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Facing Infant Mortality Crisis, Competing Agencies Work Together

Bram Sable-Smith
KBIA/Side Effects Public Media

This story is part of the series "Shortage in Rich Land" on Missouri's Bootheel region. Click here to see all of the stories.

It’s a cold afternoon in Kennett, Mo. The lawns in this low-income housing neighborhood are still wet from yesterday’s rain. And just inside the door of her mother’s brick home, 27-year-old Marylouisa Cantu sits on a couch, pregnant and draped in a blanket.

Her mother beckons, through the storm door.

“Come in, come in.”


Lucretia Cox, Cantu’s caseworker from the Missouri Bootheel Regional Consortium(MBRC), is also here, sitting on a couch across the room. MBRC connects low-income women like Cantu to medical and support services to help them deliver healthy babies.

The aim is to avoid something like what happened the last time Cantu was pregnant. She was living in Memphis at the time and with her due date still weeks away, she came here to Kennett to visit her mother. But when she began her two-hour drive home, something didn’t feel right.

“I felt sick and I just felt weird,” Cantu recalls. “So I pulled over to a gas station by Blytheville [Ak.] over there and I just started feeling the baby was coming.”

Credit Bram Sable-Smith / KBIA/Side Effects Public Media
KBIA/Side Effects Public Media
Dr. Alan Barnett is a neonatologist in the NICU at St. Francis Medical Center in Cape Girardeau, Mo. where Cantu's newborn was taken in 2013.

Like so many babies born premature, Cantu’s daughter was sick. The hospital wanted to rush the baby to the neonatal intensive care unit  (NICU) at the St. Francis Medical Center in Cape Girardeau, about a hundred miles away.

“They come in they’re like, ‘well we’re going to have to take the baby because she’s having respiratory breathing problems,’” Cantu remembers. “‘She’s blue, she don’t look right.’”

This is an unfortunately common experience for women in the Bootheel.  Almost 17 percent of the babies born here in Dunklin County, where Cantu now lives, are born premature. According to data from the World Health Organization, if this were a country, that’d be the fifth highest rate in the world.

And almost 10 out of every 1,000 babies born here die before they turn one, well above the state and national averages. For African-Americans the rate is even higher at about 16 of every 1,000 babies. For comparison, the WorldFactbookestimates the infant mortality rate of the Gaza Strip at 15.46 deaths per 1,000.

Sitting around a large wooden conference table at the New Madrid Health Department are five women who have been tasked with lowering the infant mortality rate of the region. They’re from Bootheel Babies and Families, an initiative that partners MBRC with the Bootheel Network for Health Improvement(BNHI).

Almost 17 percent of the babies born here in Dunklin County are born premature. If this were a country, that would be the fifth highest rate in the world.

  The initiative is tasked with lowering the region’s infant mortality rate by 15 percent in 10 years. One of the big challenges to bringing the rate down is making the community aware there’s even a problem.

I ask the group, "Is there a general understanding that infant mortality is a problem in the Bootheel with people in the Bootheel?" Everyone replies with a simple "no."

Teletia Atkins is a program assistant from BNHI who knows first hand about the issue of awareness.

“I lost a child 11 years ago,” she says. “I just thought it happened to me. And I’m pretty sure it’s a lot of people who think it’s just happened to them.”

The initiative’s goal is an ambitious one, especially considering the complex web of factors that lead to infant mortality. Premature births are the leading cause, but other contributors include issues of general poverty and poor nutrition as well as even just finding a ride to the doctor’s office.

“We need to remember we can do things to counteract it and to make the numbers better,” says MBRC’s Chantal Herrion, one of two project management coordinators for the initiative.  

They’ve identified a set of indicators, which they believe, if they can improve will reduce the rate. Lyn Williams, Herrion’s counterpart from BNHI, names a few of them.

“Pre-conception health,” she says. “Encouraging women to take care of their bodies and to maintain a healthy weight and healthy diet. And to postpone parenthood until they are physically and emotionally ready.”

Prenatal care, interconception health and education are also on the list. But it’s hard to imagine the initiative could do more than what these two organizations already do on their own.


Credit Bram Sable-Smith / KBIA/Side Effects Public Media
KBIA/Side Effects Public Media
Members of the group Bootheel Babies and Families: from left to right, Kathleen Vaught and Chantal Herrion of the Missouri Bootheel Regional Consortium, Jayne Dees of the New Madrid Health Department, and Lyntoria Williams and Teletia Atkins of the Bootheel Network for Health Improvement.

The health departments that make up BNHI already administer the Women, Infants, and Children (WIC) program, a federal program that provides healthcare and nutrition assistance to low-income mothers and their babies. In every Bootheel county at least 75 percent, and sometimes as high as 98 percent of newborns are enrolled in WIC.

And MBRC runs Healthy Start, the federal government’s own infant mortality initiative. In 2008, one in four women in their program had a low birth weight baby. By 2012 they lowered that rate to just one in ten.

But that’s kind of the point of the Bootheel Babies and Families initiative. Until now these two groups were working on their own.

“I actually think that’s been one of the biggest successes down in the Bootheel,” Melissa Logsdon says, “these two organizations coming together and working as closely as they are.”

“I’ve heard from them that they really didn’t even talk to one another before,” she adds.

Logsdon is a program officer at Missouri Foundation for Health, which is funding infant mortality initiatives in both the Bootheel and in St. Louis. (Full disclosure, the foundation also provides funding for the KBIA Health & Wealth Desk).

Credit Bram Sable-Smith / KBIA/Side Effects Public Media
KBIA/Side Effects Public Media
From left to right, Missouri Bootheel Regional Consortium's Emily Nyaga, Addie Walker and CEO Cynthia Dean.

  To be fair, it’s not like the MBRC and BNHI were bitter rivals. They just focused on their own programs. Although with scarce funding available for public health in the state, at times there was a perception of competition.

Chantal Herrion acknowledges this back in New Madrid when asked if the two organizations used to be competitors.

“Yes, but now we’re at the table together,” she says after a brief pause. Everyone laughs.

“That’s what makes this initiative so different,” adds Jayne Dees, Administrator of the New Madrid Health Department.

Logsdon says bringing these two groups together was important.

“This isn’t about funding programs necessarily,” she says, “But it’s really about funding a collaborative approach."

The approach is called collective impact framework, a term coined in 2011 for a model of collaboration to tackle complex problems in communities. In 2006, Milwaukee used a similar model on an awareness campaign targeting the city’s high teen pregnancy rate. Within 7 years that rate had dropped by 50 percent.

Bootheel Babaies and Families is now trying to replicate that same kind of success. They’re gearing up to hold their first public events: two community round tables the second week of April.

The hope is by getting the community talking, they can help more women like Marylouisa Cantu deliver healthy babies.

Cantu’s daughter made a complete recovery and is now a healthy, trouble-making 2-year-old. This time, she’s hoping for a happy, healthy boy.

“Hopefully that’s what I’ll get,” she says. “Ain’t no telling.”