Back in the Victorian Days, upper-crust families – those who came from old money, perhaps – enjoyed wealth enough to employ nurses to attend to young, anxious, first-time mothers-to-be.
Today, the awareness of how social determinants can affect health is flipping that scenario around. Now the county’s nurses make weekly house calls to pregnant women who lack the means to hire help. The happy result: A tangible boost of at-risk moms’ odds at turning around the family’s fortunes for the next generation.
Public programs to improve health outcomes are increasingly making inroads into communities – from the White House’s new initiative for disadvantaged dads, to foundations’ efforts to ratchet up wellness in low-income locales, to school reforms of zero-tolerance policies that hit kids of color hard.
The goal du jour is resilience: Teach people to help themselves, adopt healthy outlooks and habits, and you give a leg up to those in the cross-section of society who find the American Dream elusive. Experts say the best, most-effective way for social services to do this is to provide support, encouragement and education face-to-face, one-on-one.
Sound expensive? Maybe so, but proponents argue these programs deliver societal benefits that far outweigh the costs.
In Sacramento County, for example, where statistics show poor health outcomes for many children of color, the Department of Health and Human Services is deploying two notable programs with proven records of preparing first-time pregnant women for one of life’s biggest challenges: raising a kid.
• The Nurse-Family Partnership, operating since 2001, is now funded through the Patient Protection and Affordable Care Act for its effectiveness as a preventive health initiative. It’s grown from two nurses to nine, even as the threat of budget cuts looms like a guillotine over taxpayer-funded social services.
Rigorous, long-term, randomized controlled trials throughout the nation show the Nurse-Family Partnership improves prenatal health, decreases childhood injuries and eventually leads to improved school readiness among kids and a greater likelihood of a career for mom. Most importantly, urban kids in crime-stressed neighborhoods develop the resilience to resist the pull of street life.
Bottom-line watchers beam at the return on investment from this program – about $5 is saved for every $1 spent. Foremost, the nurses’ goal is to ensure that moms stay healthy, and that drugs, alcohol and smoking do not pose a danger to the babies’ development.
This is hardly an issue for Amelia Carrillo, 32, and her 20-month-old son, Luis Yahel. Rather, it’s the at-risk south Sacramento neighborhood that she describes in Spanish as “not so good.” She and her husband moved from Natomas into a fenced-off rental home after the economy tanked. For work, her husband drives daily to San Francisco.
Carrillo, an open, a friendly and soft-spoken woman from Guadalajara, met four criteria for joining the program: a low-income household, a disadvantaged neighborhood, the pregnancy was her first, and she was less than 28 weeks along.
The former accountant signed up for the Nurse-Family Partnership as soon as she spotted a bus advertisement. “I didn’t know what to expect. I was scared, hearing all these things people say can happen during childbirth,” Carrillo said. “But then the nurse came once a week and brought a video with information on how to breathe to manage the pain.”
For that, Carrillo is especially grateful. A petite woman, she suffered sharp contractions as she delivered Luis Yahel at a robust 8 pounds, 7 ounces. “I didn’t expect that because I was tiny,” she said.
The new mother also learned to breast-feed, bond with her newborn, communicate with him and to take a break, walking outside in the yard (with the baby safely asleep in his crib) whenever motherhood gets overwhelming. She also learned how to treat anemia so her breast milk would stay nutritionally robust.
“She has been very professional,” Carrillo said of her nurse-partner. “For me, she’s someone I can trust, and it’s confidential.”
She looks forward to the nurse home visits, which come every week or two until the baby is 2 years old. It’s clear to her that her toddler has benefited. As Luis Yahel busily made a drawing he called “dos flores y un conejo” (two flowers and a rabbit) for a visitor, he was attentive, curious, alert and relatively calm.
His sketch completed, Luis Yahel did a little bouncy dance in the middle of the room in a display of happiness.
County officials say such behavior is a hallmark of the Nurse-Family Partnership. There’s less fussing and screaming from babies who feel safe and secure because their parents use neither baby talk nor raised voices. Carrillo and other moms are taught to address their children in a respectful tone consistent with how they talk to adults.
• The county-administered Black Infant Health Program has earned accolades, survived 11th-hour state budget cuts and sailed smoothly through the typically contentious budget process in Congress.
Designed specifically to close the gap in black-white health disparities, the program gathers a dozen or so low-income women before and after birth for 20 group meetings in which women learn about good nutrition and how to take care of themselves so their babies are born full-term and healthy.
County officials from Supervisor Phil Serna on down hope the Black Infant Health Program will help improve the persistently poor health outcomes found in a 20-year study of African American children in Sacramento County. That study found that black kids under 18 died at a rate two times higher on average than did white kids.
African American babies are twice as likely to be born with a low birth weight, and 1.5 times more likely to be born prematurely. Mothers-to-be are four times more likely to suffer life-threatening complications from pregnancy than white women.
These health disparities persist even in high-income, highly educated households, experts say.
Gathering in a group helps the participating women develop a sense of community that’s culturally relevant and honors the history and traditions of African Americans.
The program suggests the women read to their babies daily, breast-feed (studies show that breast-feeding is better for infants’ nutrition and intellectual development), and to be effective role models for their kids.
Sharon Saffold, the county’s program coordinator of the Black Infant Health Program, teaches that babies are as absorbent as sponges. “What they see and hear, they will mimic,” Saffold told 10 moms gathered with their newborns for the weekly session at the Sacramento Food Bank in Oak Park.
One of the participants, Alexis Senegal, reached back into her own childhood to underscore the importance of mothers being good role models. “My baby sister, it kind of broke her that my mom was on drugs and she wasn’t around. I understand that it can make you or break you,” Senegal said. “I made a choice to be better. I’m going to be a better mom.”
Mercedes Jones added, “There’s nothing wrong with coming from humble beginnings as long as you work hard, and you don’t let that stress you.”
One young mother told of her bittersweet discovery of her ancestry: “I’m from Mexico. I didn’t know I was black until I was called (the n-word). I was sad and down. I didn’t even know what it meant. But I knew it was meant to hurt me.”
Another mother responded: “I hope you know you have beauty and inner peace. You are beautiful.”
As the meeting broke up, each woman had the opportunity to share their thoughts about the Black Infant Health Program. The words “grateful” and “thankful” came up often.