EDITOR'S NOTE: More needs to be done to address racial disparities in infant mortality and poor birth outcomes in the Capital Region. In Day 3 of our series looking at these issues, Gazette columnist Sara Foss discusses programs that might make a difference.
They say that one of the first steps to fixing a problem is admitting you have one.
During the months I spent researching birth outcomes and infant mortality, I found it was fairly easy to find people who could talk about local efforts to improve infant health.
DAY 1: 'Any death hurts': In Schenectady and Albany, being born black is a fight against the odds
DAY 1: Birth Justice Project hopes to see more Capital Region women use doulas
DAY 2: New Baby Cafe in Schenectady aims to help nursing mothers
DAY 2: Glenville, Albany women form Black Breastfeeding Empowerment Network
What was hard was finding people with insight into the Capital Region's high African-American infant mortality rates.
Most people — and I'm talking about people who work in the health care system, social services and other community organizations — seemed unaware of the severity of the problem.
This surprised me, because the Capital Region is a big place, with any number of nonprofit organizations and experts working to ameliorate a wide range of social problems. But as time went on, I couldn't escape the conclusion that infant mortality is one social problem that, for whatever reason, has mostly flown under the radar.
This could be changing, as groups such as the March of Dimes and the promising new Albany-based nonprofit organization the Birth Justice Project, which I wrote about on Sunday, focus on the issue.
But more is needed.
In particular, more programs geared toward those most likely to suffer an infant loss might make a big difference.
That isn't to say there isn't a need for programming that aims to improve birth outcomes among all racial groups and demographics. There is.
But there's also a need for programming that directly addresses the alarmingly high infant mortality rates in the African-American community. After all, black babies are almost two-and-a-half times as likely to die in their first year of life as white babies.
"We need more conversations around racial disparities and more targeted programs," Kathryn Mitchell, the Albany-based maternal and child health director for the March of Dimes, told me.
There are a lot of good programs for pregnant women and babies in the Capital Region. But there are also gaps that, if plugged, would likely improve birth outcomes and reduce infant mortality rates.
Mitchell said the area would benefit from group prenatal care, in which a small group of pregnant women meet with an educator to discuss pregnancy and other health issues.
"Group prenatal care is good with a high-risk population," Mitchell explained. "There's a social aspect. You can connect with people outside of the (meeting)." One finding: Breastfeeding rates go up among women who participate in group prenatal care.
Mitchell also said there's a need for more community health workers — trained public health employees tasked with educating residents of high-poverty neighborhoods on how to lead healthier lives.
Community health workers are a key part of an Albany County Department of Health program aimed at improving birth outcomes in high-risk neighborhoods in Albany and Cohoes.
Called WILLOW (Women & Infants, Linking Lifetime Opportunities for Wellness), this program was established in 2013 with a five-year grant from the state Department of Health's Maternal and Infant Community Health Collaborative, which funds projects that address preterm births, low birth weight, infant mortality and maternal mortality. There are 23 MICHC projects in the state — WILLOW is the only one in the Capital Region.
WILLOW's three community health workers spend their days talking to Medicaid-eligible women, teen girls and their families, connecting them with services they need.
If they learn that a woman or teen girl lacks health insurance, or lacks a primary care physician, they do what they can to get them those things. Sometimes they connect them to other types of services and resources, such as food pantries, or the Department of Social Services or drug treatment.
The community health workers are also educators, and they talk to women and teens about a wide variety of health-related matters: the importance of going to prenatal appointments, of eating healthy, of using contraception.
"The research shows that if you're healthy before pregnancy, you'll be healthier during pregnancy," explained Maribeth Miller, Albany County's assistant commissioner for public health.
Neighborhoods with poor birth outcomes tend to have a higher percentage of residents who are "late to care" — that is, they do not see a doctor until late in their pregnancies, and sometimes not until they're about to give birth.
When women are late to care, it becomes much harder, if not impossible, for doctors to detect pregnancy-related problems in time to address them. And when such problems go unaddressed, the risk of a poor birth outcome rises.
"We want the women we meet with to be healthy," said Shelyan Madera, who serves as one of the WILLOW program's community health workers. She added, "We say, 'If you don't take care of yourself, who is going to take care of your children?'"
"A lot of younger girls come to us toward the end of their pregnancy," Vanessa Writer, who also serves as a community health worker, told me. "I had one 15-year-old who hid her pregnancy until she was about seven months along. In (these kinds of situations), you don't know if there's going to be a good outcome or a bad outcome."
I was impressed with both Madera and Writer, and with the concept of community health workers in general.
I was also impressed with Schenectady County's Healthy Schenectady Families program, which provides pregnant women and mothers of infants and toddlers with free home visits from family support workers.
The idea is to improve the health and well-being of women, babies and children by visiting them on their home turf and offering education and support through pregnancy, birth and early childhood.
"We make sure moms are ready to deliver, that they're ready for the process," said Peggy Sheehan, who oversees the Healthy Schenectady Families program for Schenectady County Public Health Services. "We talk about safe sleep, maintaining a safe environment, nutrition."
About nine years ago, I observed a trained family support worker's meeting with a 19-year-old Schenectady mother-to-be; the two women discussed whether the mother-to-be was prepared to go to the hospital and whether she planned to breastfeed once her baby was born.
The research suggests that home visiting programs are a good investment — that they lead to healthier babies and healthier children.
That's why getting more families into these programs — and increasing the number of families these programs can serve — should be a priority.
There's a cost to poor birth outcomes that goes beyond the immediate family and impacts the entire community. If we can create a world where more babies are healthier when they enter the world, everyone will benefit.
Mitchell, from the March of Dimes, believes we're on the verge of making real progress on issues related to infant health — that more people are becoming concerned about poor birth outcomes and interested in finding ways to address them.
"We're on the brink of seeing a lot of movement in the state on birth outcomes and maternal health," Mitchell told me. "I'm very optimistic."
Listening to her, I felt optimistic too.
Reducing high rates of infant mortality, preterm birth and low birth weight will not be easy. But it's important that we try.
NOTE: A number of readers emailed me to point out that in Sunday's article on infant mortality rates in the Capital Region I listed an Albany ZIP code when discussing Schenectady's Hamilton Hill neighborhood. They were right to point this out — due to a typo, I got the ZIP code wrong. It should have been 12307.
Reach Gazette columnist Sara Foss at firstname.lastname@example.org. Opinions expressed here are her own and not necessarily the newspaper's. Her blog is at https://dailygazette.com/blogs/thinking-it-through.