DETROIT — In perhaps the cruelest side effect of the Motor City's economic malaise, Detroit, ever since the bleak days of the recession in 1982, has had the highest infant mortality rate of any major city in America.
The city's babies are dying at nearly twice the rate of infants in the rest of the country, and infant deaths among poor blacks in Detroit's worst slums occur almost as often as they do in some of the world's least-developed nations.
In fact, the infant mortality rate here is climbing even though the national average continues to decline.
According to the National Center for Health Statistics, Detroit's infant mortality rate was 21.8 deaths per 1,000 live births in 1982, nearly double the national average of 11.5 and the 11.7 rate for Los Angeles. After a brief decline in 1983, Detroit's rate climbed sharply again in 1984, with a rate of 22.1 for the first nine months of the year, while the national rate declined to 10.6.
Blacks Affected Most
"This is a very serious problem in Detroit, and it is one that doesn't seem to be getting any better," Jeffrey Taylor, chief of maternal and child health in the Michigan Department of Public Health, said.
It is also almost exclusively a black problem. The city's infant mortality rate for blacks (who make up about 63% of Detroit's population) was 26.9 per 1,000 in 1982, the highest black rate for any major city in the country. In contrast, the rate for white Detroit residents was below the national average, at only 9.4 per 1,000.
"There is a marked difference in infant mortality rates between races all over the country, but especially in Detroit," Rita Zemach, an analyst with the state health department, noted.
Now, an area of central Detroit that includes the Cass Corridor, one of Detroit's bleakest inner-city neighborhoods, is suffering infant deaths at a rate of more than 34 per 1,000 live births, forcing city health officials to designate infant mortality as a top-priority health problem.
No Cuts in Funding
"If it were a disease, we would find a cure for it," said a frustrated Dr. John Waller, director of the Detroit Health Department.
The infant mortality problem has developed here even though federal funding for maternal and infant care programs in Detroit's inner city have not been cut, local health officials say.
"People always come to me and ask if the problem is the result of the Reagan Administration's cuts, and I have to say no," said Albert Head, director of a city-county program that helps to administer maternal and child health clinics for indigent women in Detroit.
In fact, Head and others say that government-subsidized free or inexpensive nutrition and prenatal care services are available for Detroit's poor women to take advantage of, and inner-city mothers agree.
"I have a low income, and it makes it harder, but if you try hard you can have a healthy baby," said 33-year-old Annette Martin of Detroit, a single woman expecting her third child, who receives prenatal care at a clinic run by Detroit's Hutzel Hospital. "If you want to get prenatal care, you can get it."
"They have ads on TV about how to get prenatal care, and the poorest person has a TV," added Martina Waterman, 21, who is receiving care at Hutzel for her first pregnancy. "That's why I can't understand why they say so many black babies are dying, because the care is available."
Local health experts are convinced that the crisis in the city's maternity wards, if not related to government cutbacks, is directly related to the suddenness with which poverty in Detroit has expanded as a result of the recession, creating a group of newly poor women who have fallen into a gap between the private and public health care systems.
Low Birth Weights
That is a trend that has shown up in the large number of babies born here with low birth weights in recent years. State health officials report that 14.9% of the babies born in Detroit in 1983 weighed less than 5.5 pounds at birth, compared to a national average of just over 6%.
Health researchers say the birth weight of an infant is the overriding factor in deciding whether it can survive its first few weeks of life, and babies who weigh less than 5.5 pounds at birth face much longer odds than do infants who weigh more.
Low birth weights are usually caused by such social and economic-related problems as a mother's poor diet, her inadequate education about the need for prenatal care or her lack of access to proper care, smoking, alcohol and drug abuse. As a result, Detroit's poor, less-educated women have many more high-risk, low-birth-weight babies--and suffer more infant deaths--than do the city's more affluent women.
Perhaps the most troubling factor in Detroit's infant mortality crisis has been the rapid rise in the number of pregnant teen-agers, who now account for about 20% of the babies born in the city.
While they are having more and more children, teen-agers also tend to have smaller babies than older women. As a result, they are suffering the highest infant mortality rates of any group of pregnant women in Detroit. The infant mortality rate in Detroit among babies born to girls younger than 15 was 48.6 per 1,000 in 1980, and females between the ages of 15 and 19 had a rate of 25.9, according to city statistics.
"I'm not sure there is much more medical technology can do," Dr. Steven Blount, a city health official, said. "Infant mortality is the medical expression of a social problem. The problem is poverty--poverty of resources, and poverty of information among inner-city women about the importance of prenatal care."