By Jared Chausow
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By Jon Campbell
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In some communities, the infant mortality rate (IMR) is twice the city and national averages of 6.9 and 7.2 respectively per 1000 live births.
A snapshot of communities with higher IMRs (when infants die before one year of age) would reveal large numbers of immigrants, particularly from the Caribbean, African Americans, or Hispanics, especially Puerto Ricans, as well as common risk factors such as poverty, lack of or inadequate health insurance, and low levels of education and literacy.
PolicyLink (PL), a national policy and research organization, recently published a report on the importance of Congress keeping intact the $90 million, federally funded Healthy Start Program (HSP) because of its emphasis on local leadership having significant input into creation of infant mortality prevention programs.
According to HSP, the IMR can be as high as 15.4 in predominantly at-risk African American neighborhoods in Manhattan. In sections of the Bronx, the rate can run as high as 13.9, and in Queens as high as 14.4. In other neighborhoods in Brooklyn, Harlem, and Queens, the rate remains unacceptably high, despite a citywide downward trend in the IMR from 11.6 to 6.9 since 1990. On September 15, the New York City Department of Health announced that "for the second straight year, [the city's IMR] has surpassed the federal government's Healthy People 2000 goal of 7.0."
One way to determine why women may not come for prenatal care is to ask them. Recently, during a focus group in Brownsville, Adrienne Mercer, program coordinator for maternal and child health at the Caribbean Women's Health Association (CWHA) in Brooklyn, learned from 10 African American women that half of them live in family shelters. Most were willing to get prenatal care, but had either been placed in shelters away from their home boroughs or believed that finding an apartment was a higher priority. Mercer's program helps women access prenatal care by accompanying them to medical appointments or helping with paperwork; they follow up if a woman misses an appointment.
CWHA, which also has offices in Queens, is in the middle of a six-month "Fight Infant Mortality" campaign, providing outreach and education to immigrants, specifically those from Panama, Grenada, Barbados, Guyana, Trinidad and Tobago, Jamaica, Puerto Rico, Nigeria, and Ghana. Women from these countries have the highest IMR rates among all immigrants in the five boroughs. CWHA educates not only women but the health care providers who serve them.
With immigrant women accounting for more than 50 percent of births in the city, Goldie Watkins Bryant, New York City project director for New York's HSP, says, "Poor women face so many barriers, such as poverty and family responsibilities, in a [health care] system that is not always culturally sensitive or linguistically representative. . . . There are problems of domestic violence and substance use; poor women face enormous stress trying to maintain families against tremendous odds.
"Women who have planned pregnancies usually get prenatal care in the first trimester," says Watkins Bryant. "In [low-income] communities, there are a lot of unintentional pregnancies, and women often don't get care until the second or third trimestermost, not at all."
Mercer says that in Far Rockaway many women from Central America believe that getting prenatal care will cause a miscarriage. Among African Americans, she says, "pregnancy is not considered a sickness; traditionally a woman gets advice from her grandmother about [pregnancy and childbirth]. Some Caribbean women place their babies at risk by rubbing their bellies with liquid mercury, believing that it will increase the likelihood of having a healthy baby."
In 1998, the Clinton administration and the Department of Health and Human Services launched an initiative to eliminate racial disparities in health in six areas, including infant mortality, by 2010. However, in the next few weeks, Congress will determine whether or not to reauthorize HSP (with sites in 34 states) or provide block grants, whereby each state will decide how maternal health services will be provided. Administration of these services by the states could mean the loss of a community focus in infant mortality programs.
Senator Edward Kennedy, Democrat from Massachusetts, is the sponsor of the S.2868 bill which supports HSP; the House's HSP bill has already passed. But supporters remain unsure of how the Senate will vote. The Congressional Black Caucus supports reauthorization.
In the meantime, State Senator David Paterson, Democrat from Harlem, who will speak at a meeting of the Healthy Start Central Harlem Consortium on September 28, says, "The [decline] in the IMR is directly proportional to resources. When you put money in prenatal and neonatal unitsat hospitals and clinicsyou get results."