Protecting Our Most Vulnerable

In the twelve months since last Thanksgiving, I've added one very small (but growing every day) thing to be thankful about. For almost ten months now, I've been the proud dad of a beautiful baby girl. So far, my wife and I have been extremely lucky -- our daughter is a great and easy kid and she has been healthy and happy thus far. It is this that I am most thankful for this year.

But even as lucky as we have been, raising a child is difficult work. For those of you who are parents, I'm not telling you anything you don't already know. For those who are not parents, the difficulty and incredible sense of responsibility of child rearing cannot be fully understood until you are staring down at a tiny, helpless human being and you know that it is now your job to turn her into an independent person. The process is filled with joy, but it requires patience, sacrifice, and careful attention to the details through which babies send us signals about their health, hunger, and happiness.

This week, my thankfulness stretches even deeper as I realize I live in the city with the highest infant mortality rate among the sixty largest American cities. In Memphis, 14 of 1,000 infants die before they reach their first birthday. That's more than double the national average. More human beings die in Memphis as infants than from homicides. In some of the poorest areas of Memphis, the rate is four times the national average. Even though these children live in the most medically-sophisticated country in the world, a child born in these areas has about the same chance of reaching its first birthday as the average child born in several third world countries.

While infant mortality is often viewed as a medical statistic, it is more properly understood as a symptom of deeper social failures. The U.S. has more neonatologists and neonatal intensive care beds per capita than Australia, Canada, and Great Britain, but has a higher infant mortality rate than these countries. The problem is not that we lack the doctors or facilities. Infant mortality risks begin well before a pregnant mother reaches a hospital. They begin the moment a woman becomes pregnant and the U.S. -- Memphis, in particular -- has done a poor job of delivering information and services to the pregnant women whose children are most at risk.

The characteristics most highly correlated with an increased risk of infant mortality are poverty, lack of education, lack of access to health care, and a mother's use of alcohol, tobacco or other drugs while pregnant. Many mothers do not see a doctor during the entire term of their pregnancy until they enter the hospital for labor. They neglect a visit to the doctor because they do not have health insurance or they dont know that regular visits during pregnancy are important or they cannot get time off from their employer or a thousand other reasons. Even if our health care system removes these barriers in theory, many women are still paralyzed by them in reality. This lack of early and regular prenatal care puts infants at a disadvantage even before they enter the world.

As a society, we should be alarmed that in a country where we are capable of achieving medical miracles, so many of our fellow citizens do not have access to the information or health care needed to give their children the best opportunity to survive. Even in the best of circumstances, raising a healthy child is a difficult task. To avoid making it even more difficult, we must do better at getting information to pregnant women that will allow them to have safer pregnancies and births, and we must remove barriers these women feel toward seeing physicians early and often during their pregnancies and during a child's earliest months. We will not reach every pregnant woman and we'll never eliminate the tragedy of infant mortality, but we must do better at protecting our most vulnerable.