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Weighing a Baby's Chances

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Nothing brings more joy to a family than the birth of a child. In New Orleans, however, that joy is all too often tempered by news that the infant has low birthweight.

A low birthweight baby weighs less than 5.5 pounds at birth. Low birthweight is more prevalent among African-American women, regardless of marital status, age, or whether or not the mother smokes. The rate stays constant even across income levels, from extreme poverty to wealth. "Either way, that black woman still has a 2-to-1 chance of having a low birthweight baby," says Gail Gibson, head of Maternal Child Health for the Medical Center for Louisiana, which encompasses University and Charity hospitals and is the birthplace of 70 percent of this city's babies.

In the state of Louisiana, one in 10 babies are low birthweight -- the second-highest rate of low-birthweight babies in the nation, according to the 2002 Kids Count data book. (Mississippi, which ranked last, had a low-birthweight rate only 0.3 percent worse than Louisiana's.) The Kids Count book, compiled and published annually by the Annie E. Casey Foundation, ranks states from 1 to 50 on factors that affect child and family well being. Locally, the group Agenda for Children compiles a similar book, Kids Count Louisiana, which breaks down this data for each parish in the state.

Louisiana typically falls near the bottom of the Kids Count rankings, and 2002 was no exception. Overall, Louisiana ranked 49th (once again, just barely ahead of Mississippi). Our state came in at or near the bottom in four key areas: percentage of low birthweight babies; percentage of children in poverty; percentage of children living in families in which no parent has full-time, year-round employment; and percentage of families headed by a single parent.

Reports such as these are troubling and raise an obvious question: "What can we do?" When it comes to the problem of low birthweight babies, the unfortunate answer is that in at least half the cases we don't yet know. According to the National Institutes of Health, one of the greatest research challenges before us is deciphering "the underlying reasons for ethnic variations in low birthweight and preterm delivery."

It's a mystery that affects Louisiana every day. Low birthweight babies have extremely high infant-mortality rate. Survival is also costly -- some of the tiniest babies require more than a half-million dollars worth of care before they leave the hospital for the first time. There are long-term effects as well. Low birthweight babies are more at risk for a number of problems, including chronic lung disease, brain damage, mental retardation, cerebral palsy and blindness. Some will grow up with trouble learning, and some will suffer numerous health problems into adulthood.

Half the babies born at low birthweight have known, traceable causes. To help these infants, the Louisiana Office of Public Health (OPH), with local advertising and public relations agency Keating Magee, launched a noteworthy campaign called Partners for Healthy Babies. The project, started in 2001, features a designated 24-hour helpline (800-251-BABY) and a distinctive television spot produced by Keating Magee that promotes early prenatal care for teens and young women.

In addition, OPH emphasizes early detection of infections, proper weight gain, and spacing between children -- all factors known to be connected to low birthweight. Yet there are many women of all classes, colors and ethnicities who have done everything they should for the health of their newborn and still go into labor months before their due date. Nearly one in five New Orleans babies were born as a result of labor that started preterm, or before 37 complete weeks of gestation. Preterm labor is connected closely to low birthweight babies.

Prenatal care is vital for the overall health of a newborn child. But some researchers, such as University of Michigan professor Dawn Misra, contend that the idea of prenatal care has been oversold as a solution to low birthweight. They note that prenatal-care rates have risen appreciably nationwide and yet the rate of low birthweight babies hasn't budged since the 1960s. Nationwide, Healthy Start agencies -- including the local group Great Expectations -- have begun to look at other factors that can affect women. Most experts in low birthweight babies now believe that stress is a key component. Perhaps, they suggest, daily stresses faced by African-American women in America cause higher rates of low birthweight.

Recognizing this possibility, some cities have discussed the idea of providing comprehensive medical care and other support services to women of childbearing age -- specifically those women who have miscarried within the past year. This is an idea worth considering here. We can't expect healthy, full-size babies from mothers who have been in poor health for the rest of the year. The cause of many low birthweight babies remains elusive, but increasing efforts to provide greater care for women and their unborn children would be one way to help ensure happy, healthy babies.

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