Guide Resources to The Folks Who are Doing The Work

Y’all!  I conducted my very first real interview for Tiny Cat Pants, where I had some questions, found someone who could answer them, and asked her my questions and learned stuff from her!  Is this what citizen journalism feels like?  I just don’t know.

Anyway, in continuance of my quest to discover what we’re doing for born babies, to keep them alive and healthy, I’ve been reading and thinking and asking questions.  And I did some actual research.  The state, as you may know, has this “1st for Everyone” initiative in which they are pushing to lower our infant mortality rate, which, according to the Tennessee Department of Health’s website (pdf, sorry), is almost 9 per every 1000 births across the state and for African Americas is almost 17 per every 1000 births.

One of the reasons this number is so abyssmal is that, according to the latest news, almost 15% of babies in Tennessee are born prematurely.  As you know, babies born prematurely often die.  In our state, however, “often” varies a great deal by race.  Again from the Department of Health’s website:

Black premature babies were almost twice as likely to die in infancy as white premature babies. For black premature babies the infant mortality rate was 66.1 per 1,000 live births versus 34.9 for white premature babies.

So, I tracked down Barbara Clinton, the Director for the Center for Health Services at Vanderbilt University (and in the spirit of full disclosure, I serve on the Board for the Center, so tracking her down wasn’t very difficult and, of course, I think the work the Center is doing is awesome and important) and asked her about what we can be doing better or more effectively to lower these numbers.

The thing that concerned me when I looked at the State’s website is that there seemed to me to be a lot of victim blaming.  Oh, if only these women had stayed in school or gone to the doctor more regularly or not been teenagers, they wouldn’t have suffered the death of their children.

I asked, “To me, this rings a little false, like the problem is just that these women won’t get their acts together.  Is it really as simple as getting women to shape up or is there something systemic about women’s lack of access to healthcare? ”

Barbara replied (via email):

Three of the explanations for the shockingly high rate of infant mortality (Adolescent pregnancy, Use of alcohol, tobacco and other drugs, Mothers with less than a high school education) appear at first glance to be related personal choices that women make.  However these factors are community and culture driven.  For instance, there is research that suggests that young girls with limited horizons, who do not believe they will succeed in education, job, etc, may opt for an early pregnancy because it is a clear and important life role.  Their “limited horizons” are community driven in so far as they are linked to inadequate and poor quality adult role modeling and guidance, schools that do not respond to their learning styles, neighborhood crime, etc.  In the case of early teen pregnancy, the evidence suggests that it is not uncommon for the other partner (the man) in the pregnancy to be significantly older, raising questions of power and intimidation.

The other causes you mentioned (Maternal infections during pregnancy, Preterm deliveries, Low birth weight babies, and Poverty) are clearly related to access to health care, use of health care, quality of health care, and financial resources.

I then asked what the State Legislature might do to help turn this around and Barbara replied:

Support community based, peer to peer interventions that address health issues by being embedded in community culture.  For instance, the Vanderbilt Center for Health Services (CHS) Maternal Infant Health Outreach Worker (MIHOW) program partners with medically underserved communities to improve the health of mothers and the birth outcomes and health of children.   MIHOW’s trained “natural helpers” are trained community women who assure that families utilize preventive care and parent in ways that assure good birth outcomes and healthy infancy and early childhood.  Approximately 50% of the participants across the south are African American.  In Nashville, current participants are approximately 90% Latina but two new MIHOW programs will be launched in January 2009 to serve the African American community.  Funding will come from  the TN Governor’s Office in partnership with United Neighborhood Health Services.  One is.  Data from MIHOW programs currently operating in Memphis and the state of MS suggest that the  program is reducing low birth weight and the indicators that lead to infant mortality.

I’m thrilled to be able to give another plug for the MIHOW program, especially because it is not about going into communities, telling them what they need, and then inflicting your change on them, but about communities identifying a need themselves and coming to MIHOW and saying, “Teach us to do this in our community.”

I am in love with believing that people know what their own problems are, even if they don’t know how, exactly to fix them.

But the thing that I think is important about her response is this: She’s not asking for more government programs.  She’s asking for the State to throw its resources behind programs that are already in place, that already work.

And, it’s important to note, if the State doesn’t throw its resources behind programs like MIHOW, they will still continue.  Not as broadly as they might, but they will still be there.  (And so could use your support.)

I have been thinking a lot about what we might do while we’re waiting for the Democrats to get their acts together (which Mack keeps insisting means while we’re getting our acts together) and I think the thing is, which is the obvious thing, we’ve got to have a vision for how we want the state to be and we’ve got to put our time and resources into achieving that vision.  If we can’t do it with the Democratic party as it (fails to) exist right now, then we’ve got to do it without them.  If we can’t do it with the Legislature as it exists right now, then we’ve got to do it without them.

The thing I’m strugging with is just what exactly, for me, “it” is.  Insisting that, if you’re born, you have a first birthday seems like a small part of it.