AP Features, June 3rd, 2007
Shantaya McDaniel and Victor Reyes, teenagers who are refreshingly sensible for their age, now know what contributes to the high death rate of infants in their city and steps they can take to help keep babies alive.
Credit a six-week class called Crib Notes offered at their Lincoln Middle School for helping them apply lessons on healthy and proper eating, sleeping and living.
It was more than an academic exercise. Shantaya, 14, is helping her cousin and stepsister with their babies. Victor, 15, is using his newfound knowledge to help raise his 3-month-old son, Giovonni.
"I was nervous at first, very nervous," said Victor, an eighth grader. "I thought it was going to be a little bit complicated until they showed us a video and brought a demonstration baby in. ... Now that I'm good at it, it's not even a problem."
Crib Notes, which was created and taught by public health nurses, was designed to reduce infant mortality in Pontiac, which has the highest rate in Oakland County. If the program delivers on that promise, it could serve as the catalyst for a larger effort in a state with high infant mortality rates, although not the highest in the nation. That distinction goes to Washington, D.C., and Mississippi.
State and federal experts on infant mortality, including those at the Centers for Disease Control and Prevention, are unaware of similarly structured programs in other states. And Crib Notes' creators say the hands-on program is uncommon in the way it reaches and teaches children in middle school.
Developers of the joint project between the county's health division and Pontiac schools say it made sense to tailor the curriculum for that age group based on their interaction with babies and the opportunity to instill healthy behaviors in themselves.
"When you look at middle school-age children ... these are kids that are crossing the bridge from childhood into adolescence," said Lois Winer, a nursing supervisor for the county who oversees the program. "We thought this was a perfect population to begin to educate on ... prevention."
The program, taught to sixth- and eighth-graders in three schools, is not a sex-education class or one that teaches about reproductive health or pregnancy. Instead, it focuses on areas that research has linked to prematurity or infant mortality, such as smoking, obesity and sleeping in unsafe positions and places.
The message appears to be getting through. Victor told his girlfriend and their respective parents, who help raise Giovonni, about removing bumper pads from the crib because he could be smothered. He and Shantaya also have counseled family members about sleeping with babies.
"We learned not to sleep on the couch," Shantaya said. "That's what my mom did. She's still doing that. I had to tell her, 'No, that's not good.'"
Teachers, counselors and administrators select the pupils for Crib Notes. They could be those likely to share the information with peers, help care for younger family members, baby-sit for others, or have a child of their own.
Winer said the program, which started as a pilot project in spring 2005, doesn't yet have data to show its progress. But health officials are developing a plan to follow up with participants through high school.
Funding is provided by the county, but money from the state allows for home visits by nurses to first-time, low-income pregnant women in Pontiac with a focus on black mothers. A main goal is to reduce infant mortality and the discrepancies between black and white infant mortality rates.
In Pontiac, the infant mortality rate for all races has decreased from 16.6 per 1,000 live births in 1998-2000 to 13.2 per 1,000 live births in 2003-05 _ still higher than the county's average rate of 6.7 for the most recent three-year period. Michigan's overall average infant mortality rate was 8.09 per 1,000, compared with the national average rate of 6.86, according to 2002-04 figures, the most recent available from the CDC.
For that recent period, the nation's capital had an average of 11.42 deaths per 1,000 live births followed by Mississippi, with 10.32 per 1,000.
D.C.'s infant mortality rate has dropped dramatically from a high of 20.3 in 1989-91. The rate for blacks decreased from 23.89 in 1989-91 to 14.8 in 2002-04.
Recognizing the high rates and racial disparity, Congress in 1992 mandated a federally funded research program, the D.C. Initiative to Reduce Infant Mortality. One of its projects, Pride in Parenting, provided primarily black mothers with information about child health and resources available to them through home visits, developmental play groups and support groups.
Rather than using nurses for home visits, the program recruited people from the mothers' communities and trained them in child health and development. Federal health officials said that has led to higher acceptance than standard programs and the mothers were more likely to begin child well-care earlier, make frequent visits to the pediatrician and complete scheduled immunizations.
Mississippi's rate and ranking have been relatively constant since 1989, although the state saw an increase from 9.7 in 2004 to 11.4 in 2005 _ its highest rate since 1993.
In response to its high rates, Mississippi is about to complete a similar, federally funded pilot study in eight counties. The three-year program called Closing the Gap on Infant Mortality: African-American Focused Risk Reduction, is part of the Department of Health and Human Services' Healthy Start Program. It's also running in Michigan, South Carolina and Illinois.
While Crib Notes' creators chart its progress, they can take comfort that current attitudes appear to be shifting.
Victor has taken on greater responsibility as a father and plans to get a summer job to help support Giovonni. Shantaya has learned ways to help raise others' babies _ and realizes she's not ready for that responsibility herself.
"It made me think a lot about some of the choices my friends are making, and a lot of teen mothers I knew," she said. "It taught me really to look back and tell myself I'm glad ... I'm not a mother."
___
On the Net:
Centers for Disease Control and Prevention report on infant mortality: http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_14.pdf
