A public health crisis

Our view : The battle against infant mortality in Baltimore is waged one mother at a time

November 09, 2008

A pregnant 17-year-old in a disheveled apartment who says her first baby died last year. An obese woman in her 20s who fights violently with her neighbors despite being five months pregnant. A 19-year-old woman with a month-old infant strapped to her stomach who wanders the streets all day because she's afraid to return to her grandmother's home where she witnessed a gruesome murder last week.

These are the faces of the public health crisis in Baltimore that is the city's tragic infant mortality rate. In 2007, 11.3 infants died for every 1,000 live births here - more than in Hong Kong, the Czech Republic or Malaysia. And the faces of the crisis are well known to Sheila Washington, a recruiter for the city's Healthy Start initiative that helps pregnant women and new mothers by providing medical care, food, furniture and other services. Since 1992, the program has enrolled more than 10,000 new and expecting mothers in an effort to reduce infant deaths in the city. And yet the infant mortality rate has remained depressingly constant over the years.

Last week, Ms. Washington and her assistant, Tanya Harrison, drove through West Baltimore's Sandtown-Winchester community looking for potential recruits. They knocked on doors and talked to people sitting on porches; when they spotted a woman with a protruding belly or pushing a stroller, they stopped their car and hopped out to chat, determined to find every pregnant woman and new mother in the neighborhood. Their conversations ranged from the advantages of breast-feeding over bottled formula to domestic violence to the dangers of sleeping in bed with your baby.

Some of the stories they heard were heart-rending, like the confused teen in her second pregnancy who was still a child herself, or the distracted expecting mother who appeared more focused on hair care than child care. In 2 1/2 hours of canvassing the neighborhood block by block, Ms. Washington and Ms. Harrison persuaded half a dozen women to sign up to receive regular home visits from a follow-up worker, as well as parenting classes, transportation to and from a prenatal clinic and nutritious foods for themselves and their babies.

In an era of high-tech hospitals and computerized medical record-keeping, it may seem surprising that Healthy Start's low-tech approach remains an essential component of the city's long-term effort to reduce infant mortality. Most programs that provide pre- and perinatal care for women and children rely on referral lists from doctors and local clinics rather than on the kind of aggressive, one-on-one outreach practiced by Healthy Start's recruiters. But those programs often miss the poorest, least-educated women who don't show up on hospital and clinic radar screens yet need help most.

City Health Commissioner Joshua M. Sharfstein says infant mortality is so intertwined with poverty, substance abuse, chronic illness, emotional stress and lack of access to health care that next month, the city will unveil a comprehensive plan to respond to the impact of all those social conditions on infant mortality.

With fewer low-birthweight and pre-term babies and better infant sleeping habits, Dr. Sharfstein believes infant mortality will improve. But right now, some of the best assets the city has are women such as Sheila Washington and Tanya Harrison, who are fighting to save Baltimore's children one mother at a time.

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