November 27, 2009

An article that highlights the benefits of medical social service programs for pregnant women. There is a large racial gap in infant deaths, with black mothers having a higher incidence of very premature births. In 2007, the infant mortality rate nationwide for white mothers was 6 per 1,000 and the rate for black mothers was 13 per 1,000.
The article features a case study of Dane County, Wisconsin (which is where Madison is located). Between the 1990s and the current decade, the rate of infant deaths among black mothers has fallen sharply -- from an average of 19 deaths per thousands births to fewer than five in recent years. The rate is now at parity with white mothers. Researcher wants to figure out what "went right" in Dane County, in order to help out other areas in Wisconsin. In Milwaukee, Racine, and two other counties, black infant mortality rates are some of the highest in the nation. The article mentioned a mother that used to live in Racine, and while she lived there she had a stillborn child for her first pregnancy and then a premature child for her second pregnancy. Then she moved to Madison and, for the first time, had a full-term, healthy pregnancy.
Some are perplexed by this drop in infant mortality, saying there isn't a medical explanation. As one doctor said in the article, there has been no significant changes that have occurred in prenatal care or in medical technology. However, the social setting in which a pregnant mother lives, and the social and medical services provided to her during her pregnancy can have a huge impact on the pregnant mother and her child. It can't be a coincidence that the mother mentioned in the article had troubles delivering a healthy baby to full-term when she lived in Racine, but then once she moved to Madison, she did. The community you live in can be really important to your health. This mother moved from an area with a lot of poverty to a better neighborhood in Madison. She said that she felt fear and isolation during his first two pregnancies (in Racine). She was exposed to more stress. Racine is more segregated and violent. Madison is safer and the African-American community in Madison is described as close-knit.
Furthermore, there are more public and private services in Dane County. The Dane County health director pointed out services that started in the mid-1990s to help pregnant mothers: A law center that connects poor women with insurance and medical services; local health and maintenance organizations started to act far more assertively to promote the health of pregnant women; a federally-supported clinic opened up which serves the uninsured and provides women with nurse-midwives, who tend to bond with pregnant women and spend more time with them on appointments. Furthermore, county nurses visit low-income women that are at high-risk of premature births. They provide transportation to appointments, help the mothers join anti-smoking programs, and refer them to anti-depression therapies. This program exists state-wide, but other areas in the state (like Racine and Milwaukee) haven't achieved the same broad coverage like Dane County, according to a state secretary of health services. Moreover, community leaders in Dane County have increased outreach to young pregnant women and are keeping a closer watch on them.
The article gives the example of one 26-year-old pregnant mother in Madison that is benefiting from the medical and social services provided to pregnant women in her community. She lives in a subsidized apartment, she receives monthly visits from a county nurse who helps her out (including putting her in contact with a dentist. Periodontal disease increases the risk of premature births), a social worker visits weekly and helps her look for employment, she receives prenatal care from the community center's nurse-midwives, and a local church gave her baby clothes and changing table.
As the Dane County health director said, "I think it's a community effect. Pregnant women need to feel safe, cared for, and valued. I believe that when they don't, that contributes to premature birth and fetal loss in the sixth and seventh month." (Full Story)