Chattanooga resident Cocoa Beasley couldn't help but burst out crying when she learned she was six weeks pregnant last year during a visit to the local public health department.
The 24-year-old said she cried even more when she learned a few weeks later that her baby's father would be in jail for most of her pregnancy, serving six months for failing to pay child support for another child.
But Ms. Beasley saidshe quickly steeled herself to do better for her baby than many of her friends were doing for theirs.
"Most of my friends that's pregnant now, they don't even go to the doctor. They're on drugs they don't have business doing," she said.
"I wasn't going to let that get to me. I said, 'I ain't gonna cry no more.' I just talk to Miss Toni about the situation."
Toni is Antoinette Hannah, a program educator with the Healthy Babies Healthy Ladies program at the Chattanooga-Hamilton County Health Department, which teaches women with high-risk pregnancies about prenatal care. "They are just really eager to learn, especially when they may have had someone (a baby) in their family that passed away," Ms. Hananh said.
The Healthy Babies program is one piece of a growing network of community resources tackling a long-recognized problem in Tennessee -- the high rate of deaths before age 1.
Tennessee is among the states with the worst infant mortality rates. And Hamilton County ranks second-worst in the state among metropolitan counties. Some ZIP codes in Hamilton County and Shelby County, Tenn., have worse infant mortality rates than El Salvador, Nicaragua and Syria, according to data compiled by BlueCross BlueShield of Tennessee, the state's largest health insurer.
Ms. Beasley said following Ms. Hannah's suggestions made a difference. Throughout her pregnancy she ate fruits and vegetables, took her prenatal vitamins and walked daily around her West Chattanooga neighborhood.
Her boy, Meko, was born after 38 weeks in October, weighing in at a healthy 7 pounds, 9 ounces. Now living with her baby's father, Ms. Beasley intends to finish high school when Meko is old enough that she'll entrust him to a daycare center.
"I said I was going do better, and that's what I did," she said.
NOT A NEW PROBLEM
Infant mortality is not a new problem in Tennessee or Hamilton County, but with the growing recognition of the complex reasons for the death of babies, momentum is growing to tackle the issue from all angles, health advocates say.
"We've been talking about this problem for a long time," said Bill Hicks, executive director of the Southside and Dodson Avenue Community Health Centers. "It remains a high priority, because we haven't really done what we want to do in terms of reducing the incidence of adverse birth outcomes."
Social issues like poverty and educational disparities underlie many of the more direct causes of infant mortality, such as lack of prenatal care, domestic violence and substance abuse. The tangle of causes makes infant survival monumentally challenging.
"The factors are extremely complex," said Rae Bond, chairwoman of the Core Leadership Group, which coordinates the efforts of local groups working on infant mortality. For those living in poverty, "there are more risk factors for alcohol and substance abuse if you have a sense of hopelessness. ... If you're fighting for survival every day, that affects your physical health as well as your emotional health."
Local advocates are particularly hopeful about a prenatal and post-partum care program called the Blues Project, which in five years has achieved significant success among participating mothers in Memphis. The program, funded by BlueCross BlueShield of Tennessee's nonprofit health foundation, will expand to Chattanooga this year.
In 2002 the issue of infant mortality first made it to the forefront of the Chattanooga-Hamilton County Regional Health Council's priority list.
At the time, the black infant mortality rate in Hamilton County had doubled from a decade earlier, reaching more than 20 deaths per 1,000 live births, said Mr. Hicks, who was then president of the Regional Health Council.
Health leaders were horrified by the statistics, he recalled.
"The issue was, 'Whoa, look at these numbers. They're Third World,'" Mr. Hicks said. "This shouldn't be happening here. We can't afford that, nor can we tolerate that in Hamilton County."
Years of research, focus groups and outreach have culminated in a number of local initiatives that health leaders hope soon will start to affect the county's dismal statistics.
FOCUS ON MATERNAL HEALTH
A study undertaken in 2007 by the Chattanooga-Hamilton County Health Department identified maternal health as the major factor to be targeted in public health interventions.
Especially in low-income neighborhoods, women face barriers to proper nutrition, local doctors said.
Some women go through their entire pregnancy eating groceries purchased at small convenience stores or gas stations, like canned foods high in sodium, with very little of the protein a fetus requires to develop well, said Dr. David Adair, maternal-fetal medicine specialist at Regional Obstetrical Consultants in Chattanooga.
Women living in rural areas face significant logistical challenges in getting to a high-risk obstetrician, he said.
The group launched a telehealth program last year, also funded by BlueCross' nonprofit health foundation, to allow high-risk mothers in rural areas to connect electronically to specialists in Chattanooga.
Several new programs aim to create social support for women facing pregnancy with few resources:
* The Centering Pregnancy program will begin at the Southside and Dodson Avenue Community Health Centers this summer, bringing "cohorts" of women together for education and clinical care, Mr. Hicks said.
* The local Baby Basics program focuses on improving moms' health literacy and creating a network of community support for mothers-to-be, said Judith Miller, who runs the program in coordination with local adult education center Re:Start.
* The Blues Project, launched in 2005 in Memphis, will focus on improving maternal health during pregnancy and will follow women after they give birth through the second year of their child's life, said state program coordinator Kimberly Lamar. She is assistant professor at the University of Tennessee Health Science Center's department of preventive medicine in Memphis.
"We know we can bring her home normal birth weights. but then what happens? Can mom keep that baby alive for the next year?" she said.
The program is expanding to Chattanooga in June, in partnership with Erlanger hospital and the local community health centers, Dr. Lamar said.
In 2007 the Governor's Office of Children's Care Coordination established an infant mortality reduction program in Hamilton County to coordinate the efforts of a number of community programs in reducing poor birth outcomes. The Hamilton County Core Leadership Group came together in 2008 to coordinate the efforts of dozens of local groups working on various angles of infant mortality, including La Paz de Dios, geared toward bridging cultural and economic barriers for Hispanic mothers, and Girls Inc., focusing on an awareness campaign.
Of the more than 800 women enrolled in the program in Memphis, only 9 percent had low birth weight babies between 2005 and 2009, compared with 18.6 percent of the 758 women at the same clinics who weren't enrolled, she said. Prematurity rates were 7.4 for participants and 19.7 for
Infant deaths occurred in only 0.24 percent of cases for Blues participants, compared with 3.1 percent for nonparticipants.
By diagnosing untreated mental illness and encouraging women to finish their schooling, the program can improve the parenting experience dramatically, Dr. Lamar said.
"They're reading to their children and understand why that's important to that child," she said. "They're looking at parenting from a different perspective than they did at the beginning. Ultimately, that baby has a stronger mom, a stronger family, is living in a stronger community."
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