Infant mortality rates in Boston’s inner-city neighborhoods have historically been higher than in other parts of the city or even in greater Boston. With a grant from the Blue Cross Blue Shield of Massachusetts Foundation, doctors at Boston Medical Center and Boston University researchers will address the issue by creating a network of care for pregnant women in these neighborhoods.
The $300,000, three-year grant aims to reduce infant mortality resulting from health-care disparities affecting pregnant and postpartum African-American women in certain Boston neighborhoods.
According to Larry Culpepper, a MED professor and chairman of BMC’s family medicine department, who will lead the project, statistics show that babies of African-American women in Boston are 2.7 times more likely to die before their first birthday than babies of white women. These high infant mortality rates are especially concentrated in Dorchester and Mattapan.
“The Mattapan neighborhood has some of the most severe health problems in Boston, including very high infant mortality rates,” says Azzie Young, executive director of the Mattapan Community Health Center.
The grant will enable doctors at BMC and MED to work with doctors in community health centers to coordinate care among agencies. The project will include cooperation from 15 area community health centers, faculty at MED’s family medicine and obstetrics and gynecology departments, and “frontline staff” nurse care managers at BMC.
“The plan is to develop an approach to make the care available to these women and make it state-of-the-art — services already demonstrated to be of help to women in other communities,” Culpepper says. “It will put in place not only services, but we’ll really have a framework that over the long term will evolve and be responsive to the needs of the population.”
He created a similar network in Rhode Island, the Blackstone Valley Perinatal Network, which operated for 10 years, until the mid-1990s, when the network of health centers was restructured. He plans to draw on that experience and bring to the current project the elements that would translate to Boston’s communities.
In Rhode Island, for example, shelters refused to take in pregnant women, which added to the problem that women in their first pregnancy were more likely to be victims of domestic violence. Researchers found that shelters would take a woman if they were promised medical backup from the local community health center.
“Communication is a big issue” says Josephine Fowler, director of maternal and child health at BMC, who came to Boston from the Blackstone Valley Perinatal Network specifically to help improve infant mortality rates among African-American women. She completed a fellowship under Larry Culpepper while working in Rhode Island and now works at Dorchester’s Codman Square Community Health Center.
Some women in the Codman Square, Dorchester, and Mattapan areas, the target neighborhoods of the project, are assigned to public health nurses before they have a baby, but some only after they give birth. Getting a mother assigned to services such as the Healthy Babyprogram earlier can mean the difference between life and death for her baby, Fowler says.
Young agrees. “Early and continuous prenatal care is the key,” she says. “We’re going to focus on prenatal care utilization, and zero in on getting them care in the first trimester, to increase the number of women getting care early.”
The project of connecting health centers and hospitals has a bit of a head start, according to Fowler, since a previous grant created a common electronic records system linking Boston community health centers and BMC.
“The purpose of the project is to get providers working together, primary care and nurse practitioners who take care of the perinatal patients,” she says, “and get services in the community known to everyone and collaborating their care.”