Trying to Reach Mothers to Give Babies Better Starts
New York Times, Monday, May 15, 1989

CHICAGO, May 14 - Edith McAfee was more than eight months pregnant before she first went to a Chicago public health clinic for prenatal care.

"It was summer, and everything was going good." explained Ms. McAfee, who is 19 years old and unemployed. "I had a lot of fun and stuff. And it didn't seem right that I was pregnant again."

Brendan McAfee was born healthy on April 11, just three weeks after his mother first saw a doctor. Thousands of other women and their children are not so fortunate.

Many infants who die within the first year of life, or who are born prematurely, underweight or ill, are the children of mothers who did not receive medical care until late in their pregnancies, if at all. Many could have been saved if the mothers had been treated earlier for problems like improper diet, hypertension. anemia and sexually transmitted diseases.

Chicago has one of the highest infant mortality rates in the country. In 1987, the figures were 16.6 deaths for every 1,000 live births. or 914 deaths out of 55,216 live births, There were nearly 23 deaths per 1,000 births among blacks.

'Right From the Start'

Now health officials here have joined with corporate sponsors in a campaign to bring women into prenatal care earlier. The program. "Beautiful Babies... Right from the Start," offers pregnant women a coupon hook with $600 in discounts on baby-care goods, vitamins, maternity clothes, furniture, diapers, toys, and services like classes, haircuts and car rentals. The coupons can be redeemed at stores only after being stamped by a doctor after the woman's monthly prenatal visit.

While the campaign is open to every pregnant woman, the groups considered to be at highest risk are poor, black or Hispanic mothers, under 15 or over 35 years old, drug or alcohol abusers, and those who have had a previous child born under five and a half pounds.

The program, which began in Chicago in January, made its first appearance two years ago in Washington. Jerry Wishnow, a Boston-based promoter of public-service projects, proposed the campaign to combat infant mortality in the United States, where the rate is 10 deaths per 1,000 live births, higher than in 18 other industrialized nations.

The campaign is being sponsored by the University of Chicago hospitals, some corporate and foundation donors, and WBBM-TV, which has donated programming about the importance of prenatal care and the availability of the coupon books. The Chicago Tribune also published a supplement dealing with the program.

The booklets are available at drugstores and medical clinics and can he ordered by phone. Besides the coupons, they contain emergency telephone numbers, information about nutrition and community services, and explanations of what mothers should expect in pregnancies.

Filling a Need for Education

So far, there have been 41,000 requests for the coupon hooks, and 7,000 doctors have asked for the stamps used to validate the coupons. The campaign has cost $1.3 million, not including the publicity donated by WBBM. "Our key goal is to get women into care earlier, and to get them to go more often," said Leatrice Berman, administrator of the Perinatal Network at University of Chicago Hospital and general manager of the campaign.

Pregnant women put off getting medical attention for a variety of reasons. Helen Kinney, a social worker at a health clinic for mothers and children on the city's South Side, says many women she sees have mixed feelings about their pregnancies, especially if they have recently given birth. Pregnant teenagers may be afraid to confront their parents. Many mothers who are struggling to feed and shelter their families do not have the time to see a doctor, Ms. Kinney said. Others are not aware that free or low-cost medical care is available.

Success In Washington

An extensive evaluation of the Chicago program is being planned for about a year from now.

In Washington, where an estimated 70,000 residents received coupon books starting in 1986, prenatal visits to public health clinics increased by 22 percent in the first year of the campaign. Infant mortality decreased to 19.6 from 21 per 1,000 births.

Blue Cross and Blue Shield of Washington, which has contributed $471,000 to the program, has also seen some improvement. Insurance claims for seriously ill babies decreased to $3.2 million in 1987 from $4.3 million in 1985. In that period, however, there were fewer maternity claims in general. and the proportion of claims for sick babies remained about the same.

While health professionals in Chicago are enthusiastic about the prospect of curbing infant mortality, they say the program has its limitations. Doctors in the poorest areas say many patients will not he able to make much use of the coupons because they do not have enough money to buy even the discounted goods.

James Masterson, deputy health commissioner in Chicago. said a third of infant deaths in the first year occur after the child leaves the hospital. "We can save very young babies, but once we let them out of the hospital, the environment takes over," he said. "There isn't enough to sustain life."