Reguero W, Crane M
Department of Obstetrics and Gynecology, Hospital of Saint Raphael, New Haven, CT 06511.
Public Health Rep. 1994 Sep-Oct;109(5):647-52.
Starling national statistics indicate that New Haven, CT, is the seventh poorest city of its size, in terms of per capita income, in the United States. In 1989, it was reported to have the highest rate of infant mortality--18.5 infant deaths per 1,000 live birth--in the nation for a city with more than 100,000 people. Seventy-five percent of all perinatal deaths are attributed to low birth weight infants. Adequate prenatal care is a proven means of reducing this risk. To further compound the problem, substance abuse among pregnant women has increased dramatically. Census tract data revealed that many of the infant deaths were localized to several well-defined areas of the city. Forty-four percent of the infant deaths were ascribed to extreme immaturity or other causes related to low birth weight. Approximately 21 percent of the pregnant population had either no prenatal care or care was begun late--after the first trimester. The traditional avenues for prenatal care have been ineffective; an innovative approach, one that can be replicated, was initiated. The Hospital of Saint Raphael's "Project MotherCare" embarked on an initiative to address these problems by reducing the access barriers to prenatal care regardless of insurance status or ability to pay. The mission was twofold: (a) to bring prenatal care to underserved neighborhoods of New Haven and (b) to identify the substance-abusing pregnant woman and deliver a continuum of services including prenatal care, counseling, social services, and referral to a drug treatment program. Community need caused the program to expand beyond prenatal services and provide additional primary care services to other residents of these neighborhoods.
斯塔林国家统计数据表明，就人均收入而言，康涅狄格州纽黑文市是美国同规模城市中第七贫困的城市。1989年，据报道，在全国人口超过10万的城市中，该市婴儿死亡率最高——每1000例活产中有18.5例婴儿死亡。所有围产期死亡中有75%归因于低体重婴儿。充分的产前护理是降低这种风险的已证实方法。使问题更加复杂的是，孕妇中的药物滥用现象急剧增加。人口普查区数据显示，许多婴儿死亡集中在该市几个明确界定的区域。44%的婴儿死亡归因于极度早产或其他与低体重有关的原因。大约21%的孕妇要么没有接受产前护理，要么护理开始得很晚——在孕早期之后。传统的产前护理途径效果不佳；于是启动了一种可以推广的创新方法。圣拉斐尔医院的“母亲关爱项目”着手采取一项举措，通过消除产前护理的获取障碍来解决这些问题，无论保险状况或支付能力如何。其使命有两个方面：(a) 为纽黑文市服务不足的社区提供产前护理；(b) 识别滥用药物的孕妇，并提供一系列服务，包括产前护理、咨询、社会服务以及转介到戒毒项目。社区需求促使该项目超出产前服务范围，为这些社区的其他居民提供额外的初级保健服务。
