Giving babies a Healthy Start

July 28, 1996|By Sara Engram

A FEW YEARS AGO the federal government took an unusually bold risk on a social issue.

It decided to get serious about reducing the nation's shamefully high infant-mortality rate and set a goal for reducing it. The Healthy Start program was charged with reducing infant deaths by 50 percent over five years.

Building on local health initiatives, Baltimore applied to be one of the nation's 15 Healthy Start demonstration cities. The proposal was successful, winning for the city millions of dollars in federal .. funds -- and, equally important, accountability for actually making a difference in infant health in the city's targeted areas.

In these neighborhoods, Healthy Start found that for every 1,000 babies born, 20 did not live to see their first birthday. That was twice the national rate of infant mortality.

The five-year period ends in 1997. But early data show intriguing results, as well as surprising contradictions of conventional wisdom.

At a recent meeting of the Maryland Commission on Infant Mortality Prevention, Healthy Start officials presented preliminary findings showing that pregnant women enrolled in Healthy Start programs had significantly better outcomes than women who enrolled after their babies were born.

Most surprising about this comparison was that although the majority of women in each group considered their prenatal medical care adequate, the early enrollees had almost half the rate of premature births and significantly fewer low-birth-weight babies. They also had one-third the rate of very-low-birth-weight babies, the infants most likely to die or to require long periods of intensive treatment.

If both groups got reasonably good prenatal care, what accounted for the better outcomes of women who participated in Healthy Start programs while they were pregnant?

Conventional wisdom suggests that good prenatal care is key to reducing infant mortality. But among women in the high-risk areas targeted by Healthy Start, prenatal care alone was not enough. That's important for policy makers to know.

Bernard Guyer, who chairs of the Department of Maternal and Child Health at the Johns Hopkins School of Hygiene and Public Health and also heads the state commission, sees the Healthy Start data as exciting.

Many of the gains in reducing infant mortality have come through improvements in the technology that keeps premature infants alive. It has been much more difficult to tease out the factors that can help ensure that babies are born healthy in the first place. Reducing smoking, getting women off drugs, involving men, trying to ease potentially violent domestic situations, encouraging women to eat well -- how do these factors compare to prenatal care?

Avoiding technology

Although technological advancements are important, good public policy should address ways to avoid the need for high-tech intervention by increasing the chances of a healthy birth.

Despite all the money we have spent on issues like infant mortality, too few of these programs have done what Baltimore's Healthy Start is doing: relentlessly monitoring its activities, tracking its clients and evaluating the results.

This is time-consuming and expensive, and most social programs dismiss the need for evaluation by saying it takes resources away from efforts to deal with the problem. But that approach hasn't worked. It also robs us of the opportunity to find out what works and to make a real difference.

Healthy Start is an expensive initiative. But plenty of less expensive attempts to deal with the problem have failed to make a dent in it. As Dr. Guyer notes, ''Maybe you have to do something big to have an impact. But if you can show benefits, it may be worth the expenditure and save money in the long run.''

When Healthy Start finishes its first five years, it may not have reached its goal of cutting in half the number of babies who do not live to see their first birthday. But it will have some clear ideas about why it didn't reach that goal and what it can do to make the program more effective.

Either way, it can't be chalked up as just another case of throwing money at a problem with little or nothing to show for it.

Thanks to a clear goal and the investments in research and evaluation to document its results, Healthy Start stands a good chance of proving that there really are ways to make a difference in a social problem as difficult and elusive as infant mortality.

Sara Engram is deputy editorial-page editor of The Sun.

Pub Date: 7/28/96

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