By Brian Park
In a pharmacy in Brownsville, a young woman quietly peruses the aisles. She is looking for something, but does not want to draw attention to herself. She stops at the shelves lined with various home pregnancy tests. Quickly, she takes one box and stuffs it away inside her shirt. But all the while, a plain-clothes officer has been watching her every move.
This is just one of the many stories Sharon Marshall-Taylor has to offer about young pregnant women who are desperate for help but are unaware of how to get it. She is the community service coordinator for the Brooklyn Perinatal Network, a community task force established to tackle infant mortality in the borough. She remembers this story especially well because she was there.
What happens next, Marshall-Taylor tells with some satisfaction. Instead of arresting the young woman for shoplifting, the officer turned to Marshall-Taylor, who is a familiar face in the community. “I told him what I do and gave him my card. I asked him to give her my card because putting her in the system wouldn’t do her any good,” said Marshall-Taylor.
The officer gave the young woman a stern warning and handed her the card, with information about services the prenatal center offers, says Marshall-Taylor, turning the incident into an opportunity for the young woman to get help with her possible pregnancy.
Marshall-Taylor’s story is just one example of some of the desperate measures and the difficult circumstances that women in the Brownsville neighborhood face—women who are pregnant or who believe they are.
Marshall-Taylor has met many of them. Scared and in need of answers, they are either unaware of the prenatal services available in their community or may travel long distances to seek help.
Had the young woman known, “she could have received a free pregnancy test and counseling just four block away,” said Marshall-Taylor.
Such confusion and unawareness of the availability and importance of prenatal services have contributed to Brownsville’s unusually high infant mortality rate, or IMR, said Marshall-Taylor. Healthy People 2010, a set of national health objectives and goals set forth by the Surgeon General, aims to reduce IMR to 4.5 per 1,000 births. From 2006 to 2008, the IMR in Brownsville was 11.3 deaths per 1,000 births. In comparison, the entire borough of Brooklyn had an IMR of 5.4 during that same time period.
As it is often the case, the women most vulnerable to losing a baby are the ones who are unaware of the gravity of their pregnancy and do not take care of themselves until it is too late. “Some [expectant mothers] don’t come in until their second or third trimester,” said Yolando Vasconcellos, project manager for the Brooklyn Infant Mortality Reduction Initiative (IMRI).
Teenage pregnancy accounts for more than half of Brownsville’s infant deaths. Working in conjunction with the Brooklyn Perinatal Network, health educators from the IMRI travel to local high schools to speak with and inform teenagers about proper procedure and care should a pregnancy arise. The IMRI conducts workshops for teenagers, covering topics such as reproductive health, pregnancy prevention, sexual-decision making, and STI/STD awareness.
“I was at a high school recently, and there was one girl who said she knew everything and acted like it wasn’t a big deal,” said Vasconcellos. Although the student was not looking for answers at the time, a semester later, she was pregnant and looking for help. Help that Vasconcellos was there to provide.
Vasconcellos said financial issues also play a role.
“A lot of people go the hospital emergency rooms instead of seeing the prenatal doctors because they can’t always pay the $75 copay,” said Vasconcellos. Emergency rooms generally do not deny treatment, so patients with no insurance or sparse financial flexibility often use them as their entry point for medical care.
Marshall-Taylor calls these circumstances “social determinant,” or simply “stressors.” Things such as housing difficulties, joblessness and abusive homes qualify as stressors. “Ultimately, if a woman can’t quickly get to a prenatal program or service because she lost her job, she’s worrying about where she is going to live and it takes too long to get to a facility, then those are very real factors. Those are stressors.”
Stressors are all too familiar for Erica Millen-El, a 37-year old mother of three. While pregnant with her youngest son, Eric, in the late summer of 2008, Millen-El was laid off from her job as an executive assistant at an investment banking firm in Manhattan. But in addition to losing her job, Millen-El also lost the health insurance that came with it. With Medicaid as her only viable option for affordable health insurance, Millen-El was unable to access her physician—an HMO doctor—from a previous pregnancy.
“By the time I got to a clinic, I was five months pregnant with Eric,” said Millen-El. “One-and-a-half months after, I went in for a neo-natal scan at SUNY Downstate [Medical Center].”
WomensHealth.gov, a federal resource for women’s health, recommends expectant mothers see their doctor once a month between the fourth and seventh month of pregnancy. Women over 35, like Millen-El, are encouraged to see their doctor more often because their pregnancies are at a higher risk for complications.
The delay in Millen-El’s pregnancy had unfortunate consequences. A doctor informed her that she had to be admitted into the clinic because the scan had shown a possible leakage of amniotic fluid in her womb. Also, a series of tests confirmed that Millen-El was suffering from gestational diabetes and more seriously, preeclampsia, a potentially life-threatening disease for both mother and child when protein is found in the mother’s urine.
“After I was admitted, I thought I would be in the hospital for a few days, that I’d be brought back up to speed and then I would get to go home,” said Millen-El. “I was in the hospital for five days and the doctor told me [Eric’s] heart rate was dropping. I was just a couple days into the seventh month, but the doctor said I needed to have a C-section … I never thought I’d have a premature baby.”
Millen-El’s son Eric was born on January 16. “The day after the plane crashed into the Hudson,” she remembers. Two months premature, Eric weighed only two pounds, four ounces—healthy newborn weight falls in the range of six to nine pounds. “He was very tiny. I was scared to touch him,” said Millen-El. “I saw him on the second day and he had no fat on him. The nurses told me he was iron deficient so he had to have two blood transfusions. I was told he wouldn’t make it without the transfusions.”
In addition, Millen-El said her son had weak lungs, so he received a 24-hour supply of oxygen and steroid treatments. After 49 days, Millen-El was able to take Eric home. He weighed four pounds the day he left the SUNY Downstate Medical Center. Nearly two years later, Eric is now 22 pounds.
Eric will probably have developmental problems and need physical and speech therapy, said Millen-El. But despite the challenges of being a single mother, her personal experience with a difficult pregnancy has motivated her to share her story with the community. After discussing it with Marshall-Taylor, Millen-El says she is interested in speaking with other expectant mothers regarding the proper measures to take during a pregnancy to ensure a safe birth and a healthy baby.
“I want to speak to the community about this because it’s a big problem,” said Millen-El. “It’s a serious problem and people need to heart it for their safety and for their baby’s.”
Currently, the Brownsville Action Community for Health Equality (BACHE) is working to implement a new digital referral system that would “provide at-risk women with the services needed to improve both their health and the health of their babies.” The BACHE is a coalition of medical providers, community based organizations and government officials who are united in their effort to address Brownsville’s high IMR. The Brooklyn Perinatal Network is the central coordinating organization that oversees and aids groups like the BACHE and the IMRI.
Similar digital systems have already proven to be successful. In Monroe County, NY, which includes the city of Rochester, the implementation of such a system resulted in a decrease in the amount of admissions into the neonatal intensive care unit—107.6 per 1,000 in 1998 to only 56.7 in 2003. It is Marshall-Taylor’s hope that Brooklyn area hospitals and health facilities will also adopt the program, and that in doing so, a similar outcome may arise in Brownsville.
According to Marshall-Taylor, the new system would enhance prenatal care by encouraging advanced screenings. Once an expectant woman meets with her physician, her entire medical history and also her psychosocial profile—made up of the aforementioned stressors—would be entered into a shared but private system. Furthermore, once a patient is referred to other physicians, programs or facilities, the system will automatically update that information so as to build a personal profile and to keep track of her progress.
The BACHE is currently seeking funding to extend the program, now in year four of its five-year pilot phase.
“It is a challenge but everyone we’ve spoken to and everyone we’re working with is on board,” said Marshall-Taylor. “Now, we have something that’s been proven to work and we’re confident we can help a lot of mothers during their pregnancies.”
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