Jeannette McDonald

Ashley Harris is 18 and alone — except for the baby growing inside her.

She can’t find a job and needs a new place to live. She can’t depend on her baby’s father, who she says “can’t even afford a block of cheese.”

On top of all that, she said she hasn’t found a doctor she trusts to help her through her first pregnancy.

In other words, she has all the risk factors for delivering a low birth weight baby.

Even Ms. Harris’ race is working against her, as statistics show that in Hamilton County, black mothers are twice as likely as white mothers to give birth to babies weighing 5 pounds 8 ounces or less.

That means they are twice as likely to have babies that may not survive their first year, or, if they do, live with serious, long-term health problems, said Jeannette McDonald, coordinator of the Hamilton County Infant Mortality Reduction Initiative.

Ms. Harris is trying to do something about it.

“I don’t want my child to go through what I went through,” Ms. Harris said after attending a group meeting for women that Ms. McDonald recently held at the Harriet Tubman Development Site in East Chattanooga, one of the highest-risk areas for underweight births in the county.

Ms. Harris came out beaming after the group gave her the chance to ask other women — women she lives around and trusts — whether breastfeeding really hurts, which doctor she should try and where she can get milk and a car seat for her baby.

Ms. Harris now can spread that knowledge, and that’s the key to addressing the county’s low birth weight problem in the long term, Ms. McDonald said.

“There are a lot of different layers and factors that go into the causes,” she said. “But one of our main focuses has been the health of the mother before she even gets pregnant.”

state backing

In 2006, Gov. Phil Bredesen committed to tackling poor birth outcomes following a summit held on the issue in Memphis, said Dr. Tom Catron, director of the Governor’s Office of Children’s Care Coordination.

Memphis and Chattanooga are among the worst cities in the country for low birth weight and infant mortality rates, he said.

Gov. Bredesen budgeted $1.4 million a year, boosted by a 50 percent federal match for four years, to address infant mortality by targeting Medicaid-eligible women, according to Dr. Catron.

A women’s health initiative to improve prenatal and obstetric care for all women — though primarily those who are most underserved — received $5 million that first year and $3 million in recurring annual payments.

Even in this tight budget year, the initiative is in a hiring freeze but lost only $40,000 in program funds, Dr. Catron said.

The agency has issued about $13 million in grants across the state and has about $5.5 million left, he said.

The Hamilton County Infant Mortality Reduction Initiative is in its second year and finally has gathered enough data and held enough focus groups to develop a strategy tailored to this community, Ms. McDonald said.

The group is promoting a state-sponsored program, Centering Pregnancy, that encourages women to attend prenatal appointments in groups so they are less intimidated, Ms. McDonald said.

The group also plans to add a health educator position at the Chattanooga-Hamilton County Health Department and provide funding to La Paz de Dios, which uses lay health workers to educate Hispanic women, said group member Rae Bond, executive director of the Chattanooga and Hamilton County Medical Society.

Lay health workers — women without medical degrees but trained as peer educators — are a model the group wants to explore for black communities in Alton Park, East Chattanooga, East Lake, St. Elmo and downtown. They plan to start young — something Dr. Catron says is essential.

“The youth are not thinking about starting families and things like that. It’s not even on their radar screen yet,” he said. “But you get them thinking about it, and you educate them about it and they start talking to their peers about it. You create this little ripple of information, and then the correct information is making its way through the adolescent communication chain.”

breaking barriers

One of the biggest obstacles the group faces is cultural stereotypes and stigmas, said certified nurse-midwife Meg Brasel.

In some cultures, breastfeeding is almost a stigma, she said. Advice on prenatal and infant care is handed down by grandmothers and aunts who distrust formal, Western medicine, Ms. Brasel said.

“These ladies who are pregnant right now will someday be the aunties and the grannies,” she pointed out.

Part of the problem is that some of these women have so much else to worry about, Dr. Catron said.

“Health care is not very high on their priority list,” he said. “They’re worried about shelter, food and are they going to get killed on their way home from work or school.”

As the mortality reduction group began its work, the governor’s office contracted with the local youth advocacy organization Girls Inc. to get younger women involved, Dr. Catron said.

Eight high school students became peer educators for the program and were trained in preconception and prenatal health as well as video production, Dr. Catron said.

The group’s video public service announcements will be screened in Nashville for the governor later this month and eventually will be aired on television, he said.

But the work won’t end there, said participant Jasmine Ray, a 17-year-old rising senior at Chattanooga School for the Arts and Sciences. Though their funded program was over at the end of the school year, she said, the group plans to regroup for a town hall meeting in August to keep the issue alive in the community.

Ms. Harris said she is very interested in doing the same kind of thing within her East Chattanooga community.

“I just want to help,” said Ms. Harris, who is in her first trimester of pregnancy.