residents who are active and well-known in their community to find pregnant women and build a relationship of trust with them.
Knocking door-to-door or following leads from neighbors, the advocates find potential clients and try to persuade them to join the project. Once the client joins, the health advocate helps them fill out applications for Medicaid, health care, prenatal care and any other programs that will help them have a good birth.
"We want to be a conduit to all these other resources. We try to get her the best information and best services she can possibly get," said Mrs. Morris. "We hope that if she does become pregnant again, she won't need us and she'll be able to get help on her own."
Ms. Gaither and her colleagues said another big concern was getting housing for the women. "The newly renovated houses in the area are too expensive for any of them to afford." Ms. Gaither said. "Sandtown residents who have grown up here are practically being pushed out."
The center also counsels mothers on drug and alcohol abuse, use of tobacco, nutrition and use of contraceptives.
"Their problems seem to keep piling up until you can't take it anymore," Ms. Washington said.