Saving Baltimore Babies


November 29, 1992|By SARA ENGRAM

Conventional wisdom is not always common sense, and learning the distinction can make a world of difference.

That's one lesson gleaned from the Baltimore Project in Sandtown-Winchester, one of the city's poorest areas. The project is the Schmoke administration's attempt to demonstrate that some simple and sensible efforts can have a big effect on Baltimore's high rate of infant mortality.

Coordinated by the city health department with financial support from local foundations, the two-year-old project has worked well enough to help the city win one of 15 federal "Healthy Start" grants, designed to meet the ambitious goal of helping to lower the country's infant mortality rate by 50 percent over five years.

The infant mortality rate -- the measure of children who die before their first birthday -- is a basic indicator of any country's standard of living. The United States ranks 24th in the world. The problem is obvious in cities like Baltimore, where the 1988 infant mortality rate was 17.5 deaths before the first birthday for every 1,000 live births.

It's not that we don't know how to give babies a healthy start in life. The problem lies in the breakdown of the support systems any society depends on -- strong families, accessible medical care, adequate housing and jobs that enable parents to support their children.

With Healthy Start money, the project will be able to reach a larger area and provide more comprehensive services to women, children and families. The program addresses the health and medical needs of pregnant women by helping to make clinics and other medical care providers more "user-friendly." Things like reducing waiting times and arranging for transportation and child care can make all the difference in whether a woman actually sees a doctor. The project also provides education about health and nutrition and the advantages of breast-feeding -- information many young women will never hear otherwise.

But before these services can be effective, the program must attract the women who need them. For this, the project depends on community outreach -- not an uncommon method. What is less common is that it hires community people, rather than social workers, to do the outreach work.

By creating jobs there, it also puts sorely needed money back into the neighborhood. Tom Coyle of the Baltimore City Health Department describes this approach as "deprofessionalizing" the system.

It works. By hiring people from the community, the program is getting exactly the kind of expertise it needs -- workers are known and trusted by the people they are supposed to reach.

Crystal Williams, who gave birth to a healthy baby girl last January, describes the effect these workers have on young pregnant women. "You just can't say no when you've got problems and somebody's trying to help you and they make you feel comfortable." she says. "You just can't say no."

As executive director Daisy Morris describes it, the Baltimore Project seeks to go beyond a "medical model" to address the larger issues that contribute to infant mortality. The tendency to view infant mortality only as a medical or health care problem seems to be one of the factors that frustrates efforts to improve the chances for infants.

One of the leading contributors to infant mortality is low birth weight -- and women who get no prenatal care are at high risk of delivering low-weight babies. Consequently, most programs are designed to get pregnant women into prenatal care early in their pregnancy.

That's where the gap between conventional wisdom and common sense comes in. Many women at risk of low-birth-weight babies -- drug users, for instance -- often don't confirm or acknowledge their pregnancy until the second trimester. Programs designed to work with these women for seven or eight months are simply unrealistic.

The Baltimore Project takes a longer view in which pregnancy is seen as an opportunity to make a more lasting difference. To be truly effective it tries to reach women before they become pregnant.

Follow-up services are also important -- especially family planning. One of the project's priorities for ensuring an infant's healthy development is to help the mother prevent an unwanted pregnancy in the 12 months after the birth.

Other common sense factors also come into play -- involving male partners, as well as efforts to address other pressing needs like housing and jobs.

There is no single solution to infant mortality, and certainly no easy one. But in Sandtown-Winchester, common sense is producing some welcome success stories.

Sara Engram is editorial-page director of The Evening Sun.

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