Reposted from the Washington Post.
BRIDGEPORT, Conn. — As a kid who grew up in violence-racked public housing here, Wanda Verret had no idea what to do when she got pregnant at age 14. She didn’t go to the doctor until her sixth month of pregnancy, smoked cigarettes and dropped out of school. “I was a baby having a baby,” she said.
Now 34, Verret is a little over four months pregnant with her fourth child. Living in a county with one of the nation’s sharpest income divides, she faces all the pressures that so many in this poor city confront: losing a car, no job, a cramped apartment. But she receives plenty of advice on how to have a healthy baby. She’s not smoking. And on a recent morning, she met with a nutritionist, picking up vouchers to buy fruit and vegetables, and went for a sonogram at a clinic. “I definitely do things differently,” she said.
Something extraordinary is happening to poor pregnant women such as Verret: They’re giving birth to healthier babies. While other economic and health disparities have widened, giving way to huge national debates about inequality, pregnant women at the lowest rung of the nation’s economic ladder are bucking that trend. They have narrowed the gap with wealthier women in the health of their babies.
While experts agree that government policy has been critical to boosting the health of poor newborns, the improvements aren’t because of a single policy or administration. Rather, they reflect improved access to care, as well as a complex array of other factors, some not easily within the government’s grasp to change, from pollution to nutrition to violence at home.
“The whole inequality story has an inevitable feel to it. People have this sort of pessimism about whether it’s possible to do anything,” said Janet Currie, a Princeton University economist who has led research in the field. “I don’t think government policy can take all the credit. But at the same time, there is evidence that our programs for pregnant women have a real impact on well-being.”
Birth certificates do not record information about a woman’s income, so a wide range of researchers use demographic markers such as race, marital status and education as proxies.
In a recent study on birth weights, a leading indicator of infant health, Currie and a co-author compared black, unmarried, high school dropouts with white, married, college graduates — two groups statistically on opposite sides of the income scale.
They found a large disparity, but a shrinking one. The study found that in 1989, one in six babies born to the economically challenged group weighed less than the 51 / 2pounds doctors consider healthy — compared with one in 32 babies born to the more advantaged group.
Over the following 20 years, the study found improvements for the less advantaged group, with the odds of having an unhealthy baby falling close to 1 in 8. The rate was essentially unchanged for more advantaged women. Currie also found that even if race is taken out of the equation, birth weights follow the same pattern.
Despite this improvement at birth, there remain big socioeconomic gaps throughout life, and those gaps are even widening at death. The poor suffer from a range of ailments — diabetes, obesity and high blood pressure — at much higher rates than the wealthy.
Most strikingly, wealthier Americans don’t just live longer than poor Americans, the gap is increasing. Twenty years ago, a female child who never finished high school was expected to live about two years fewer than a child who finished college. Today, the gap is more than six years, according to data provided by Jay Olshansky, a professor of public health at the University of Illinois in Chicago.
“We can change things . . . through the resources that a child comes into the world with,” said Anna Aizer, an economics professor at Brown University and Currie’s co-author. “And after that, we’ve got 18 more years to make sure they don’t slide back.”
The disparity in birth weights has far-reaching implications at a time when both sides of the political spectrum agree that every child deserves an equal chance at starting out in life, though they disagree on how to achieve that ideal.
Researchers have found that the effects of an unhealthy birth weight often linger for a lifetime, raising the odds of illiteracy, minimizing high school graduation rates and reducing earnings. In this sense, poverty feeds poor health, which helps feed poverty.
Studies exploring why poor women are having healthier babies do not tell a straightforward story, complicating hopes that by simply expanding health insurance it is possible to significantly improve the life chances of poor children.
Researchers have found that Medicaid, the insurance program for the poor that was significantly expanded under the Affordable Care Act, leads women to visit doctors earlier in their pregnancies but has a surprisingly modest impact on babies’ health.
Experts say health interventions alone have had limited impact, in part because poor women face so many other pressures harmful to the health of a fetus, from pollution to stress to violence.
Women who make less than $25,000 a year, for instance, are
2½ times more likely to be victims of domestic violence, according to research. And being sent to the hospital as a result of domestic violencetends to cost a woman 5 ounces on her infant’s birth weight.
“If we’re really interested in improving birth outcomes, we have to look at the situation under which disadvantaged women find themselves — and that means violence in communities, violence in relationships, and a whole host of other factors,” said Lisa Dubay, a senior fellow at the Urban Institute.
Research has found that the big changes in infant health have come from a mix of policy and social trends.
Programs such as food stamps and nutritional counseling have led to healthier outcomes. Declining rates in smoking, which is a factor in up to a fifth of unhealthy pregnancies, are thought to be a contributor.
As are environmental regulations that have limited pollution from power plants. One study found that the installation of EZ-Pass booths in New Jersey and Pennsylvania reduced auto emissions and improved birth weights among women living in the area surrounding the tolls. A study has also suggested that policies that gave authorities less discretion in deciding when to prosecute men accused of domestic violence have helped.
Wanda Verret grew up in P.T. Barnum, a notoriously dangerous public housing complex in Bridgeport. She lived in the shadow of a coal-fired power plant that spewed harmful emissions — and at the epicenter of the nation’s widening inequality.
Bridgeport, one of the biggest cities in Fairfield County, has a poverty rate of nearly 24 percent. Nearby Greenwich, the hedge-fund capital of the world, has a poverty rate of less than 4 percent. By some measures, Fairfield is the most unequal county in the nation.
Verret’s first baby, a boy, was born at under 6 pounds — she didn’t remember the exact weight — though she said he was healthy. They were lucky. In the 1990s, the most disadvantaged women in Fairfield County had on average a 14 percent chance of having a low-birth-weight baby. By comparison, the most advantaged women had on average a 2 percent chance of having a low-birth-weight baby.
Over time, a confluence of factors to help poor pregnant women in Bridgeport have healthier babies, from coordination between doctors and nutritionists, to home health visits, to programs in high schools aimed at educating pregnant teens about healthy practices. Under public pressure as the last coal-fired plant in Connecticut, the Bridgeport Harbor Station has even cut down dramatically on emissions.
By 2010, the rate of low-birth-weight babies born to disadvantaged women, which can be volatile from year to year, fell to 8 percent in Fairfield.
A recent morning spent with Verret shows the level of care that poor pregnant women receive, as well as the continuing challenges they face.
Verret lost her car when she couldn’t afford to pay the municipal registration fee, so she commuted for one hour by bus to a Women, Infants and Children (WIC) program run by Southwest Community Health Center, a network of low-income health clinics in Bridgeport.
“Every dollar we get we’ve got to manage,” she said. Leaving her three sons at home fills her with anxiety. “The age of the killing is getting younger.”
Still, Verret recognized that she had to stay focused to make sure she had another healthy baby. She had already forsworn smoking after a doctor recommended she go to a class for pregnant women, where they showed pictures of disfigured babies born to mothers who used tobacco.
Now, on a warm Wednesday morning, she was sitting in the office of a nutrionist at the federally sponsored WIC office.
“Do you drink milk?” asked Annie Ko, the nutritionist.
“One cup a day,” Verret said.
“You want to drink three cups of a milk or having three servings of cheese,” Ko told her.
“Okay, I will,” Verret said.
“Do you drink any juice?”
“A lot, four cups.”
“You want to limit your juice, and your soda,” Ko said. “What about deli meats, do you eat any deli meat?”
“Oh, yeah.”
“You should cook the deli meat,” Ko said.
“Lunch meat?” Verret asked, confused.
“Yeah, you should microwave it for 10 to 15 seconds because of the risk of listeria,” Ko said.
“Wow, I didn’t know that.”
As they wrapped up the meeting, Ko gave Verret $12 worth of vouchers to use at the local farmers market before their next meeting in September. She also got vouchers to buy 22 ounces of milk, 2 pounds of beans or peanut butter, 36 ounces of breakfast cereal, a dozen eggs and other staples.
Afterward, Verret walked across the street to Southwest’s Fairfield Avenue office, a sleek facility that replaced the run-down office that she had been going to her whole life.
In an examination room, a nurse, entering data into a laptop, asked if she has been taking prenatal vitamins. She needed a refill. Verret was weighed, coming in heavy for her 5-foot-3 frame. But her blood pressure was fine.
After more questions, the moment Verret had been waiting for all morning came. Her doctor, Claudia Ortiz, arrived and asked her to climb onto an examination table. Ortiz squeezed blue lubricant on her stomach and turned on the sonogram machine. She moved a wand across Verret’s abdomen. A grainy image of a fetus appeared on the screen to her right.
“That’s your baby’s heartbeat,” Ortiz said. “Do you hear that?”
“Can I have one picture?” Verret said, wanting to hold on to the moment.
“Sure.” As she printed the photo, Ortiz cleaned the lubricant off Verret’s stomach. Then she showed her the picture. “Everything looks good,” Ortiz said.
Verret lingered, gazing at the photo.