West Virginia: Babies in the Balance

By Michael Riley/Gary

In the poverty-racked mountains of McDowell County (pop. 35,233), the arrival of a baby is taken as a sign that life is getting better. The hope persists, although the county has one of West Virginia's highest rates of infant mortality: 13.5 per 1,000 births, one-third above the national average. "It's always been a problem," says Franki Patton, director of Tug River Clinic's maternal and infant health program. "But I think the community has gotten used to it. They don't want to lose their babies, but they see it as a part of life."

< Several years after the clinic opened in 1976, the rate of infant deaths was 16.2 per 1,000 births; its efforts since then to provide better prenatal care and medical services have helped improve the odds that children will live to celebrate their first birthday. But the program barely survives on a mix of federal, state and foundation money, and the demand for services is overwhelming. The clinic's doctors and six outreach staff members currently treat 170 families, a number that could easily triple if the staff could handle the load. More than 90% of the patients are on Medicaid. Many have not graduated from high school. Some women must travel 90 minutes to get to the clinic, and many have no car. Outreach workers visit them monthly to provide instruction on prenatal care, proper diet, childbirth and parenting. And they even offer child-safety seats at cut-rate prices.

Rachel and John are typical of the families the clinic serves. John worked part-time cutting firewood or driving a coal truck. The couple subsisted on food stamps, supplemented by the generosity of neighbors who often invited them over for dinner. Though the clinic is located in Gary, a one-hour drive over twisting roads from their spartan four-room house in Panther, Rachel, 19, never missed an appointment with her doctor. "She was one of our prize patients," says Kem Short, an outreach worker in the clinic's maternal and infant health program. John, 24, kept an untouched $10 bill in his pocket to buy gasoline for his old truck when Rachel went into labor.

In 1989 Rachel gave birth to a daughter, Louise, who had Down's syndrome and a defective heart. The baby died three months later. Though one test indicated no problem with the fetus, other, sophisticated tests that could have alerted doctors to her condition earlier were not performed. The state paid for her burial in a family plot, and local florists donated the flowers. Rachel and John have since moved to Virginia, and they are again trying to have a child.

If the Bush Administration decides to rob Peter to pay Paul for its infant- mortality program, the clinic could suffer decreased funding. Any cutback in the program's $130,000 annual budget could be disastrous. "We can't afford to lose what we have," says Patton. "To us, what could be more logical than saving babies? But when you put a price tag on it, it becomes something else. It becomes a political thing."