In saving the lives of infants, America ranks 19th among the nations of the world. Considering white babies and black babies separately results in whites rising to 11th while blacks fall to 21st. Each year, 40,000 American babies die before age 1. Most babies who face early life problems are born too small and too soon. This is because many mothers do not get decent care and guidance during their pregnancy. In some parts of the country, distance from a doctor or hospital is a problem; in other parts, medical personnel are in short supply. Some physicians are unwilling to accept high-risk patients out of fear of malpractice suits. Other doctors are reluctant to accept poor patients if they anticipate that their bills will not be paid or that they will receive inadequate reimbursement from public insurance programs. Shortcomings in the delivery of services are only one aspect of the dilemma. Some pregnant women fail to appreciate the need for early prenatal care or the importance of changing behavior--smoking or drug use--which affect not only the mother's health, but also that of the fetus. The problem is not just the number of infant deaths. Infant mortality is the symptom, and the cause is the difficulty in reaching women who fall into the classically "at risk" categories.
Part of recognizing the problem is defining the players. Thirty percent of America's workforce are women of child-bearing age. One million babies are born to these women each year. Today's American family is often headed by a single parent, usually a woman. Mothers with young children are the fastest-growing segment of the workforce. Corporate health policies that fail to acknowledge these realities are costly in terms of dollars, productivity, and human potential. This has been the prevailing attitude in America. Most women have babies when they are young and their incomes are modest. The most important actors in this scene are the at-risk ...