Sunday, February 27, 2000
Home visits fight to improve infants' chances
Mortality rate an area problem
BY MARK CURNUTTE
The Cincinnati Enquirer
:Adona Gray was 16, using cocaine and drinking when she was pregnant the first time. By the time the Hamilton teen was pregnant again, two years later, she was sober.
The difference was her relationship with Butler County Early Start nurse Kay Farrar, whose regular home visits connected Ms. Gray with services — Alcoholics Anonymous and mental health therapy — that have helped her become a better mother.
“Oh, my gosh, Kay changed my life,” said Ms. Gray, who will turn 20 Tuesday.
Expanding home visitation programs that pair nurses or social workers with at-risk mothers is one of the major ways the region is trying to reduce its high rate of infant mortality and related social problems.
The Cincinnati Enquirer's sixth annual Tristate Child Index illustrates the Tristate's continuing difficulty with infant mortality. The local rate is 17 percent worse than the rest of the country, 8.4 deaths per 1,000 live births compared to 7.2 nationally in 1998.
The Tristate has a high rate of infant mortality for many reasons, say health professionals. Some factors:
• The region is home to a large mix of Appalachians and African-Americans, who tend to suffer higher rates of infant mortality. In Hamilton County, 122 children died before age 1 in 1998; 60 of them were black.
The infant mortality for children born to black mothers in Hamilton County is 16.2 per 1,000 live births, according to the Ohio Department of Health. It's 7.5 per 1,000 live births for white mothers.
• The area has a high percentage of teen pregnancies. Teen mothers who are expecting tend to smoke, have poor diets and lack education about prenatal care.
For example, 22 percent of expecting mothers in Butler and Clermont counties and 16 percent in Hamilton County smoked cigarettes during pregnancies before giving birth in 1998.
Children die here before age 1 for many reasons: congenital defects, improper use of car safety seats, fire, suffocation.
Earlier installments of the index brought the Tristate's high infant death rate to the attention of health officials, social service agencies and policy makers. Discussions led to the expansion and generous funding of home visitation programs to reach at-risk mothers and infants.
The first Enquirer index revealed an eight-county infant mortality rate of 9 deaths per 1,000 live births in 1993; the national rate was 7.9.
The Tristate rate then decreased each of the next four years before increasing; 229 children died before age 1 in 1998, 199 the year before.
Other programs and agencies have helped the region stay ahead of the country in terms of women seeking first-trimester prenatal care. The Tristate is on par with the nation in low birth-weight rates, where slight recent increases are attributed to the number of women over 35 taking fertility treatments and having multiple births.
Prevention program
Butler County Early Start is one of two dozen existing programs that are folding into the $25 million Every Child Succeeds initiative. The umbrella program aims to reach 11,000 mothers a year in a nine-county area stretching across Southwest Ohio, Northern Kentucky and Southeast Indiana.
Organizers say the program has proven to reduce rates of infant mortality, child abuse and rapid successive pregnancies in other cities. Women in an Elmira, N.Y., group were more likely to complete basic education, find work and avoid welfare.
Mothers who received no prenatal care or are teens, single or low-income are eligible. Mothers can receive regular home visits while pregnant until the child is 3.
The cost will be about $3,000 for each Tristate mother who enrolls. It's an investment in prevention that will save money in the future, said Dr. Frank Putnam, scientific director of Every Child Succeeds and director of the Mayerson Center for Safe & Healthy Children at Children's Hospital Medical Center.
“It is a critical time of enormous growth,” he said. “The problems magnify when kids get into school and the criminal justice system, when they begin to abuse drugs and alcohol as young adults. We all pay for poor outcomes of children's lives.
“We can increase moms' protection of their children. They are less likely to strike out at the child. There will be less shaken baby syndrome.”
Every Child Succeeds was created in May 1997 by the United Way & Community Chest. Children's Hospital lends medical personnel and expertise. The Community Action Agency is recruiting workers and Beech Acres is training them.
The United Way gave $750,000 to Every Child Succeeds in 1999. And the program will receive the same amount for the first six months of this year with more funding expected to be announced in April.
“It's a credit to this community because this is prevention in the best sense of the word,” said Judith Van Ginkel, Every Child Succeeds president.
One family at a time
Every Child Succeeds, which started visiting women in July, reached its 600th family in January. More than 90 percent of the program families are headed by single mothers.
Ms. Gray's family is one of them. She lives in a Hamilton apartment with her son, Daniel, 2; daughter Ayreonna, 3 months; and the children's father, Daniel Shirrel, 22.
The approach is holistic.
“Since they were pregnant, they were told they screwed up, they made a mistake,” said Jaylene Schaefer, a social worker and director of Butler County Early Start. “We're trying to change her perspective. "This child is the most important thing you'll ever do. We value your child. We value you.'”
That's where Ms. Gray's nurse, Ms. Farrar, started.
“She'd had a sorry past life,” Ms. Farrar said. “I listened in a non-judgmental way. I let her unload it once and for all.”
The nurse tries to meet the mother's needs — emotional and physical.
“We gave her a crib, diapers,” Ms. Farrar said. “We try to be there to develop a relationship.”
“She got me out of my grandmother's house and got me my own place,” Ms. Gray said.
Ms. Farrar took Ms. Gray to her first few AA meetings. She got the teen mom into counseling. She convinced the high school dropout to pursue her GED. She taught her that young Daniel's “getting-into-everything” behavior was normal and showed developmental promise.
“When I first went over, she'd put Daniel in the high chair and want to interact with me,” Ms. Farrar said. “Now she gets down on the floor and plays with him.”
“Legos,” Ms. Gray said. “He loves Legos. We build stuff together, and he loves to break it.”
Ms. Gray started to use birth control, but she got pregnant anyway.
Now sober, Ms. Gray learned the importance of proper diet.
“I cut down on greasy food,” she said. “I eat more pasta, more dairy.
Ms. Farrar also talked with the children's father.
“She got me to finish my GED and go after my commercial driver's license,” said Mr. Shirrel, who now has a job as an over-the-road trucker.
The family set goals: They want to buy a house. They plan on getting married. They're working to get off public assistance. Ms. Gray receives Ohio Works First benefits for her two children.
“Kay is a godsend,” Mr. Shirrel said.
They've learned how to talk with each other. They've learned how to better deal with stress.
“We're still working on that,” Ms. Gray said. “I read now. I love horror books. Kay gave me a journal to write in.”
“She writes in it all the time,” Mr. Shirrel said.
Pinpointing policy
Even as Greater Cincinnati's infant mortality rate continues to outpace the rest of the country, health officials and public policy makers are trying to understand exactly why children die before age 1.
Last year, Children's Hospital and the University of Cincinnati created the Child Health Statistics Center at the hospital. Its mission is to collect information from a three-state, 29-county region surrounding Cincinnati and to help health officials and policy makers target programs and funding.
For example, the center aims to look more specifically at areas of the region where infant mortality rates are high.
“We'll start with what are preventable and non-preventable causes of death,” said the center's director, Dr. Edward Donovan. “Where are children born with congenital birth defects and how many children died at 6 months because they weren't in a car seat? We want to get down to the neighborhood level.”
The center will examine differences in black, white, Appalachian and teen-mother infant mortality rates.
In Hamilton County, some areas have low mortality rates, while other areas and population groups contributed to the 9.9 deaths per 1,000 rate in 1998 that was higher than other urban counties in Ohio — Cuyahoga, Montgomery, Mahoning and Montgomery.
At the same time, the mortality rate in 1998 for Boone, Campbell and Kenton counties in Northern Kentucky was 6.3.
“Any loss of life is a concern,” said George Kent, director of Northern Kentucky Health Centers Inc., whose seven clinics in Bracken, Campbell and Kenton counties serve 85 percent low-income people. Half of the agency's patients receive Medicaid.
While the infant mortality rate in Northern Kentucky is lower than in Hamilton County, the clinics saw an increase in low birth-weight babies and a decrease in women seeking first trimester prenatal care.
“These are sensitive issues that reflect housing, nutrition and lifestyle issues,” Mr. Kent said.
A mother's plea
Martha Bacher's son, Jacob, died at nine weeks in November 1996. The cause of death was Sudden Infant Death Syndrome (SIDS). A sitter found him in his crib, not long after she had put him down for an afternoon nap.
“He was healthy, in the top percentiles for height and weight,” said Mrs. Bacher, now 40, of Westwood and a nurse with the Veterans Affairs Medical Center in Corryville. “I did everything I could. I quit smoking a year before I got pregnant. I didn't drink. I was off-the-scale compulsive. I took vitamins even though they made me sick.”
After Jacob's death was ruled SIDS by the coroner, Mrs. Bacher and her husband, Edgar Bacher, would get angry when they saw media reports of child deaths caused by abuse, neglect or other preventable means.
“I can't even watch it on ER,” he said.
As she healed emotionally, the anger melted into a conviction to help any way she can. Telling her story is one way.
“I want all pregnant women to realize the preciousness of what they have inside them,” she said. “The child deserves the best you can give. Please do the best you can. Even if you're not going to keep it, do what you have to do until it's born. Stop smoking crack. Stop drinking. Keep your appointments. It's so awesome. Then go back to what you have to do after the baby's born.
“It breaks my heart to think what happens to all these babies. It really does.”
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