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NewsLouisiana Taking Baby Steps Toward Reducing State Infant MortalityBy Mary JimenezShreveport Times April 28, 2007 LaQuisha Burks wasn't happy when she learned she was pregnant and due to deliver her first child in August. But she found comfort in news that there is a program that would help guide her through the pregnancy and the first two years of her baby's life. "I didn't know anything," said the 23-year-old Shreveport resident, who admitted her maternal instincts didn't really kick in until after she got the first glimpse of her baby on a sonogram last month. "I've learned how to eat healthier and take care of myself." The program Burks and 162 other moms-to-be in Caddo and Bossier parishes are enrolled in is community prenatal care, offered through the Northwest Louisiana Coalition for the Health of Women and Children for Medicaid-eligible women. Each part of the program is an important tool in an effort to improve the region's and Louisiana's infant mortality rate, the highest in the country. Louisiana has a 10.4 infant mortality rate, meaning at least 10 babies die before age 1 for every 1,000 births, according to the National Center for Health Statistics. Mississippi, at 10.2, is the only other state with a rate over 10. For northwest Louisiana the numbers get worst. Region 7 - which includes Bienville, Bossier, Caddo, Claiborne, DeSoto, Natchitoches, Red River, Sabine and Webster parishes - has a rate of 12 and is the highest in the state. Caddo Parish has a rate of 13.3 and the 71103 zip code in Shreveport has an astounding rate of 32.7, according to the Louisiana Center for Health Statistics. "People can't believe those stats when I tell them," said registered nurse Linda Brooks, the NWLC director, who helped write the federal grant to answer these numbers. "There is poverty in this area like you've never seen and teen pregnancies (15-19) are a big problem accounting for 55.6 percent of all births." During April when March of Dimes, an advocate for babies, holds its annual WalkAmerica events, Louisiana's infant mortality rate is thrust into the limelight. The Shreveport-Bossier City event begins today at 9 a.m. at the Louisiana Boardwalk in Bossier City. Dr. Rodney Wise, the maternity program medical director for the state and a faculty member at LSU Health Sciences Center-Shreveport, was Brooks' grant-writing partner. "We knew each other and both of us had worked with the underserved our entire careers. We knew if we could put a perfect program together, we could take care of some of these barriers," she said. The state Department of Health and Hospitals uses the federal grant with matching state funds to fund the program and contracts with LSU Health Sciences Center to provide staff. The NWLC also offers nutritional services, social services, transportation, child care and a 24-hour registered nurse on call. Home visitation for first-time mothers through a statewide program called the Nurse Family Partnership also is provided. In Region 7, the NFP is expanding in July from four parishes to nine. Chandra Pouncy is a first-time mother who has benefited from the NFP program. Chloe', now 7½ months old was born a healthy 7 pounds, 9 ounces and 21 inches long. Pouncy can't say the program was directly responsible for her healthy baby but research shows prenatal care improves a baby's chance. According to the federal Maternal and Child Health Bureau, babies born to mothers who get no prenatal care are three times more likely to be born at a low birth weight, less than 5½ pounds (the average newborn weighs 7 pounds). These babies are also five times more likely to die and have greater chance of living with a disability. "I didn't even know how to change a diaper," said Pouncy, 20, a Southern University student studying to become a dental hygienist. "It's been good for me. This is my first child and you want to know you're doing it right." The program also aims to prepare mothers for the outside world as a mother, sometimes solo, like both Pouncy and Burks. "We help them stay in school or get their GED and continue their educations," said Brooks, who refers to Pouncy and Burks as golden examples of how the program should work. "But it can also be frustrating." Pregnant women, some as young as 12 years old, will come in to NWLC not even knowing how they got pregnant. Other girls seem to understand how they got pregnant but just didn't bother to take birth control and indicate they don't use condoms for safe sex. Still others indicate they became frustrated with the limited or time-consuming access to family planning resources because of their financial status and gave up on birth control. "The most difficult thing is not shoving your wants and wishes on the client," Brooks said. "Sometimes little baby steps is all you get and you have to be satisfied with that. It's a lifestyle and culture change." Making a change Although the infant mortality rates from 2003 to 2004 increased for Caddo Parish, Region 7 and the state, Brooks and Wise both think the state is on the right path. "We started our program in 2002, but our first births weren't until 2003 and most data is two years behind," said Brooks, who is looking forward to the newest stats for 2005. "We'll need data through 2007 to see the effect of these programs. "But if you look just at our patients so far, we're seeing good results." There's only been one stillborn and one death in 308 deliveries in the community prenatal care program. NWLC has actually served closer to 800 but most transfer to a private physician once they sign up for LaMOMS, Medicaid coverage for pregnant women with an income up to 200 percent of the Federal Poverty Level. The NFP in Region 7 has also reported only one infant death in its 390 clients since 2002. The bigger picture, Wise says, is the state's infant mortality rate is too convoluted by other variables to find any quick solutions. One is racial health disparities. The federal government's Office of Minority Health finds that in 2003 blacks had 2.4 times the infant mortality rate of non-Hispanic whites. Blacks had 2.2 times the sudden infant death syndrome mortality rate as non-Hispanic whites and black infants are four times more likely to die of causes related to low birth weight than non-Hispanic white infants. "That's anywhere in the United States," Wise said. Louisiana has the second largest percentage of total population of black Americans. Mississippi has the largest, according to the 2000 U.S. Census. Another factor is poverty and Louisiana is one of the poorest states in the nation. Education, lack of access to health care and obesity are other factors. The state is chipping away at the problem. In addition to LaMOMS, and the NFP, the state is also using a national program called Fetal Infant Mortality Review. The program uses a community case review team to examine each infant death and then offer recommendations. "Infant mortality is just so complex," Wise said. "If we weren't doing what we are, it would be a whole lot worse and if we continue, we'll see some improvement." |
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