Every time a woman gets pregnant, a piece of her community's future sits precariously between her hipbones. Her quality of life during pregnancy can set her child up for disease, disability, early arrival or even death.
Cincinnati's infant mortality rate (12.9 per 1,000 live births) is worse than other cities of similar size, and nationwide African-American babies are three times more likely to die than their white counterparts.
Cincinnati Children's Child Policy Research Center describes infant mortality as "the tip of the iceberg," representing the most negative outcome for a multitude of birth health risks.
To understand the iceberg's ugly tip, it helps to look at the other outcomes lurking under the water. Among the approximately 11,000 live births each year in Hamilton County, 1,300 babies suffer from prematurity, congenital malformations, SIDS, injury, complication or infection.
And there's a strong correlation between early arrival and mortality, as two-thirds of all infant deaths occur in the 27 days following birth.
"We have a problem: We have way too many babies dying," says Kay Brogle of Healthy Moms and Babes. "With all the expertise and technology we have, this should not be happening. And minority women are suffering the most."
But there are women like Brogle who are trying to make change. Her organization is one of those working to solve the problem by connecting women to sources of aid.
The risks of premature birth are real, and avoiding them is a prevention game. According to the March of Dimes, 12.1 percent of all live births are premature (born prior to 37 weeks gestation). These infants are far more likely to suffer from learning disabilities, cerebral palsy, asthma and loss of sight or hearing.
The medical roots of prematurity -- including poor nutrition, lack of prenatal care and short spans between pregnancies -- are often preventable, correlated with social factors like single parenthood and low income.
Obstetricians and midwives can teach women how to reduce the risk of prematurity or even stem a preterm labor, but economic and cultural barriers stand between the doctor's office and expectant mothers.
Nationwide, the working poor are least likely to access health care. One in four Americans has no access to employer-based insurance, and many more simply can't afford the premiums.
Many of the mothers Brogle encounters don't know how to apply for Healthy Start and other government medical programs. Pregnancy is a qualifying event, meaning that people too "wealthy" to receive Medicaid can get treatment.
Some immigrant mothers have the means to pay cash for prenatal care but fear visiting the doctor due to their illegal status. In the African-American community, some women mistrust the health care system.
"They are forced to jump through hoops for other government programs," Brogle says. "They may have had a bad experience with a doctor in the past, and they're tempted to lie about their lifestyle choices."
She and other workers at Healthy Moms and Babes provide a bridge between expectant mothers and government program and encourage women to build relationships with their doctors. When a patient is open and honest, the practitioner is better able to assess risk and prescribe treatment.
For 22 years, Healthy Moms and Babes (www.healthymomsandbabies.org) has sent a van to disadvantaged Cincinnati neighborhoods four days a week. Women can obtain information on how to have a healthy pregnancy. Support and education continue during baby's first year of life, with immunizations and parent training. Home visits, Spanish-speaking case workers and transportation to the doctor are also available.
When a young single woman becomes pregnant, the rest of her life can fall apart. Parents might throw her out of the house, and a boyfriend might become abusive.
That's why relationship is key to the work of Healthy Moms and Babes. Many of the women on its staff were once clients.
Stephanie Satterwhite, a staffer, became pregnant at 15 and feared telling her parents. She credits Healthy Moms and Babes with nutrition education and moral support.
"I didn't have the money to buy the prenatal pills," she says. "They told me about the Flintstones vitamins I could take. They backed me up."
Queen Smith, who suffered from gestational diabetes, credits the organization with preventing a premature birth at a time of personal crisis.
"They taught me I had to take care of myself so that I could take care of my family," she says.
Nationwide, the rate of premature birth is up 29 percent since 1981. African-American women are twice as likely to have a preemie, a fact not entirely explained by socioeconomic factors; more research is needed to understand the risks specific to minority groups.
The March of Dimes is at the forefront of birth risk research and started the "I Want My Nine Months" campaign to raise awareness in the African-American community. Backed by singer/spokeswoman Heather Headley, the campaign urges women to ask their doctors nine medical and lifestyle questions to increase their chances of a full-term pregnancy.
To reduce premature birth and infant mortality, the women of Cincinnati need multifaceted support. Knowing the benchmarks of a healthy pregnancy -- and the warning signs of gestational jeopardy -- is critical. Affordable prenatal care should be provided without strings attached; earlier treatment could help reduce the enormous cost of hospital care for preemies.
"Twenty years ago you went to a clinic down at University Hospital (for prenatal care) and sat for three hours," Brogle says. "Medicaid took a long time, and the doctor would not see you without a medical card. All that has changed. The state and the feds are doing as much as they can do to make the financial help available. It's an issue of public education and of breaking down racial and ethnic perceptions."
The most successful birth health initiatives empower women as the guardians of their children's health destiny. By accessing social and medical services early and often, young mothers can reduce the health risks to her child and the health costs of our community.
Those creating support networks for young mothers -- as Smith, Satterwhite and Brogle are doing at Healthy Moms and Babies -- are on the front lines of the battle for full-term babies. And that battle begins while the child is still in the belly. ©